Proceed as follows

1. Check FBC pre-platelet infusion, 1 and 12h post-infusion to assess the rate of platelet count decay. Failure to show a rise of platelet count by at least 10 x 109/L at 1h or any rise after 12h post-infusion merits further testing.

2. Samples should be sent to a blood transfusion centre for HLA and platelet antibody screening (10mL EDTA samples and 20mL serum).

3. The patient's own HLA type should be checked.

4. If HLA or platelet antibodies are identified, the provision of HLA or platelet antigen matched platelet products may improve the platelet transfusion responsiveness.

Platelet refractoriness—More than two-thirds of patients receiving multiple transfusion with random platelets develop anti-HLA antibodies. Refractoriness defined as failure of 2 consecutive transfusions to give corrected increment of >7.5 x 109/L 1h after platelet transfusion in absence of fever, infection, severe bleeding, splenomegaly, or DIC.

GvHD—Rare complication where there is engraftment of donor lymphocytes in platelet concentrate in severely immunocompromised patients.

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