Analysis of Platelet Refractoriness in a Tertiary Care Hospital

Introduction: Platelet refractoriness is a major concern for treating physicians. Refractoriness is also aggravated by a number co-existing conditions such as fever, sepsis, splenomegaly, drug intake, chemotherapy etc. Refractoriness may also be due to immunological causes such as HLA (Human Leukocyte Antigen) antibodies and anti-platelet antibodies. Material and Methods: This study was prospective observational study undertaken in the department of Transfusion Medicine of the Institute of Medical Sciences and SUM hospital, Bhubaneswar India. The study population included patients who required transfusion of platelets by SDP (Single Donor Platelet) concentrates. The study group included patients of both sexes and of all age groups. Data was collected from patient, patient register present in the treating units and analysed. Results: Out of the 155 patients 93 patients received single unit of SDP transfusions and 62 patients received two or more units of SDP. Out of the 62 patients, 28 patients received two SDP transfusions, 17 patients received 3 SDP transfusions, 6 patients received 4 SDP transfusions, 7 patients received 5 SDP transfusions, and 2 patients each received 6 and 7 SDP transfusions. Of these 62 transfusion who received more than 1 transfusion, 28 patients were refractory to SDP transfusions. Of these 28 patients 16 (57.14%) were male and 12 (42.86%) were female. Various risk factors associated with refractoriness are fever (60.71%), chemotherapy (46.43%), bleeding (50%), drug therapy (42.86%), splenomegaly (10.71%) and others (64.29%). Out of the 28 patients, 23 patients had no evidence of refractoriness after 1-hour post transfusion, but the 24-hours CCI (Corrected Count Increment) confirmed refractoriness. Both the 1-hour and 24-hour CCI were in refractory range in the rest 5 patients. These 5 patients have been grouped under immune category.