Research progress on the immunological platelet transfusion refractoriness in patients with acute leukemia: A narrative review

Abstract

Acute leukemia (AL) is a malignant clonal disease of hematopoietic stem cells, many patients have achieved remission, long-term survival, and even cured. Thrombocytopenia is one of the main clinical manifestations of AL. With the development of blood transfusion medicine, platelet transfusion has become an important measure for the treatment of AL. However, platelet transfusion refractoriness (PTR) increases the risk of bleeding in patients and intensifies the demand for platelet transfusion, the occurrence of PTR is still a huge challenge for clinicians. This article reviews the research on the mechanism, prevention and treatment of immunological PTR in AL. PTR includes immune and non-immune factors, immune factors are an important reason for PTR. Some patients are prone to PTR, while others are not. The specific mechanism is currently unclear. Among the immune factors, humoral immunity is currently considered to be the main reason, including HLA antigen incompatibility, antibodies produced by platelet-specific antigens (HPA), and ABO blood group incompatibility, it has been discovered that anti-CD36-mediated alloimmune responses can produce platelet immune abnormalities. There is still a lack of effective methods to completely prevent and treat immunological PTR, we still need to conduct more in-depth research on the mechanism of immunological PTR in AL. Only by further clarifying the mechanism of immunological PTR can be possible to find more effective prevention and treatment methods.