Managing HLA Matched Platelet Orders

[RrayVCU]

Hi folks!

 

I am wondering how your establishment handles orders for HLA matched platelets.  I am at a lvl I trauma center with a major cancer center.  We end up having to HLA match many patients after they stop responding to our single donor pheresis.  The increased need for platelets after chemo is obviously the driving factor here.  Currently, our Immunomolecular Path lab does the HLA typing and we relay that information to our blood center to search their donor pool or see about doing a national search.  This can sometimes lead to delays in product, especially when a patient has frequent need and is receiving transfusion on an out-patient basis.  It is hard to coordinate.  Most of the time, the physicians have to approve single donor platelets in the meantime or hope we can get acrodose platelets shipped in for better odds of HLA match.  

 

Any insight or organizational tips are much appreciated! Thank you!

[RrayVCU]

Anyone do HLA matched platelets at all?

[AMcCord]

We are a smaller facility but do occasionally have a patient who needs HLA matched platelets. All I can tell you is that we work closely with our blood supplier and the patient's physician to try to come up with some kind of regular schedule for the patient. If we can tell our supplier (ARC) that the patient will be coming in every Wednesday, they will do their best to make sure we have the product available every Wednesday. If the type is less common, once they find suitable donors they will try to dedicate the donors so that we get first offer for our patient. If we don't need it, we let them know and it's released to the network. If necessary, they will schedule the donors to come in on a particular day so that the needs of the patient are met. (To further complicate things, we are 150 miles away from our supplier.) We have to pre-plan as much as possible and make it clear to the physician that we can't make any promises otherwise. 

 

If the type we need isn't too uncommon, we can get product more than once a week. Our last patient had a fairly rare HLA type, so it took almost 7 weeks to find the first donor for her. Then we got lucky and within days a 2nd donor who matched started coming in again after a hiatus from donation of more than a year. These 2 were scheduled on alternating weeks to support our patient and faithfully donated on schedule for almost 2 years. The best we could do for her was a weekly donation - no other donors were found. She needed a couple of surgical procedures during that time - the surgeon had to coordinate with the platelet schedule, but it all worked out.

[ChrisW]

I agree that managing HLA-matched platelet orders - especially for outpatients - is very challenging. We recently entertained a recommendation to move to Crossmatched platelets as the first step in providing product for patients who may have become refractory to platelet transfusions. We are pursuing that option and our Hem/Onc docs are on board. The rationale is that it will provide a greater pool of suitable platelets for transfusion; it will take into account antibodies that may contribute to less than successful response to HLA matched platelets. We are in the process of adapting our procedures and evaluating the logistics since a fresh within 3 day sample will be required.

[BloodBankBlake]

I work at a community blood bank. We have found that the platelet bumps the cancer patients were receiving from the crossmatched platelets were as good, and sometimes better, than from the HLA matched units.

[CMCDCHI]

Another option is to occasionally run a PRA (platelet antibody screen) and AVOID the antigens that are causing problems rather than trying to have a perfect match.  When I worked at the blood center, we did a mixture of HLA matching, antibody avoidance, and crossmatching.

[RrayVCU]

Thank you for your replies!

 

We already do antibody avoidance instead of perfect match, if necessary.  And PRA/HLA screens are done routinely, but we have so many patients that are 99% reactive because they weren't getting compatible platelets sooner.  Crossmatching has been discussed, but it seems like high upkeep.  What processes do you use if you do crossmatch compatible platelets?