Lymphocytotoxic antibody is a predictor of response to random donor platelet transfusion

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Abstract
The transfusion records of 189 patients with acute leukemia were analyzed to correlate lymphocytotoxic antibody (LCTAb) levels with response to a series of random-donor platelet transfusions (Tx). Twenty-one patients were studied twice at times of different LCTAb levels. All transfusions were given when patients were clinically stable without disseminated intravascular coagulation, bleeding, temperature > 101°F, or splenomegaly. The mean 1-hr and 24-hr corrected count increments (CCI) for all patients with negative LCTAb were 16,100 and 12,000, and values for patients with positive LCTAb were 5,600 and 2,600 (P < 0.0005). Thirteen patients had intermediate LCTAb (10–20%) and a variable response to Tx. Of the 137 patients with negative LCTAb levels 106 (77%) had good mean CCI of > 10,000 at 1 hr and > 7,500 at 24 hr following transfusion. In contrast of 60 patients with positive LCTAb (> 20% cytotoxicity), 53 (88%) had poor CCI of < 10,000 at 1 hr and < 7,500 at 24 hr after transfusion. Only 4 patients with positive LCTAb had a good response to random donor platelets at both 1 and 24 hrs. Eighteen patients had negative LCTAb with a high 1-hr and low 24-hr CCI. Thirteen of these had a history of positive LCTAb and in 9 there was an anamnestic rise following transfusion. Nine of 137 patients had negative LCTAb with low 1-hr and 24-hr CCI. LCTAb is highly predictive of response to random donor platelets. Cytotoxicity to > 20% of tested lymphocytes virtually precludes a good CCI at 1 and 24 hr.