1 Determine policy for prophylactic platelet support, and select the platelet count below which platelet transfusions will be used. 2 Consider using leucocyte depletion of red cell and platelet concentrates to prevent HLA alloimmunization from the outset. 3 Type patients for HLA-A and B antigens at an early stage. 4 Use random donor platelet concentrates for initial platelet support (either single or multiple donor, depending on availability). 5 If refractoriness occurs, determine whether clinical factors, which may be associated with non-immune consumption of platelets, are present and test the patient's serum for HLA antibodies. 6 Use HLA-matched platelet transfusions if HLA alloimmunization is the most likely cause of refractoriness. 7 If there is no improvement with HLA-matched transfusions, platelet crossmatching may identify the cause of the problem and help with the selection of compatible donors. 8 Discontinue prophylactic platelet support if a compatible donor cannot be found. Use platelet transfusions from random donors to control bleeding and increase the dose, if necessary.
