When a patient does not respond to platelet transfusions, everyone gets worried! These frustrating situations can lead to a variety of interventions and strategies, but which is best? Pat Kopko shows us a clear pathway to quicker success!

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Dr. Pat Kopko

Dr. Pat Kopko from the University of California-San Diego talks with me about a practical approach to patients with platelet refractoriness. This is an enormous issue that is an especially big deal in hematology/oncology and other multiply transfused patients. Pat takes us through three main strategies for addressing this issue, once you know that it actually is an issue:

  • HLA-matched platelets
  • Crossmatched platelets
  • HLA antigen-negative platelets

But which is “better?”

Clinicians and blood bankers alike often struggle to find the “best” answer to getting a product that will work well for a refractory patient, without waiting for days to do it! Dr. Kopko has a wealth of experience that includes her history of being both a hospital transfusion service medical director as well as a medical director for a large blood center, so she clearly understands the issue from both hospital and blood center perspectives. Dealing with platelet refractoriness can be complicated, but Pat outlines her strategy to get a product with maximum benefit to the patient as quickly as possible. In fact, you may find that the quickest way to get an effective platelet product in a refractory patient may not be the option you might have thought! Her views on HLA-matched platelets and their utility in modern platelet transfusion practice may also surprise you!

About My Guest:

Dr. Pat Kopko is a graduate of the Loma Linda University School of Medicine in Loma Linda, CA. She did a residency in anatomic and clinical pathology at Loma Linda, followed by a transfusion medicine fellowship at Cedars-Sinai Medical Center in Los Angeles. She is currently Professor of Pathology at the University of California, San Diego, where she serves as Director of Transfusion Medicine and Associate Director of the Immunogenetics and Transplantation Laboratory. Dr Kopko’s research interests center around transfusion reactions, particularly Transfusion-Related Acute Lung Injury (TRALI), currently the leading cause of transfusion-related mortality in the United States. She has published extensively on TRALI and other topics, including platelet refractoriness, transfusion in ABO-incompatible HPC transplantation, and blood transfusion practices.

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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Kopko nor I have any relevant financial disclosures.

Reference: Kopko PM et al. Methods for the selection of platelet products for alloimmune-refractory patients. Transfusion 2015;55:235–244.

Platelet Refractory choices

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