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Review
. 2025 Nov 1;32(6):357-363.
doi: 10.1097/MOH.0000000000000888. Epub 2025 Jul 14.

Immune response to platelet transfusions

Rachael P Jackman  1   2 , Kimberly A Thomas  3   4
Affiliations
Review

Immune response to platelet transfusions

Rachael P Jackman et al. Curr Opin Hematol. .

Abstract

Purpose of review: Platelet transfusion can have a significant immunological impact, exposing the recipient to alloantigens on the surface of platelets and contaminating leukocytes, a dynamic range of soluble immune mediators, and donor platelets that can directly and indirectly contribute to the inflammatory profile of the recipient. Here, we will review recent developments in our understanding of the mechanisms regulating the immune response to platelet transfusion.

Recent findings: Using animal models, much has been learned about the mechanisms regulating the alloimmune response to platelet transfusion and how this response is shaped by the underlying health of the recipient. There is also a growing appreciation of the active role platelets play in immunity and their impact on the recipient immune system and transfusion outcomes, and how these immunological profiles are shaped by product collection, processing, and storage practices.

Summary: While platelet transfusion carries significant benefit to a wide range of patients, it carries risk of alloimmunization and other immune-mediated adverse reactions. Further characterization of the mechanisms regulating these outcomes can lead to new interventions to prevent alloimmunization and help to identify which platelet products are best suited to different patient populations.

Keywords: alloimmunization; immunomodulation; inflammation; platelet transfusion.

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Conflict of interest statement

Conflicts of Interest: None.

References

    1. Tran JQ, Muench MO, Gaillard B, Darst O, Tomayko MM, Jackman RP: Polyinosinic: polycytidylic acid induced inflammation enhances while lipopolysaccharide diminishes alloimmunity to platelet transfusion in mice. Front Immunol 2023, 14:1281130. - PMC - PubMed

    2. Found that inflammation can either suppress (LPS) or enhance (Poly(I:C)) the alloantibody response to platelet transfusion. Using MHC tetramers, phenotyped the allospecific B cell response and found that LPS treatment led to blocked activation and germinal cell differentiation of allospecific B cells, consistent with the reduced alloantibody response. Interestingly, the enhanced alloantibody response to platelet transfusion seen with poly(I:C) was associated with slight reductions in activation and germinal center responses within the allospecific B cell population and slight increases in marginal zone responses, suggestive of a extrafollicular contribution.

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