Objective: To investigate the causes of ineffectiveness of platelet transfusion with monoclonal antibody solid phase platelet antibody test (MASPAT) matching in patients with allogeneic hematopoietic stem cell transplantation and explore the strategies of platelet transfusion.
Methods: A case of donor-specific HLA antibodies (DSA) induced by transfusion which ultimately resulted in transplantation failure and ineffective platelet transfusion with MASPAT matching was selected, and the causes of ineffective platelet transfusion and platelet transfusion strategy were retrospectively analyzed.
Results: The 32-year-old female patient was diagnosed as acute myeloid leukemia (high risk) in another hospital with the main symptoms of fever and leukopenia, who should be admitted for hematopoietic stem cell transplantation after remission by chemotherapy. In the course of chemotherapy, DSA was generated due to platelet transfusion, and had HLA gene loci incompatible with the donor of the first transplant, leading to the failure of the first transplant. The patient received platelet transfusion for several times before and after transplantation, and the results showed that the effective rate of MASPAT matched platelet transfusion was only 35.3%. Further analysis showed that the reason for the ineffective platelet transfusion was due to the missed detection of antibodies by MASPAT method. During the second hematopoietic stem cell transplantation, the DSA-negative donor was selected, and the matching platelets but ineffective transfusion during the primary transplantation were avoided. Finally, the patient was successfully transplanted and discharged from hospital.
Conclusions: DSA can cause graft failure or render the graft ineffective. For the platelet transfusion of patients with DSA, the platelet transfusion strategy with matching type only using MASPAT method will miss the detection of antibodies, resulting in invalid platelet transfusion.
题目: MASPAT配型相合血小板输注无效的异基因造血干细胞移植患者的血小板输注策略.
目的: 探讨异基因造血干细胞移植患者血小板抗体固相凝集法（MASPAT）配型相合血小板输注无效的原因及血小板输注策略。.
方法: 选取1例因输血诱导产生供者特异性HLA抗体（DSA），且该DSA导致患者移植失败和MASPAT配型相合血小板输注无效的案例，详细分析该患者血小板输注无效原因及血小板输注策略。.
结果: 患者女，32岁，以"发热、白细胞减少"为主要表现起病，于外院明确诊断为急性髓系白血病（高危），化疗缓解后拟行造血干细胞移植入院。在化疗过程中，患者因输注血小板产生DSA，且该DSA存在与首次移植供者不合的HLA基因位点，导致首次移植原发植入失败。该患者在移植前后多次进行血小板输注，结果显示，MASPAT配型相合血小板输注有效率仅为35.3%，进一步分析血小板输注无效的原因为MASPAT方法漏检了抗体。行二次造血干细胞移植时，选择了DSA-供者，且规避初次移植过程中配型相合但输注无效的血小板，结果该患者移植成功，顺利出院。.
结论: DSA可引发移植失败或使移植物失功。对于已经产生DSA的患者，在输注血小板前仅采用MASPAT配型相合的血小板输注策略会漏检抗体，导致血小板输注无效。.
Keywords: donor-specific HLA antibody; ineffective platelet transfusion; missed detection of antibody; monoclonal antibody solid phase platelet antibody test; primary implantation failure.