Algorithm for managing the platelet refractory patient.

ABSTRACT

Refractoriness to platelet transfusions continues to be a major problem for many thrombocytopenic patients. A proposed algorithm for managing these patients is presented which proceeds from easily instituted changes in platelet transfusion therapy such as provision of ABO-compatible and "fresh" platelet transfusions to the more difficult and costly process of selecting compatible platelets for patients who are documented to be alloimmunized. For nonimmunized platelet refractory recipients, multiple clinical and drug factors that may adversely effect transfusion responses have been identified. Identifying which of these factors are causally associated with poor platelet responses in any given patient remains a substantial challenge.