Platelet transfusion refractoriness responding preferentially to single donor aphaeresis platelets compatible for both ABO and HLA
Bibliographic record
Abstract
Platelet transfusion refractoriness is challenging to manage. When human leucocyte antigens (HLA)-sensitized patients fail to respond to HLA-matched (HLA-m) platelets, non-immune destruction may be assumed, and collections of HLA-m platelets abandoned. We report cases of highly HLA-sensitized patients whose only satisfactory platelet transfusion responses were consistently associated with products compatible for both HLA- and ABO-matched (HLA-m/ABO-m) platelets, and in whom unsatisfactory increments occurred if either form of major incompatibility was permitted (HLA-u or ABO-u). Absolute platelet increments (APIs) were measured and classified as satisfactory if ≥10 and unsatisfactory if <10. Patient 1, age 59 years, group O, with myelodysplastic syndrome/acute myelogenous leukemia (MDS/AML), was unresponsive to either fresh ABO-m or HLA-m platelets. Of 17 HLA-m platelets, satisfactory responses occurred for 75% of HLA-m/ABO-m units, and failures for 100% of HLA-m/ABO-u, with mean API differing significantly (14·1 vs 1·1, P = 0·0059). Of 36 HLA-m platelets given to patient 2, age 49 years, group O, Gravida 2 Para 2, with severe aplastic anaemia, a satisfactory response occurred with 75% of HLA-m/ABO-m units, and failures for 63% of the HLA-m/ABO-u (mean API 26·7 vs 7·6, P = 0·008). Increment failures from HLA-m platelets need not imply intractable refractoriness. If resources permit, selection of HLA-m/ABO-m platelets may optimise the incremental response.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".