There exist three primary tools to provide appropriate units to immune refractory patients: Human Leukocyte Antigen (HLA) matching, platelet crossmatch and use of HLA antigen negative units. All three tools will be presented, with emphasis on the understanding of matched platelets. Most transfusion programs are familiar with the HLA-A, B Match Grade system, utilizing cross-reactive groups (CREG) matches, developed by R. Duquesnoy in 1977. More recently, Duquesnoy developed an alternative approach, using Matchmaker software, based on HLA epitope match. This approach has not been widely used due to the current limitations in the available HLA typing resolution of both patients and donors. Epitope matching has real potential to increase platelet count increments in complex cases. However, for successful implementation of this algorithm, a minimum testing standard in HLA typing of patient and donors must be established.
This course will present the best practice requirements utilizing the newest literature based on newer test methodology for HLA typing and antibody identification. This course will also stress the importance of consideration of clinical information, such as immune function status, transplant status and expected length of transfusion dependency as important parameters when selecting the most appropriate units. This course will compare and contrast the CREG-based HLA matching with epitope-based matching. In the second part of the course, the audience will be engaged through the presentation of a series of platelet transfusion refractory case studies. This will be followed by a group exercise in which participants will be asked to utilize the information presented to design and present algorithms for utilization of a combination of HLA matched, crossmatch compatible and HLA antigen negative units to fulfill the needs of a diverse patient population.
Utilize information presented in the session from the series of platelet transfusion refractory case studies to examine practices in home facility.
Utilize the information presented to design and present algorithms for utilization of a combination of Human Leukocyte Antigen (HLA) matched, crossmatch compatible and HLA antigen negative units to fulfill the needs of a diverse patient population.
Describe changes to HLA platelet matching algorithms that are gaining traction in the field.