Practice variability in the evaluation and management of HLA alloimmunization in platelet refractoriness: a multi-institutional survey in the USA.

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.