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HLA‐reduced platelets to overcome platelet refractoriness: can lemons help?

Since its introduction into clinical practice in the early 1960s, the transfusion of platelet concentrates (PCs) has been the mainstay of supportive (nonprimary) therapy given to patients with hyporegenerative thrombocytopenia.' This practice is based on data published about 30 years ago by Gaydos and coworkers,* who reported that hemorrhagic episodes in acute leukemia were more severe and frequent when the patient's platelet count fell below 5 x lo9 per L, while they occurred only on 8 and 4 percent of days when the platelet count exceeded 10 and 20 x lo9 per L, respectively. A standard dose of platelets prepared by centrifugation of whole-blood units or by apheresis is used for the prophylaxis or treatment of hemorrhagic episodes. After PC transfusion, a proportion of patients develop alloantibodies that react mainly with determinants of the HLA system and less frequently with platelet-specific antigens. Some of these patients become refractory to further platelet transfusion, as indicated by the inability of transfused platelets to increase the patient's platelet count and to stop bleeding if present. The fate of these patients is dire, as they can die in a short period of time. Efforts to obviate this severe complication include both preventive measures and treatment strategies.