Platelet Support in Polysensitized Patients: Role of ... - Blood Journal

From www.bloodjournal.org by guest on May 16, 2018. For personal use only.

Platelet Support in Polysensitized Patients: Role of HLA Specificities and Crossmatch Testing for Donor Selection By J. Gm’#{252}r, A. von Felten,

NCIDENCE bone marrow transfusions of usually

cytotoxicity

in alloimmunization

tests

following

the

in the

remaining

contaminating

antigen-antibody

reactions

been

postulated

to

HLA

identity.9

The

present

study

in such

involving

explain was

poor

can

platelet

platelets

out

Front

Division

the

of

Submitted

Jul’

Supported

by the Julius

Medicine, (H)

Blood,

1978

Vol.

for

29,

1977;

reprint

accepted MOller

December Foundationfor

requests:

J.

Universitb

Hospital.

8091

b,t’ Grune

& Stratton,

Inc.

51,

of

usually

“innocent

highly

Internal

by

Non-H

LA

bystanders”

platelet

have

increments refractory

despite to

response of such of HLA identity, in predicting the

Medicine,

8

pado-

be improved

concentrates.9

as

in patients

Department

to random

University

random patients (2) the response

Hospital

of

Switzerland.

Zurich,

A ddress

Hematology,

transfusion.

70 of alloimmunized from HLA-identical

donor platelets in order to evaluate ( I ) the transfusion to platelets from single donors of different degrees value of different leukocyte crossmatch tests in vitro

Zurich,

predictive

refractoriness

posttransfusion

carried

no

showed that such patients A and B ofthe HLA system.6

30#{176}, however,

leukocytes

initial

subsequent

co-workers for loci

On the other hand, it was claimed recently that only tients responded to standard platelet concentrates nors.9”#{176}Responses

of

in thrombocytopenic patients with by platelet transfusions.’ Multiple random donors, however, have

with

donor platelet support.4’5 Yankee and will later respond to platelets compatible

removing

were

value in typo-O match pairs. The influence of specific antigranulocyte antibodies on type-O match platelet transfusions was assessed in four recipients. Although severe transfusion reactions were observed, no detrimental influence on platelet increments could be observed, at least

OF HEMORRHAGE aplasia can be reduced platelets from unselected,

resulted

P. Frick

transfusion responses could be achieved with typo-i or -2 match donors. In 77% of typo-i or -2 match transfusions with poor posttransfusion platelet increments, the lymphocyte cytotoxicity test ( incubation time 1 80 mm at room temperature) was positive. This test therefore seems to be a useful tool in predicting the outcome of transfusion responses in typo-i and -2 match pairs. In contrast, the lymphocyte

Twenty-four thrombocytopenic patients reto random-donor platelet support were given 1 06 platelet transfusions obtamed from 57 different HLA-typed single donors. For critical evaluation of the transfusion responses, “fullhouse” HLA typing of donors and a precise measurement of the number of infused platelets were performed. Posttransfusion platelet increments were related to the HLA matching of donor-recipient pairs and to leukocyte crossmatch tests in vitro. The transfusion response displayed a striking difference depending on the absence (type-O match) or presence ( type- 1 or -2 match) of donor HLA antigens differing from the recipient. Whereas 95% of transfusions from type-O match donors resulted in a compatible platelet increment, only 20% successful fractory

I

and

No.

5 (May),

1978

GmOr, ZOrich,

ISSN

20,

1977.

Cancer M. D.

.

Research. Division

of

Hematology.

Dept.

of

Internal

Swit:erland. 0006 -4971/78/5l05-0008$01.00/0

903


904

GMUR

to single-donor upon

transfusions,

transfusion

and

response

(3) the

the

collection

Aminco

mean

x

Mass.’2)

l0

citrate

trates

per

aration

platelets;

gard

to 24-hr

Platelet trates

kept

at

of

platelets

donors

Leukocvte time

of

60

match

at

were

Absorption (lOt/mI

studies

at 37’C The recipients

acute

marrow

culating

of

All

to

further

vascular

a

concen-

donation. of

white

the

two

178

of

collection.

to

be

g

For

prep-

for

3 mm

Effective-

identical

(see

also

collected

with

Ref.

re-

14).

platelet

concen-

loci

cytotoxicity

locus A

cells

B.

and

by HLA

blood LT),’6

recipients

incubation

time

being

tested

recipient

without

parents.

recipient

[standard of

sera

incubation

180

test

6

and

defined

ofthe

and pretransfusion tests

mm

at

room

All

()7

simultaneously

cross-

against

the

sera.

performed

were

method

all

B were

cytotoxicity

antibodies

In

typing

cytotoxicity or

leukocytes

l09/ml).

or thrombocytes

(5

with

x

either

109/ml),

granulocytes

each

incubated

for

on ice. transfusions

platelet

random

transfusion

six

fever at

to

time

the

their

donors ten

above

with 6

below

in

random

of

either

6 patients

counts

transfusions

from

or splenomegaly

were

platelet

support

with

17 of

verified

posttransfusion

5 x

of the

microgranulocyte

donor

6 hr proved

microlymphocyte

microlymphocyte

pretransfusion

after

coagulation,

of

“split-ACD” platelet

per

use with Natick,

standard

responses

A and

of the

donor

by

multiple

Patients

by

transfusion.

locus

regularly

granulocytotoxic

with

within methods

standard

antigens

with

platelet

counts

occasions.

the

collected (2.5

had

the

consecutive

centrifugation

microscopy15

(standard

later

all

(I)

collections

lHaemonetics,

platelets

transfusion

was

two

as

single-donor

failure. platelet

three

HLA

by 60 mm

leukemia,

fractoriness

well

the

followed

l0

administered different

of

locus

as weekly of

x

56

by

four

additional

24 hr after

by

between

lymphocytes

10 mm with

done

temperature

repeated

serum),

of 2.0

to

methods:

30

(3)

two

in compatible

by

as

as well

pretransfusion

of

and three

to and

four

tests

room

Model

10#{176}platelets;

an

speciticities

ofeither

(long-LT)] tests

was

simultaneously

mm

temperature

Haemonetics

a mean

the

prior

study

crossmatch

Md,”)_

by phase-contrast

13 lILA

in this

were performed

by

done

Homozygosity

different

Spring,

x

temperature

testing

included

exception.

by three

Silver

concentrates,

recipient

detecting

METHODS

preparation

recoveries

were

Histocompatibilits’ antisera

of 4.1 with

collected

as ofthe

antibodies

transfusion.9

room

posttransfusion

counts

AND performed

of the

with

platelet

were

as well

with

a mean

platelet

before

in vivo

use

14 collections

of leukocyte-poor

ness

by

method,13

donation

performed

was

Instrument,

(2) with

dextrose)

Platelets

donors

(American

36 collections

(acid

this

single

Celltrifuge

of4.8

was

from

of antigranulocyte

in vivo. MATERIALS

Platelet

influence

ET AL.

random

of single-donor

to

leading

failure

to

to

on

were

re-

cirat

least

disseminated

transfusion

18

bone

increase

concentrates

suspected

and

owing

histories by

platelet

sepsis,

anemia

I09/liter

past

as judged

38’C,

aplastic

x

intra-

excluded

from

study. Platelet

from

from

Swiss

a computerized

Red

Cross

Transfusion the

were 57 normal

donors

or

tients

one

area

platelet

dividing

Platelet

(sq m)

the

and being number

0.85

least

4.5

by x

of

responses at

selected

3000

from

ABO-

and

as “corrected

independently

divided

unit

were

crements

adults

over

among

family

HLA-typed

members

of the

unrelated

blood

pa-

donors

banks.

increments

total

et al., transfusion

of

were expressed

increments

fused platelets. surface

blood

responses

posttransfusion

healthy file

hr

after

transfusion

the

calculated

number

10#{176}platelets.

l0

The

collected

defined sq

of the

24

platelets

were x

platelet

of size

x

were

0.85 All

various

therefore

so-called of

units

x

10”.

In

if the

U.9

in order

and

of

number

by

as compatible

m/liter

increments”

recipients

multiplied platelet

units

could

be

24-hr were

evaluate

of

trans-

by

body

transfused,

calculated

accordance

corrected

transfusions

to

doses

with

by Yankee

posttransfusion

ABO

and

in-

crossmatch

compatible. Matching

of donor-recipient 1-ILA

nonidentical antigens

differing

platelets

from

spect

21

to our

pairs

type

pairs

antigens: from

those

57 different classification

I, and

was

type-0,

-I,

in the

recipient.

donors, ofthe

18 pairs

thus HLA

type

classified

and

2.

addition

in between to

three

types

according

corresponded

Twenty-four resulting

matching In

into

-2 matching

patients 57

were

different and

responses

to

recipient, the

the

one,

initial

number

or

supported

donor-recipient

donor

to

to zero,

two

106

times

pairs. 18 pairs transfusion

of

donor with

With

were

re-

type in

these

0,


PLATELET

SUPPORT

IN

57 difi’erent

pairs,

responses

of the

I 8 type-0

SENSITIZED

match

PATIENTS

to subsequent

905

transfusions

of the

same

donor

could

be analyzed

in

II

pairs.

RESU ITS Response

to Initial

Results

Transfusion

of the

initial

transfusion

Fig. I. Type-0 match platelet pairs,with a mean corrected Eight cal

pairs

were

HLA

donors

genotype-identical

phenotypes

homozygous

for did

corrected

not

of each

transfusions 24-hr increment

and HLA

differ

increment

in the

loci

siblings,

four

remaining

six

A and/or

significantly 8725

versus

donor-recipient (Fig. IA) of8300

were

from

those The

are

with

nonrelated

incompatible

Response

Donor

mum

responses

of

trast,

Match

of HLA-identical

siblings

(mean

sole

platelet

trans-

incompatible

sibling. Type-l incompatible in compatible in 5

From

the

Pairs

9) continued

to reveal

MLC-nonreactive in the

remaining

to

incompatibility

shifted

were

nonrelated

transfusions of single-donor platelets were performed in I 1 pairs of only. In five pairs, all subsequent transfusions (minimum 2, maxi-

19, mean

identical,

Transfusions

in Type-O

Repeated type-0 match

identi-

in 13 pairs.

to Repeated

Satne

in

donors

fusion originated from a genotype-identical, MLC-nonreactive match platelet transfusions (Fig. 1 B) were compatible in 4 and 17 pairs, and type-2 match platelet transfusions (Fig. 1C) were and

shown

in 17 of 18 mm x U.

nonrelatives

pairs

B. Transfusion

7750).

pair

were compatible platelets sq rn/cu

sibling six pairs

compatible pairs;

one

compatible

after

one

to

responses. was

responses three

to the

subsequent

15000L

,

Four

a nonrelated

were pair.

initial

transfusions.

.

HLAIn con-

transfusion One

.

z I

.t1oooo,_

c

U 5ooo_

C

0-

‘

wI_ Fig.

1.

Corrected

sion platelet sq

m/unit)

different grade in Materials

represents

24-hr

increments

posttransfu-

(increment

x

after platelet transfusion of donor-recipient HLA match alloimmunized patients (see and Methods). Each point a single donor-recipient pair.

‘

u_i Ui

,

OL:

,

0 DONOR-RECIPIENT

..

1

HLA-MATCH

2

TYPE

of


906

GMUR

1 . Transfusion Response to Initial Single-Donor HLA Match Grade and Corresponding

Table Pairs

Platelet

Transfusion

TransfUsion

Crossmatch

Standard

0/1

0/8

20/26

3/16

1/1

GT

2/8

14/24

6/14

1/1

pairs

of

was

with

positive

cytotoxicity

tests

cytotoxicity

test,

test/number

of Initial Crossmatch

of pairs

(see Materials

a MLC-nonreactive

Correlation Leukocyte

Lymphocyte

with

poor

whereas only false negative

days

after

five were

nonrelated

posttransfusion

How-

and

in vitro in predicting in 51 donor-recipient

Crossmatch

to the responses

pairs.

of contaminating match pairs tested.

tests

were

initial transfusion consistently had

platelet

increments,

17 showed simultaneously before transfusion; three

the outcome pairs.

of

performed

(Table negative

I).

20 long

LT

a positive standard of them converted

in

Eight tests.

34

pairs In 26

were

posi-

LT. Six to positive

tests 7-- 19

transfusion.

only

incompatible

a strongly

tests were performed in 17 type-0 match pairs. Of transfusion responses, 13 had negative tests and long LT, twice in combination with a positive GT.

transfusion

positive

long

MLC nonreactivity. cytotoxicity tests.

positive

In

GT.

1 1, standard

transfusion response. The of them had a compatible number

i0 per

Of special interest GT. All four showed transfusion reactions Specificity Absorption positive GT granulocyte

ofGranulocyte

was

also

remaining transfusion

were four a compatible occurred. Cytotoxic

observed were

type-i positive;

in a sibling

obtained

and

in spite

-2 match

and

three

type-0 match transfusion

in the showed

pairs

all showed

an

S pairs had an exclusively response in spite of this leukocytes

transfusion),

studies were and compatible antibodies could

was as GT

Sixteen

LT

of contaminating

1 1 x .

rcsponse LT as well

identity and Granulocyte

j#{216}9 and

and

tests analyzed

tests. prior

Pretransfusion crossmatch the 16 pairs with compatible three displayed a positive

a high

pair,

Transfusion R esponses Tests In Vitro

cytotoxicity

tive, were

Methods).

sibling

type-l and -2 match pairs with compatible transfusion situations

and

tested.

were again achieved by reduction preparation in three of four type-0

value of leukocyte crossmatch transfusion responses was

which

Incompatible

Long Lit

ever, compatible responses leukocytes in the platelet

The

Compatible 0/16

Lymphocyte

The platelet

Incompatible

Match

17/26

Granulocyte

them

Compatible

Type-0

0/8

*NumkSr

t

Test

ITt

Tests In Vitro

Response’

Type- 1 and -2 Match LeUkocyte

AL.

in Donor-Recipient

Leukocyte Crossmatch

of Different

ET

platelet

pairs with response,

in

showed

a

incompatible

positive positive

concentrates

an incompatible

pair of HLA

GT; GT

two and

(0.8 response.

an exclusively positive although severe febrile

A ntibodies

performed in type-0 match pairs with exclusively transfusion responses. In three sera tested, antinot be absorbed either with a mixture of platelets

x


PLATELET

SUPPORT

originating tamed from achieved

IN

SENSITIZED

PATIENTS

907

from 120 random donors or with platelets the respective donors. However, elimination

with

the

corresponding

donor

and lymphocytes of the antibodies

obwas

granulocytes.

DISCUSSION To date, no general consensus has emerged concerning the percentage of successful transfusion responses that can be achieved in polysensitized patients or to whet these

degree

HLA

questions,

ber

specificities

special

oftransfused

should

attention

was

and

to the

platelets

between platelet donors According to Yankee pressed as posttransfusion

be

given

matched.9”82#{176} to the

exact

precise

determination

and recipients. and co-workers,68 platelet increments

transfusion corrected

body surface area and per random donors represent

platelet unit infused. an average of 0.85

In

to

answer

of the

of HLA responses per sq

The platelet 10” platelets

x

order

calculation

num-

differences

may be exm of recipient

units collected from per concentrate.9

However, preparation of multiple units from a single donor reveals a highly variable number of platelets depending on the platelet count at the time of collection.’4’2’ If calculation of corrected increments to single-donor platelets is based only on the average number of platelets usually found in random platelet concentrates,69’8 the transfusion responses may be overor underestimated. Therefore to calculate platelet increments after transfusion of platelets collected from and

one

donor

the

expressed Furthermore,

veal

two

exact

number

in standardized all platelet

specificities

of

for each

of the

Thus we were able to characterize or 2) in all donor-recipient pairs. patients

refractory

good either

platelets

loci

in that

study

20#{176} of

to the results

did

not

from

this

study.

continued

was

(type 0, 1, 9S of the

to demonstrate

of polysensitized compatible”

typing

re-

type-0 match donors, In contrast to our re-

available

patients will single donors. in only

poor transfusion to undetected

71%

of

responses may HLA specificities

these

highly successful transfusion responses with donors of type-l or -2 match were

transfusions

produced

called compatible, and no significant donor-recipient pairs with either one recipient. Obviously, the transfusion not

present

the

recipients.

in the

rate

recipient

Therefore

posttransfusion few days before higher

typing

donors.

In sharp contrast match platelets, our Only

determined

grade of HLA match conditions, almost

“HLA

some of their of recipients

always

excluded

support

S0-70 from

“fullhouse”

matched donor-recipient pairs,9 have been caused by sensitization of the

B were

the these

platelet

was

platelets. whose HLA

platelets obtained from or unrelated individuals.

sults, it was recently claimed that only respond to initial platelet transfusions since

A and

precisely Under

to random-donor

transfusion responses to MLC-nonreactive siblings

However,

infused

units ofO.85 x lO donors and recipients

will our

platelet increments performance of

of compatible

depend

patients

transfusion

platelet

differences or two donor success using on

were

the

selected

increments

to type-0 very poor.

that

could

be

could be observed between HLA antigens lacking in the platelets with donor antigens degree

of

on the

polysensitization basis

of

of incompatible

to at least two random-donor transfusions a the first single-donor transfusion. A much responses

to type-

1 match

donors

was

ob-


908

GMUR

served

by others

explained bone

by

in bone the

marrow

transplant

poor

of compatible responses role of HLA

support in sensitized match, often are not

cytotoxicity

tests

incubation

meet

time

with

In 77#{176}c, oftype-l

this

demand

and

pick out crossmatch

to a considerable is extended

to

anemia who had first from random

-2 match pairs, a poor test. On the other hand,

Both

received donors

developed

lymphocytes,

HLAthe

antilymphocyte

antigens

been involved, e.g., Moreover, antibodies

and

MLC-identical

pairs role

value

sister.

that

of

pairs, where concomitant Among our patients, pure situations. In all of them, ofgranulocytes seem not

From

these

studies

we

occurred reacting

type-0

match

or

tests

suspected be

HLA antibodies antibodies were transfusion responses

that

-2 match

applied

only

Thus

in his

pairs

to

type-0 plate-

in type-0

can present with

at least initially. platelet support.

spe-

shared coded

of influencing

assessed

of

conclude

-B

as well, since with cells of

type-l

cytotoxicity

can

observed, initial

in vitro,

with

not being

extent9

were to influence

transfusions, prepared several type-0 match

than

to

precyto-

transfu3 of 16 aplastic

B lymphocyte alloantigens against specificities not

in contrast

influences antigranulocyte compatible

was

or

antibodies

to a remarkable

if the

increment lymphocyte

react

other

of

temperature.

HLA-A

lymphocyte

is questionable. of specific antigranulocyte

let transfusions

deprived antibodies

Thus

of positive

particularly

type-l or -2 match compatible responses, in two patients with

antibodies

that

i.e., sys-

donors lymphocyte

at room

posttransfusion no false positive

major histocompatibility region may have antilymphocyte antibodies were found

predictive

match The

be with

in type-0 match pairs (20#{176}())conB with respect to

extent,

excessive numbers of platelet and later, repeatedly, from

indicating

cificity might have by thrombocytes.24 for in the one patient

could

connection

compatible tests,23

180 mm

toxicity tests were observed in all eight compatible sions tested. However, in type-0 match pairs with tests were false positive. They were observed

donor

finding

in

transfusion responses in type-l and -2 match antigens of loci A and

are required to with the various

complement

by a positive

donors.

This

treatment

patients.6 9 Since the most effective donors, available owing to the complexity of the HLA

tem, sensitive crossmatch tests type-l or -2 match. Compared

dicted

recipients.’8

immunosuppressive

AL.

transplantation.22

The high proportion pairs (95) and the firmed the outstanding platelet type-0

marrow

extensive

ET

match

be excluded. in four such platelets not

antigranulocyte

antibodies

directed

against

non-HLA-A or -B antigens do not necessarily cause poor platelet transfusion responses, at least initially. After repeated platelet transfusions from the same type-0 match donors, however, transfusion responses may shift to incompatibility.

Reduction

can restore leukocytes

of

contaminating

compatible responses, in such situations.9

leukocytes thus

in the

confirming

the

platelet role

of

concentrates contaminating

ACKNOWLEDGMENTS We

would

like

to

Blood Transfusion assistance

ofC.

thank

Centers von

Felten,

Dr.

M.

of Zurich,

Metaxas

and

for

making

S. Hegetschweiler,

and

Dr.

M.

Frey-Wettstein,

available H. Hirvonen

blood

heads donors.

is gratefully

of The

the skillful

acknowledged.

Red

Cross

technical


PLATELET

SUPPORT

IN

SENSITIZED

909

PATIENTS

REFERENCES I.

Alvarado

fusion

I,

of fresh

with

acute

2.

Djerassi

concentrated

leukemia.

Freireich

transfusion

in 6:50

54,

JA,

Farber

platelet

fresh

with

leukemia

Trans-

single

to children

1976

67:13-22,

1965

Effectiveness

Transfusion of

5:

platelets

J Pediatr

EJ:

3. Cavins

I, Farber

of

and

platelet

aplastic

Methods D.C.,

Banks,

14.

5, Roy

Al:

concentrates

to

thrombocytopenia.

Transfusion adult

8:24

1968 Ster

El:

RH,

Levin

Complement

fixing

of transfused

persons:

with

survival

platelet

tients.

RH,

30’

Pl#{228}ttchen aus

Shulman

NR:

attending

platelet

6:39

49,

6.

Yankee

refractory

considera-

RA,

Grumet

FC,

of compatible by

Yankee

derson

ES:

donors

by

RA,

H LA-typing.

of

RA,

HLA

R,

unrelated

HLA

Hen-

compatible

matching.

Bull

RG

Ml,

ir:

compatible

N

EngI

Decter

Platelet

17.

Hasegawa

Burn

Ann

donors

Intern

80:9l4,

Herzig

JA,

RH,

Herzig

Lohrmann

Graw

HP,

RG:

fusion

Sout

Correction

responses

Bull RF,

of with

platelet

matched

GP,

Ml, Yankee

poor

platelet

concentrates.

Blood

P,

B:

Thorsby

E,

platelet

patible

Jr.

6:

Terasaki

P1: Trans-

test.

Weber

W,

Nissen

C,

Thrombozytenersatz

mit Einzels-

Wochenschr

Helgesen transfusion

unrelated

and

2:397-404, Mittal

of

l06:889

platelet

KK,

HLA

T: com-

donors.

EA,

Tissue

Green

D:

(HLA) Blood

CA,

DH,

14:388

for

1976 Wiernik of

plateletpheresis

Transfusion

Match-

antigens

47:31-41,

Buchholz

multiunit

donors.

Gjemdal

sibling

Ruder

transfusion. Schiffer

A, from

1972

histocompatibility

Intensive

46:743

lym-

1976 19.

21.

HLA-

RG

Med

trans-

leukocyte-poor

microdroplet

nicht-verwandten

ing

RA,

DP,

1973

Schweiz

Antigens

Decter

Singal

Transplantation

H LA-typisierten

20.

9.

I

homotransplanta-

pendern.

I 974

platelets.

cytotoxicity

Speck

Repeated

to allo-

Med

Morphology

MR. of

P, Groff

HP,

EP: blood

for test.

15:492,

Med

1977

T, Graw

Cornu

von

Schweiz

Mickey

microgranulocyte

JA,

transfusions

unrelated

patients.

1968

893,

HP, Graw

immunized

Dowling

Gewinnung

Refinement

913927,

18.

der

Serotyping

cytotoxicity

Honegger

Blutzellseparators

1950

KK,

P1: XVIII.

A

J,

des

human

3:365-377,

Mittal

plantation

1973

Lohrmann

Yankee

for

Fehr

Cronkite of

phocyte

1969 KS,

Selection

16.

GN:

donors

lymphocyte

lymphocyte

288:760764,

Rogentine

platelet

Graff

Physiol

tion.

Transfusion

G,

(ed

Association 187

H,

107:l452-l453,

Terasaki

transfusion.

Med281:1208-1212,

7.

from

pa-

1964

186-

bei

enumeration

and

Procedures

Einzelspendern.

Brecher

AppI

thrombocytopenic

Immunological

patients

N Engli

8.

serum

1966

selection

I Med

in

15.

of antibodies

4:428-435,

5.

Freireich

isoantibodies in

Transfusion

H,

Correlation

tions

The

Cooper

pp

Leistungsfahigkeit

Wochenschr

4.

and

Hirvonen

‘Haemonetics 27,

I 6:312-321,

American

1974,

GmUrJ,

H P:

patients

Transfusion

Transfusion

Washington,

of Blood

1966

platelets.

I 3. Technical 6).

anemia.

donor

394,

PH: normal

1974

750, 1975 10.

Bucher

Tschopp

L,

Shortened and

U,

failure

of

1 1. Graw 5: Leukocyte donors

separator. 12.

H:

Reiss

thrombocytopenic

of

in

A,

Spengler

Platelet

detection

multiple

H,

of

Exp

anti-plate-

and with

ir,

Herzig the

Katz

Eisel

continuous

Transfusion RF,

GP, collection

patients

Statewide with

Perry nor-

flow

11:94-101, Al:

Ri, from

blood

Filip

support ABO

matched

of

alloantisera.

2]:104,

to

J Hematol

cultured Med

Aster

RH:

for

transfusion

alloimmunized

L,

Harris

re-

5,

specific

lines

142:84

Pre-

1976

antigens cell

M, severe

globulin.

1:471-479,

Abelson of

J Exp

of

1977 Ri,

concentrates

DL,

Marty

anti-lymphocyte

Duquesnoy

Detection

B-lymphoid

A,

Treatment

of cross-matching

Mann

DB:

AJ: with

Di,

Am

cipients.

Devergie

5 [Suppl

value

platelet

of

24.

1971

Barrett

anemia

dictive

platelet

E,

Hematol

23.

Vox

1973 RG

A,

aplastic

platelets

transfusions.

Gluckmann

Faille

transfusions:

H LA-identical

vitro

after

Sang2S:l87192,

mal

Weck

Kummer survival

let-antibodies

cell

De

22.

with 90,

1975

Amos for human


1978 51: 903-909

Platelet support in polysensitized patients: role of HLA specificities and crossmatch testing for donor selection J Gmur, A von Felten and P Frick

Updated information and services can be found at: http://www.bloodjournal.org/content/51/5/903.citation.full.html Articles on similar topics can be found in the following Blood collections Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml

Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.