Alloimmunization From Transfusions Medication
- Author: Eyal Oren, MD; Chief Editor: Michael A Kaliner, MD more...
Medication Summary
Immunosuppressive agents such as IVIG can be as much as 70% effective in patients with platelet refractoriness resulting from alloimmunization. Consider using cytotoxic agents only in persons clearly unresponsive to the other treatment modalities. Only physicians familiar with the use and toxicity of cytotoxic agents should prescribe these drugs because few data support their use for alloimmunization. This indication is considered investigational.
Immunosuppressive agents
Class Summary
Inhibit activity of immune system.
Immunoglobulin intravenous IVIG (Gamunex, Iveegam EN, Gammagard)
Fractionated human immunoglobulins treated to inactivate viruses and filtered to eliminate high molecular weight complexes. Neutralizes circulating myelin antibodies through antiidiotypic antibodies. Down-regulates proinflammatory cytokines, including INF-gamma. Blocks Fc receptors on macrophages. Suppresses inducer T and B cells and augments suppressor T cells. Blocks complement cascade. Promotes remyelination. May increase CSF IgG (10%).
Cytotoxic agents
Class Summary
Inhibit immune cell growth and proliferation.
Vincristine (Oncovin)
Only one report describes effectiveness, in an 18-mo-old child with platelet refractoriness. Several reports, however, describe its use for treating autoimmune thrombocytopenia. Use for platelet alloimmunization remains investigational.
Cyclosporin A (Sandimmune, Neoral)
Two reports describe use in patients with aplastic anemia and platelet refractoriness. Both patients dramatically improved in response to platelet transfusions after treatment. Use for platelet alloimmunization remains investigational.
Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, et al. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion. Sep 2 2011;[Medline]. [Full Text].
Gilson CR, Zimring JC. Alloimmunization to transfused platelets requires priming of CD4+ T cells in the splenic microenvironment in a murine model. Transfusion. Oct 7 2011;[Medline].
Buetens O, Shirey RS, Goble-Lee M, Houp J, Zachary A, King KE. Prevalence of HLA antibodies in transfused patients with and without red cell antibodies. Transfusion. May 2006;46(5):754-6. [Medline].
Friedman DF, Lukas MB, Jawad A, Larson PJ, Ohene-Frempong K, Manno CS. Alloimmunization to platelets in heavily transfused patients with sickle cell disease. Blood. Oct 15 1996;88(8):3216-22. [Medline].
Heddle NM, Soutar RL, O'Hoski PL, Singer J, McBride JA, Ali MA. A prospective study to determine the frequency and clinical significance of alloimmunization post-transfusion. Br J Haematol. Dec 1995;91(4):1000-5. [Medline].
Kerkhoffs JL, Eikenboom JC, van de Watering LM, van Wordragen-Vlaswinkel RJ, Wijermans PW, Brand A. The clinical impact of platelet refractoriness: correlation with bleeding and survival. Transfusion. Sep 2008;48(9):1959-65. [Medline].
Allen DL, Samol J, Benjamin S, Verjee S, Tusold A, Murphy MF. Survey of the use and clinical effectiveness of HPA-1a/5b-negative platelet concentrates in proven or suspected platelet alloimmunization. Transfus Med. Dec 2004;14(6):409-17. [Medline].
Novotny VM. Prevention and management of platelet transfusion refractoriness. Vox Sang. 1999;76(1):1-13. [Medline].
Slichter SJ, Davis K, Enright H, Braine H, Gernsheimer T, Kao KJ, et al. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood. May 15 2005;105(10):4106-14. [Medline].
Slichter SJ. Evidence-based platelet transfusion guidelines. Hematology Am Soc Hematol Educ Program. 2007;2007:172-8. [Medline].
Poon MC. The evidence for the use of recombinant human activated factor VII in the treatment of bleeding patients with quantitative and qualitative platelet disorders. Transfus Med Rev. Jul 2007;21(3):223-36. [Medline].
Schonewille H, Haak HL, van Zijl AM. Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion. Jul 1999;39(7):763-71. [Medline].
Werch J. Use of Rh immune globulin when transfusing large volumes of Rh-positive cells. Am J Clin Pathol. May 1999;111(5):712. [Medline].
Werch J, Todd C. Resolution by erythrocytapheresis of the exposure of an Rh-negative person to Rh-positive cells: an alternative treatment. Transfusion. Jun 1993;33(6):530-2. [Medline].
Wahl S, Quirolo KC. Current issues in blood transfusion for sickle cell disease. Curr Opin Pediatr. Feb 2009;21(1):15-21. [Medline].
The Trial to Reduce Alloimmunization to Platelets Study Group. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med. Dec 25 1997;337(26):1861-9. [Medline].
Friedberg RC. Clinical and laboratory factors underlying refractoriness to platelet transfusions. J Clin Apher. 1996;11(3):143-8. [Medline].
Blumberg N, Heal JM, Gettings KF. WBC reduction of RBC transfusions is associated with a decreased incidence of RBC alloimmunization. Transfusion. Jul 2003;43(7):945-52. [Medline].
Delaflor-Weiss E, Mintz PD. The evaluation and management of platelet refractoriness and alloimmunization. Transfus Med Rev. Apr 2000;14(2):180-96. [Medline].
Kekomaki R. Use of HLA- and HPA--matched platelets in alloimmunized patients. Vox Sang. 1998;74 Suppl 2:359-63. [Medline].
Kickler T, Herman JH, eds. Current issues in platelet transfusion therapy and platelet alloimmunity. Bethesda, Md: AABB Press; 1999.
Legler TJ, Fischer I, Dittmann J, Simson G, Lynen R, Humpe A. Frequency and causes of refractoriness in multiply transfused patients. Ann Hematol. Apr 1997;74(4):185-9. [Medline].
Pineda AA, Vamvakas EC, Gorden LD, Winters JL, Moore SB. Trends in the incidence of delayed hemolytic and delayed serologic transfusion reactions. Transfusion. Oct 1999;39(10):1097-103. [Medline].
Sayeh E, Sterling K, Speck E, Freedman J, Semple JW. IgG antiplatelet immunity is dependent on an early innate natural killer cell-derived interferon-gamma response that is regulated by CD8+ T cells. Blood. Apr 1 2004;103(7):2705-9. [Medline].
Schiffer CA. Diagnosis and management of refractoriness to platelet transfusion. Blood Rev. Dec 2001;15(4):175-80. [Medline].
Schonewille H, van de Watering LM, Brand A. Additional red blood cell alloantibodies after blood transfusions in a nonhematologic alloimmunized patient cohort: is it time to take precautionary measures?. Transfusion. Apr 2006;46(4):630-5. [Medline].
Warkentin TE, Smith JW. The alloimmune thrombocytopenic syndromes. Transfus Med Rev. Oct 1997;11(4):296-307. [Medline].
| Platelet Antigen System | Protein Antigen | Synonyms | Alleles | Antigen Frequency |
| HPA-1 | GPIIIa | PlA,Zw | HPA-1a = PlA1 HPA-1b = PlA2 | 97% 26% |
| HPA-2 | GPIb | Ko, Sib | HPA-2A HPA-2b | 99% 14% |
| HPA-3 | GPIIb | Bak, Lek | HPA-3a HPA-3b | 85% 66% |
| HPA-4 | GPIIa | Pen, Yuk | HPA-4a HPA-4b | >99% < 1% |
| HPA-5 | GPIa | Br, Hc, Zav | HPA-5a HPA-5b | 99% 20% |
| Antigen | System | Frequency Among All Detected Alloantibodies | Frequency of Antigen (Whites) | Frequency of Antigen (Blacks) | Potency* |
| E | Rh | 16-40% | 30% | 2% | 4% |
| Kell (Kl) | Kell | 5-40% | 9% | 3% | 9% |
| D | Rh | 8-33% | 85% | 92% | 70% |
| c | Rh | 4-15% | 80% | 99% | 4% |
| Jk(a) | Kidd | 2-13% | 77% | 91% | 0.14% |
| Fy(a) | Duffy | 4-12% | 63% | 10% | 0.46% |
| C | Rh | 2-10% | 70% | 32% | 0.22% |
| e | Rh | 2-3% | 98% | 98% | 1% |
| Jk(b) | Kidd | 2% | 72% | 43% | 0.06% |
| S | MNSs | 1-2% | 55% | 31% | 0.08% |
| s | MNSs | < 1% | 89% | 97% | 0.06% |
| *Percentage of antigen-negative recipients who become alloimmunized if transfused with antigen-positive units | |||||
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