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Refractoriness to platelet transfusion therapy

Dennis Goldfinger, MD
James D Burner, MD
Section Editor
Arthur J Silvergleid, MD
Deputy Editor
Jennifer S Tirnauer, MD


Platelets play a vital role in the maintenance of normal hemostatic activity. Accordingly, for patients with low platelet counts (thrombocytopenia) or impaired platelet function, platelet transfusion can be of significant value in preventing and treating hemorrhage. (See "Overview of hemostasis".)

Although many patients have an appropriate increase in platelet count when transfused with platelets, less than adequate results tend to be common with 28 to 44 percent of platelet transfusions failing to produce a satisfactory response [1-3]. In the hematology/oncology patient, published reports have cited an incidence of refractoriness to platelet transfusion of 15 to 25 percent utilizing leukocyte-reduced blood products and even higher rates during the pre-leukocyte-reduction era [2,4-6]. This poor response to platelet transfusion leads to an increased risk of morbidity and mortality, as well as longer hospital stays and higher inpatient hospital costs [7,8]. (See "Clinical and laboratory aspects of platelet transfusion therapy".)

The numerous factors associated with poor recovery and survival of transfused platelets (non-immune and immune), and the diagnosis, management, and prevention of alloimmune refractoriness to platelet transfusion will be reviewed here. General issues related to platelet transfusion are discussed separately. (See "Clinical and laboratory aspects of platelet transfusion therapy".)


Refractoriness to platelet transfusion is often multifactorial and can be separated into non-immune and immune causes (table 1).

Approximately two-thirds of refractory episodes are due to non-immune causes, such as sepsis/infection, fever (temperature >38.4°C), bleeding, splenomegaly, disseminated intravascular coagulation (DIC), hepatic sinusoidal obstruction syndrome (hepatic veno-occlusive disease), graft-versus-host disease (GVHD) and medications such as vancomycin, amphotericin B and heparin [4,5,9]. (See 'Non-alloimmune causes' below.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 09, 2017.
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