{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T07:02:12Z","timestamp":1794294132600,"version":"4.9.0"},"reference-count":41,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Platelet refractoriness continues to be a problem for thrombocytopenic patients because the risk of a major spontaneous or life-threatening bleed significantly increases when platelet counts drop below 10 \u00d7 109\/L. The majority of patients have nonimmune causes driving the refractoriness, such as bleeding, medications, or diffuse intravascular coagulation; however, this article is dedicated to the diagnosis and support of patients with immune-based platelet refractoriness. Antibodies to class I HLA molecules (A and B alleles) are responsible for most immune-based refractory cases, with antibodies to platelet antigens seen much less frequently. Patients may be supported with either crossmatch-compatible or HLA-matched\/compatible platelet units. When trying to select HLA units it can be difficult to find a perfect \u201c4 of 4\u201d match for the patient\u2019s class IA and IB alleles. In these cases, it is better to use the antibody specificity prediction method, which identifies compatible units that lack antigens recognized by the patient\u2019s anti-HLA antibodies. For an algorithmic approach to the patient with platelet refractoriness, see Visual Abstract.<\/jats:p>","DOI":"10.1182\/hematology.2020000137","type":"journal-article","created":{"date-parts":[[2020,12,4]],"date-time":"2020-12-04T22:31:29Z","timestamp":1607121089000},"page":"527-532","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":126,"title":["Platelet transfusion refractoriness: how do I diagnose and manage?"],"prefix":"10.1182","volume":"2020","author":[{"given":"Claudia S.","family":"Cohn","sequence":"first","affiliation":[{"name":"University of Minnesota, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"issue":"3","key":"2020121621260148300_B1","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.hoc.2016.01.008","article-title":"Management of the platelet refractory patient","volume":"30","author":"Forest","year":"2016","journal-title":"Hematol Oncol Clin North Am"},{"issue":"26","key":"2020121621260148300_B2","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1056\/NEJM199712253372601","article-title":"Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions","volume":"337","author":"Trial to Reduce Alloimmunization to Platelets Study Group","year":"1997","journal-title":"N Engl J Med"},{"issue":"1","key":"2020121621260148300_B3","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/0268-960X(90)90013-I","article-title":"Platelet transfusions: the problem of refractoriness","volume":"4","author":"Murphy","year":"1990","journal-title":"Blood Rev"},{"issue":"1","key":"2020121621260148300_B4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1182\/blood-2003-03-0940","article-title":"Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness","volume":"103","author":"Seftel","year":"2004","journal-title":"Blood"},{"issue":"1","key":"2020121621260148300_B5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1365-3148.1992.tb00132.x","article-title":"The definition of refractoriness to platelet transfusions","volume":"2","author":"Bishop","year":"1992","journal-title":"Transfus Med"},{"issue":"2","key":"2020121621260148300_B6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/S0887-7963(00)80007-3","article-title":"The evaluation and management of platelet refractoriness and alloimmunization","volume":"14","author":"Delaflor-Weiss","year":"2000","journal-title":"Transfus Med Rev"},{"issue":"3","key":"2020121621260148300_B7","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1002\/(SICI)1096-8652(199807)58:3<165::AID-AJH2>3.0.CO;2-P","article-title":"Intravascular and total body platelet equilibrium in healthy volunteers and in thrombocytopenic patients transfused with single donor platelets","volume":"58","author":"Brubaker","year":"1998","journal-title":"Am J Hematol"},{"issue":"1","key":"2020121621260148300_B8","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1046\/j.1537-2995.1988.28188127957.x","article-title":"The value of 10-minute posttransfusion platelet counts","volume":"28","author":"O\u2019Connell","year":"1988","journal-title":"Transfusion"},{"issue":"10","key":"2020121621260148300_B9","doi-asserted-by":"crossref","first-page":"4106","DOI":"10.1182\/blood-2003-08-2724","article-title":"Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients","volume":"105","author":"Slichter","year":"2005","journal-title":"Blood"},{"issue":"3","key":"2020121621260148300_B10","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/j.1365-2141.1989.tb07757.x","article-title":"Factors influencing the transfusion response to HLA-selected apheresis donor platelets in patients refractory to random platelet concentrates","volume":"73","author":"McFarland","year":"1989","journal-title":"Br J Haematol"},{"issue":"5","key":"2020121621260148300_B11","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1001\/jama.1980.03300310023016","article-title":"Platelet transfusion therapy. 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