Evaluation and monitoring of response to platelet transfusion therapy: experience from a tertiary care center

Objective: Refractoriness to platelet transfusion is defined as Corrected Count Increment (CCI) <5000 after two sequential ABO identical transfusions. Immune causes include alloimmunization to HLA and/or platelet-specific antigens. Analysis of various factors leading to platelet refractoriness would help in the management of the patient in a timely manner. Materials and Methods: A prospective observational study on platelet transfusions from November 2013 to June 2015 was conducted. Demographic information, pre, and post-transfusion platelet counts and relevant clinical details were noted. Among patients who were considered refractory to platelet transfusions, platelet factor 3 assay was performed to detect antiplatelet antibodies. Data were analyzed using SPSS software. A P value of <0.05 was considered to be statistically significant. Results: A total of 1190 patients received platelet transfusions during the study period. Among these only 339 (28.5%) patients received transfusions on two or more occasions, of which 237 (69.91%) were considered non-refractory. Among the 102 (30.1%) refractory cases non-immune causes for refractoriness were present in 97 (95.1%) patients and antiplatelet antibody was positive in 18 (17.64%) patients. Bleeding and medication have shown to have significantly contributed to refractoriness (p = 0.025 and 0.003) respectively. Use of medication was independently associated with refractoriness. Conclusion: Non-immune causes are more profound in leading to a poor response to platelet transfusions. Recognizing the cause of poor response and treating the underlying cause would help in getting a better response.