{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:05:42Z","timestamp":1747188342243,"version":"3.40.5"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Platelet\u2010transfusion refractory (PR) patients do not achieve expected post\u2010transfusion platelet counts. We investigate suspected PR patients with post\u2010transfusion platelet counts, indirect platelet antibody screens (ind\u2010PAS), Class I HLA antibody tests (HLA\u2010Scr), and physical platelet crossmatch (PXM) studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>The three following cases describe possible pitfalls of laboratory tests used in PR workup and management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Case #1: Antibody testing detected antibodies to only HLA\u2010B13, corresponding to a 4% calculated panel reactive antibodies (CPRA; 96% predicted donor compatibility). However, PXM showed the patient compatible with 11\/14 (79%) donors; two of the PXM\u2010incompatible units were ABO\u2010incompatible. Case #2: PXM revealed compatibility with 1\/14 screened donors; however, the patient did not respond to the product from the compatible donor. The patient did respond to HLA\u2010matched product. Dilution studies provided evidence of the prozone effect, which caused negative PXM despite clinically relevant antibodies. Case #3: There was a discrepancy between the ind\u2010PAS and HLA\u2010Scr. Ind\u2010PAS was negative for HLA antibodies, while HLA\u2010Scr was positive and specificity testing corresponded to 38% CPRA. Per the package insert, the sensitivity of ind\u2010PAS is ~85% compared to HLA\u2010Scr.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These cases highlight the importance of investigating incongruent results. Cases #1 and #2 demonstrate PXM pitfalls: ABO incompatibility can result in positive PXM and false\u2010negative PXM can occur in the setting of the prozone effect. Case #3 reveals the importance of knowing a test's sensitivity. Centers that only perform ind\u2010PAS may fail to detect HLA antibodies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17280","type":"journal-article","created":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T09:35:23Z","timestamp":1676540123000},"page":"888-892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Three patients highlighting potential pitfalls in platelet refractory testing"],"prefix":"10.1111","volume":"63","author":[{"given":"Michel","family":"Attieh","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward A.","family":"Dent","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Logan","family":"Happney","sequence":"additional","affiliation":[{"name":"American Red Cross  Charlotte North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D.","family":"Roback","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David N.","family":"Alter","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen","family":"Barrette","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Then","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4909-7168","authenticated-orcid":false,"given":"H. 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