Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine · 2026
Practice variability in the evaluation and management of HLA alloimmunization in platelet refractoriness: a multi-institutional survey in the USA.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Baykara Yigit, Fang Deanna C, Tran Minh-Ha, Yunce Muharrem
Аннотация
BACKGROUND: Platelet refractoriness is a frequent and challenging problem in thrombocytopenic patients who require long-term platelet transfusions. However, real-world practice in diagnosing and managing refractoriness remains variable with no inclusive guidelines. This study aimed to address this variability by means of conducting a survey.
METHODS: We conducted an anonymous, web-based survey of U.S. hematology and oncology practitioners in 2024-2025 to capture current approaches to platelet refractoriness. The 20-item survey explored diagnostic thresholds, use of HLA antibody testing, application of calculated panel reactive antibody (cPRA) in clinical decision-making, strategies for selecting specialty platelets, and platelet transfusion thresholds across clinical scenarios. Responses were analyzed descriptively.
RESULTS: 28 practitioners responded, most of whom were attending hematologists at academic centers. Awareness of the technical platform for HLA antibody testing was limited, with nearly 90% of respondents unable to identify the assay used at their center. Few institutions reported a defined cPRA threshold to trigger specialized platelet support. For prophylaxis, most adhered to a 10 × 103/µL threshold in inpatients, while outpatient thresholds varied more widely.
CONCLUSIONS: This national survey highlights marked heterogeneity in the recognition and management of platelet refractoriness among hematology and oncology practitioners. Development of targeted guidelines addressing immune-mediated refractoriness could help standardize practice and optimize patient care.
METHODS: We conducted an anonymous, web-based survey of U.S. hematology and oncology practitioners in 2024-2025 to capture current approaches to platelet refractoriness. The 20-item survey explored diagnostic thresholds, use of HLA antibody testing, application of calculated panel reactive antibody (cPRA) in clinical decision-making, strategies for selecting specialty platelets, and platelet transfusion thresholds across clinical scenarios. Responses were analyzed descriptively.
RESULTS: 28 practitioners responded, most of whom were attending hematologists at academic centers. Awareness of the technical platform for HLA antibody testing was limited, with nearly 90% of respondents unable to identify the assay used at their center. Few institutions reported a defined cPRA threshold to trigger specialized platelet support. For prophylaxis, most adhered to a 10 × 103/µL threshold in inpatients, while outpatient thresholds varied more widely.
CONCLUSIONS: This national survey highlights marked heterogeneity in the recognition and management of platelet refractoriness among hematology and oncology practitioners. Development of targeted guidelines addressing immune-mediated refractoriness could help standardize practice and optimize patient care.