P095 Antibodies to human platelet antigens: when do they cause an incompatible crossmatch

Aim Our center evaluates approximately 100 platelet refractory patients each year. Previously, we have correlated single antigen bead MFI with platelet crossmatch results in an effort to optimize our process for selection of HLA-compatible platelets. However, we continue to struggle to appreciate when antibodies to human platelet antigens (HPA) are also contributing to the platelet refractory state. In this study, our aim is to understand the relationship between HPA antibody testing (PakPlus, Immucor) and platelet crossmatch (CaptureP, Immucor). Methods One patient sample with a singular u0026 strong specificity, HPA-1a, was identified based on PakPlus testing. This sample was also negative for HLA antibodies based on PakPlus testing. The plasma was then diluted and the PakPlus result, optical density (OD), was determined at each dilution. Ten antigen-positive platelet units were crossmatched with the battery of plasma dilutions. The strength of the platelet crossmatch was graded by one technologist, blinded to the dilution, with 4+ being strong positive to negative. Results The patient sample demonstrated a fairly linear dilution of HPA-1a, beginning with a neat result of OD 1.33. All 10 antigen-positive platelet units were positive at OD 0.42 or greater, yet negative at OD 0.04. There was platelet-specific variability between OD 0.3 and OD 0.06 (see Table 1). Conclusions These results demonstrate that HPA antibodies cause crossmatch positivity at low OD. The variability seen may be due to homozygosity versus heterozygosity of antigen expression. These initial results suggest that a PakPlus result as low as OD 0.06 may cause incompatibility in the platelet crossmatch and could be considered when selecting platelets for the platelet refractory patient. Download high-res image (413KB) Download full-size image