Lymphocytotoxic antibody is a predictor of response to random donor platelet transfusion

The transfusion records of 189 patients with acute leukemia were analyzed to correlate lymphocytotoxic antibody (LCTAb) levels with response to a series of random‐donor platelet transfusions (Tx). Twenty‐one patients were studied twice at times of different LCTAb levels. All transfusions were given when patients were clinically stable without disseminated intravascular coagulation, bleeding, temperature > 101°F, or splenomegaly. The mean 1‐hr and 24‐hr corrected count increments (CCI) for all patients with negative LCTAb were 16,100 and 12,000, and values for patients with positive LCTAb were 5,600 and 2,600 (P < 0.0005). Thirteen patients had intermediate LCTAb (10–20%) and a variable response to Tx. Of the 137 patients with negative LCTAb levels 106 (77%) had good mean CCI of > 10,000 at 1 hr and > 7,500 at 24 hr following transfusion. In contrast of 60 patients with positive LCTAb (> 20% cytotoxicity), 53 (88%) had poor CCI of < 10,000 at 1 hr and < 7,500 at 24 hr after transfusion. Only 4 patients with positive LCTAb had a good response to random donor platelets at both 1 and 24 hrs. Eighteen patients had negative LCTAb with a high 1‐hr and low 24‐hr CCI. Thirteen of these had a history of positive LCTAb and in 9 there was an anamnestic rise following transfusion. Nine of 137 patients had negative LCTAb with low 1‐hr and 24‐hr CCI. LCTAb is highly predictive of response to random donor platelets. Cytotoxicity to > 20% of tested lymphocytes virtually precludes a good CCI at 1 and 24 hr.