Frontiers in medicine · 2026
Personalized management of platelet transfusion refractoriness: risk factors, cross-matching, and IVIG strategies.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li Jixin, Wang Linting, Qin Yi, Liang Yingyin, Lv Piao, Yao Yuan, Fan Xinxin, Zhou Huayou
Аннотация
BACKGROUND: Platelet transfusion refractoriness (PTR) is a major clinical challenge in hematologic patients, yet real-world evidence comparing transfusion strategies-particularly the role of cross-matched platelets and intravenous immunoglobulin (IVIG)-remains limited.
METHODS: We retrospectively analyzed 144 hematologic patients diagnosed with PTR at Nanfang Hospital (2019-2022), totalling 1,345 transfusion episodes. Patients were stratified by platelet antibody status. Four transfusion regimens were compared: random platelets, cross-matched platelets, random platelets + IVIG, and cross-matched platelets + IVIG. The primary endpoint was 24-h corrected count increment (CCI). Logistic regression identified factors associated with antibody development. The primary analysis was performed using linear mixed-effects models (LMMs) with a random intercept for patients to account for within-patient correlation. Fixed effects included transfusion strategy along with prespecified episode-level and patient-level covariates. Generalized estimating equations (GEE) were used as a sensitivity analysis to assess the robustness of the findings.
RESULTS: Female sex emerged as the strongest independent predictor for the development of platelet antibodies (OR: 4.18, 95% CI: 2.25-8.24). Other univariate risk factors included age, obstetric history, diagnosis, and chemotherapy cycles. Among antibody-positive patients, both cross-matched platelets and IVIG combined with random platelets were associated with improved 24 h CCI compared with random platelets alone (all p Holm < 0.001), cross-matched platelets were associated with higher 24 h CCI relative to random plus IVIG (p Holm = 0.019), whereas cross-matched platelets plus IVIG demonstrated no additional benefit vs. cross-matched platelets alone in this cohort (p Holm = 0.444). In antibody-negative patients, no statistically significant difference in 24 h CCI was observed across the four transfusion strategies (p = 0.244). Consistent with the LMM results, the overall effect of transfusion strategy was not statistically significant among antibody-negative patients (p = 0.692) but was significant among antibody-positive patients (p < 0.001). Similar results were obtained using GEE, supporting the robustness of these findings.
CONCLUSION: Among patients with antibody-negative PTR, cross-matched platelets and IVIG demonstrated no additional benefit in this cohort. For antibody-positive PTR, cross-matched platelets showed the most favorable response in this cohort; when unavailable, high-dose IVIG with random platelets may be preferentially considered. These comparative treatment findings require prospective validation.
METHODS: We retrospectively analyzed 144 hematologic patients diagnosed with PTR at Nanfang Hospital (2019-2022), totalling 1,345 transfusion episodes. Patients were stratified by platelet antibody status. Four transfusion regimens were compared: random platelets, cross-matched platelets, random platelets + IVIG, and cross-matched platelets + IVIG. The primary endpoint was 24-h corrected count increment (CCI). Logistic regression identified factors associated with antibody development. The primary analysis was performed using linear mixed-effects models (LMMs) with a random intercept for patients to account for within-patient correlation. Fixed effects included transfusion strategy along with prespecified episode-level and patient-level covariates. Generalized estimating equations (GEE) were used as a sensitivity analysis to assess the robustness of the findings.
RESULTS: Female sex emerged as the strongest independent predictor for the development of platelet antibodies (OR: 4.18, 95% CI: 2.25-8.24). Other univariate risk factors included age, obstetric history, diagnosis, and chemotherapy cycles. Among antibody-positive patients, both cross-matched platelets and IVIG combined with random platelets were associated with improved 24 h CCI compared with random platelets alone (all p Holm < 0.001), cross-matched platelets were associated with higher 24 h CCI relative to random plus IVIG (p Holm = 0.019), whereas cross-matched platelets plus IVIG demonstrated no additional benefit vs. cross-matched platelets alone in this cohort (p Holm = 0.444). In antibody-negative patients, no statistically significant difference in 24 h CCI was observed across the four transfusion strategies (p = 0.244). Consistent with the LMM results, the overall effect of transfusion strategy was not statistically significant among antibody-negative patients (p = 0.692) but was significant among antibody-positive patients (p < 0.001). Similar results were obtained using GEE, supporting the robustness of these findings.
CONCLUSION: Among patients with antibody-negative PTR, cross-matched platelets and IVIG demonstrated no additional benefit in this cohort. For antibody-positive PTR, cross-matched platelets showed the most favorable response in this cohort; when unavailable, high-dose IVIG with random platelets may be preferentially considered. These comparative treatment findings require prospective validation.