{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:03:48Z","timestamp":1789707828465,"version":"4.0.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Platelet transfusion refractoriness (PTR) is a major clinical challenge in hematologic patients, yet real-world evidence comparing transfusion strategies\u2014particularly the role of cross-matched platelets and intravenous immunoglobulin (IVIG)\u2014remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 144 hematologic patients diagnosed with PTR at Nanfang Hospital (2019\u20132022), totalling 1,345 transfusion episodes. Patients were stratified by platelet antibody status. Four transfusion regimens were compared: random platelets, cross-matched platelets, random platelets\u2009+\u2009IVIG, and cross-matched platelets\u2009+\u2009IVIG. The primary endpoint was 24-h corrected count increment (CCI). Logistic regression identified factors associated with antibody development. The primary analysis was performed using linear mixed-effects models (LMMs) with a random intercept for patients to account for within-patient correlation. Fixed effects included transfusion strategy along with prespecified episode-level and patient-level covariates. Generalized estimating equations (GEE) were used as a sensitivity analysis to assess the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Female sex emerged as the strongest independent predictor for the development of platelet antibodies (OR: 4.18, 95% CI: 2.25\u20138.24). Other univariate risk factors included age, obstetric history, diagnosis, and chemotherapy cycles. Among antibody-positive patients, both cross-matched platelets and IVIG combined with random platelets were associated with improved 24\u2005h CCI compared with random platelets alone (all\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>Holm<\/jats:sub>\n                      \u2009&amp;lt;\u20090.001), cross-matched platelets were associated with higher 24\u2005h CCI relative to random plus IVIG (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>Holm<\/jats:sub>\n                      \u2009=\u20090.019), whereas cross-matched platelets plus IVIG demonstrated no additional benefit vs. cross-matched platelets alone in this cohort (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>Holm<\/jats:sub>\n                      \u2009=\u20090.444). In antibody-negative patients, no statistically significant difference in 24\u2005h CCI was observed across the four transfusion strategies (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.244). Consistent with the LMM results, the overall effect of transfusion strategy was not statistically significant among antibody-negative patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.692) but was significant among antibody-positive patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Similar results were obtained using GEE, supporting the robustness of these findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among patients with antibody-negative PTR, cross-matched platelets and IVIG demonstrated no additional benefit in this cohort. For antibody-positive PTR, cross-matched platelets showed the most favorable response in this cohort; when unavailable, high-dose IVIG with random platelets may be preferentially considered. These comparative treatment findings require prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1923303","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:32:09Z","timestamp":1789705929000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Personalized management of platelet transfusion refractoriness: risk factors, cross-matching, and IVIG strategies"],"prefix":"10.3389","volume":"13","author":[{"given":"Jixin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyin","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piao","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayou","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Nanfang Hospital, Southern Medical University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/S0140-6736(07)61198-2","article-title":"Platelet 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