ArticleFrontiers in medicine2026
HLA class I antibody distribution and cross-matching strategies in immune platelet transfusion refractory patients: a retrospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study aimed to investigate the distribution characteristics and clinical significance of human leukocyte antigen class I antibodies in patients with immune-mediated platelet transfusion refractoriness (PTR) in this region, and to evaluate the clinical utility of local serological cross-matching strategies for improving platelet transfusion efficacy. Methods: A retrospective cohort study was conducted involving 229 patients who underwent platelet antibody screening. Platelet antibody screening and cross-matching were performed using solid-phase agglutination assays. Human leukocyte antigens (HLA) antibodies were detected via Luminex liquid bead array technology to obtain mean fluorescence intensity (MFI), and HLA class I antibody specificity was identified using Luminex single-antigen beads. The corrected count increment (CCI) was employed as the primary efficacy evaluation metric to compare the clinical outcomes among different transfusion strategy groups. Results: Subgroup analysis revealed: in the random transfusion group, the PTR incidence was 26.92% (7/26), with a median 24 h CCI of 7.35 (3.03, 10.78); the cross-incompatible group showed a significantly higher PTR incidence of 80.0% (4/5), with a median 24 h CCI of 0.00 (-2.54, 9.39); while the cross-compatible group had a PTR incidence of 22.72% (5/22), with a median 24 h CCI of 8.11 (3.02, 12.30). The platelet antibody positivity rate was 20.96% (48/229), with 62.5% (30/48) originating from hematologic malignancies. Among these, HLA antibody positivity reached 75.61% (31/41), with HLA class I antibodies accounting for 93.55% (29/31). HLA-B locus antibodies were the most common. The maximum MFI of HLA class I antibodies was negatively correlated with the 24 h CCI ( Conclusion: This study analyzed the distribution characteristics of HLA class I antibodies in suspected or highly suggestive immune-mediated PTR patients and found that the highest MFI value of HLA class I antibodies can serve as an indicator of the maximum observed HLA antibody reactivity. Based on a serological crossmatch transfusion strategy, this approach provides a feasible implementable platelet transfusion protocol for primary hospitals in southwestern China that lack HLA genotyping capabilities.
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