Comparative analysis of low- and high-dose apheresis platelets in platelet-refractory patients with hematologic malignancies

Abstract

Background Alloimmunization-induced platelet transfusion refractoriness represents a major clinical challenge in hematology-oncology. Optimal strategies for platelet support in this population remain to be established. Objective This study aimed to compare the efficacy of low-dose crossmatched versus high-dose uncrossmatched single donor apheresis platelets (SDAP) in platelet-refractory patients with hematologic malignancies by assessing corrected count increment (CCI), percent platelet recovery (PPR), and post-transfusion platelet increment (PPI). Materials and methods Forty alloimmunized, platelet-refractory patients were enrolled. Solid phase red cell adherence assay was used for crossmatching and alloimmunization detection. Patients received low-dose crossmatched SDAP (1.49 ± 0.30 × 10 11 platelets/unit) followed by high-dose uncrossmatched SDAP (4.9 ± 1.0 × 10 11 platelets/unit) at the subsequent transfusion. The CCI, PPR %, PPI, transfusion intervals, and World Health Organization bleeding grades were recorded and compared after each transfusion. Results The CCI and PPR% were significantly higher following low-dose crossmatched SDAP compared to standard-dose SDAP (p-value <0.05). Compared to high-dose uncrossmatched SDAP, low-dose crossmatched SDAP produced slightly higher CCI and PPR%, but differences were not statistically significant (p-value = 0.27). PPI was significantly higher with high-dose uncrossmatched SDAP (p-value <0.01) compared with low-dose crossmatched SDAP. Transfusion intervals and bleeding episodes were similar across both groups. Conclusion Low-dose crossmatched SDAP achieves comparable efficacy to high-dose uncrossmatched SDAP in refractory, alloimmunized patients with hematologic malignancies. These results support low-dose crossmatched SDAP as a feasible strategy to optimize transfusion support, minimize complications, and improve hemostasis management in refractory patients.