Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec;57(1):2446689.
doi: 10.1080/07853890.2024.2446689. Epub 2024 Dec 28.

Existence and significance of anti-HLA-C autoantibodies to primary and persistent platelet transfusion refractoriness in patients with hematologic disorders: a retrospective study from a single centre

Xunhua Li  1   2 , Qi Liu  2   3 , Jingjie Dong  2   3 , Yaonan Hong  2   3 , Chuanao Xin  2   3 , Junfeng Guo  4 , Shan Liu  2   5   6 , Peicheng Wang  2   3 , Zexing Sun  2   3 , Yingying Shen  2   3   6 , Xiawan Yang  2   3   6 , Hangchao Li  2   3   6 , Yiping Shen  2   3   6 , Jianping Shen  2   3   6 , Baodong Ye  2   3   6 , Yuhong Zhou  2   3   6 , Tonglin Hu  2   3   6 , Dijiong Wu  2   3   6   7
Affiliations

Existence and significance of anti-HLA-C autoantibodies to primary and persistent platelet transfusion refractoriness in patients with hematologic disorders: a retrospective study from a single centre

Xunhua Li et al. Ann Med. 2025 Dec.

Abstract

Objectives: Platelet transfusion refractoriness (PTR) is a frustrating clinical problem, and primary and persistent (P/P) PTR who experienced persistent PTR since the first transfusion was failed to be well recognized. This study aims to investigate the incidence and risk factors for P/P PTR.

Methods: Patients with hematologic disorders who underwent HLA high-resolution genotyping and donor-specific HLA antibody or panel reactive antibody (PRA) testing between January 2019 and March 2023 were reviewed. Clinical data including infection history, splenomegaly, frequency and quantity of blood transfusions, and transfusions response were delineated and subsequently analyzed.

Results: 114 patients were included retrospectively, and 1071 transfusions were recorded. The overall incidence of PTR was 28.95% (33/114), with 63.63% (21/33) being P/P PTR. Anti class I HLA (anti-HLA-I) antibody was identified as an independent risk factor for ineffective platelet transfusion through multivariate logistic regression analysis (p = .034). Interestingly, anti-HLA-C autoantibodies were first found in six patients, and both anti-HLA-A and C autoantibodies were detected in one case, comprising a total of 10.71% (6/56) of HLA-I antibody-positive patients. Further analysis revealed that anti-HLA-C autoantibody was identified as an independent risk factor for P/P PTR (p = .039). Among patients with positive anti-HLA-C antibodies, significant differences in the effectiveness of ABO, D-matched and cross-matching transfusions were observed between patients with or without anti-HLA-C autoantibodies (p < .001 and p = .017). Notably, platelet transfusions independence was achieved by two of the four patients who received rituximab.

Conclusions: This work emphasized the significance of anti-HLA-C autoantibody for P/P PTR in hematological patients, and rituximab may therapeutic.

Keywords: Platelet transfusion refractoriness; anti-HLA antibody; anti-HLA-C autoantibody; hematologic disorders.

Plain language summary

28.95% who experienced platelet transfusion refractoriness (PTR), 23 were primary and persistent (P/P) PTRAnti-HLA-C autoantibody was identified as an independent risk factor for P/P PTRApplication of rituximab may practical in the management of P/P PTR with HLA-C autoantibodies.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
The platelet transfusion response based on locus of HLA-I subgroups. The occurrence rate of overall (A) and primary (B) platelet transfusion efficacy was compared based on locus of HLA-I subgroups, and found that either anti-HLA-A, HLA-B or HLA-C antibody positive contribute to the ineffective to the platelet transfusion (all p < .05).
Figure 2.
Figure 2.
Multivariate logistic regression identify anti-HLA-C autoantibodies as the risk factor for primary and persistent (P/P) platelet transfusion refractoriness. Factors with a univariate logistic regression result of p < .1 were included in the multivariate logistic regression analysis. The multivariate logistic regression analysis revealed that anti-HLA-I antibodies were an independent risk factor for PTR (2 A), but not in P/P PTR (2B); anti-HLA-C antibody was an independent risk factor for overall PTR (2 C), but not for P/P PTR (2D). Considering that anti-HLA-C antibody and anti-HLA-C autoantibody can be confounding factors, only anti-HLA-C autoantibody was selected for logistic regression analysis alongside anti-HLA-a and B antibodies. Result showed that no factors could predict the occurrence of PTR (2E), while anti-HLA-C autoantibody positive was the independent risk factor for P/P PTR (2 F). PTR: platelet transfusion refractoriness.
Figure 3.
Figure 3.
Comparison Of the ABO-D matched and cross-matching platelet transfusions efficiency in patients with or without anti-HLA-C autoantibodies in anti-HLA-C antibody positive population. Significant differences were observed in both effective ordinary (p < .001, 3 A) and cross-matching (p = .017, 3B) platelet transfusion between patients with or without anti-HLA-C autoantibodies (n = 6 vs. n = 26).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Schiffer CA, Bohlke K, Delaney M, et al. . Platelet transfusion for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018;36(3):283–299. doi: 10.1200/jco.2017.76.1734. - DOI - PubMed
    1. Wandt H, Schaefer-Eckart K, Wendelin K, et al. . Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet. 2012;380(9850):1309–1316. doi: 10.1016/s0140-6736(12)60689-8. - DOI - PubMed
    1. Fu Q, Xu L, Zhang X, et al. . Platelet transfusion refractoriness after T-cell-replete haploidentical transplantation is associated with inferior clinical outcomes. Sci China Life Sci. 2018;61(5):569–577. doi: 10.1007/s11427-017-9110-0. - DOI - PubMed
    1. Toor AA, Choo SY, Little JA.. Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation. Bone Marrow Transplant. 2000;26(3):315–320. doi: 10.1038/sj.bmt.1702490. - DOI - PubMed
    1. Song X, Qi J, Li X, et al. . Exploration of risk factors of platelet transfusion refractoriness and its impact on the prognosis of hematopoietic stem cell transplantation: a retrospective study of patients with hematological diseases. Platelets. 2023;34(1):2229905. doi: 10.1080/09537104.2023.2229905. - DOI - PubMed