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Use of leukocyte-depleted platelet concentrates for the prevention of
refractoriness and primary HLA alloimmunization: a prospective, randomized
trial
M van Marwijk Kooy, HC van Prooijen, M Moes, I Bosma-Stants and JW Akkerman
Department of Immuno-Hematology, University Hospital Utrecht, The
Netherlands.
Compared with conventional transfusion regimes a strong reduction in HLA
alloimmunization and refractoriness to platelet transfusions is obtained
when both red blood cell concentrates (RBCs) and platelet concentrates
(PCs) are depleted of leukocytes by filtration. Because most of the
leukocyte contamination is introduced by transfusion of RBCs, filtration of
RBCs appears rational, but uncertainty exists regarding the degree of
leukocyte-depletion of PCs needed for the prevention of HLA
alloimmunization and refractoriness. We conducted a prospective trial and
randomized patients with acute leukemia to receive leukocyte-depleted PCs
prepared either by centrifugation (mean leukocyte count 35 x 10(6)/PC of 6
U) or by filtration (mean leukocyte count less than 5 x 10(6)/PC of 6 U).
Both groups received RBCs that were filtered after prior removal of the
buffy coat. Clinical refractoriness occurred in 46% (12 of 26) of the
evaluable patients that were transfused with centrifuged PCs and only in
11% (3 of 27) in the filtered group (P less than .005). De novo anti-HLA
antibodies were detected in 42% (11 of 26) patients in the centrifuged
group and only in 7% (2 of 27) of the patients receiving filtered PCs (P
less than .004). In 8 of 11 alloimmunized patients in the centrifuged group
antibodies were detected in the first 4 weeks of transfusion therapy while
none of the patients in the filtered group became immunized against HLA
antigens during that period. We conclude that for the prevention of HLA
alloimmunization and refractoriness to platelet transfusions from random
donors, both RBCs and PCs have to be leukocyte- depleted by filtration.
Volume 77,
Issue 1,
pp. 201-205,
01/01/1991
Copyright © 1991 by The American Society of Hematology
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