Refractoriness to platelet transfusion is said to occur when a patient's platelet count fails to rise to the level expected following platelet transfusion. While this may be due to several possible mechanisms, a refractory patient who has received several prior platelet transfusions is often assumed to be alloimmunized. This requires selection of platelet donors who have HLA antigens compatible with the patient's alloantibodies.



(1) at least 3 platelet transfusions (not necessarily consecutive) within a 2 week period result in

(2) an inadequate post-transfusion platelet count increment.



• Petz (2000) cites Koerner et al (1988) relative to using 3 transfusions for defining a refractory response. Koerner refers to 3 consecutive platelet transfusion, while Petz uses 3 platelet transfusions in a 2 week period, not necessarily consecutive.


Measures of post-transfusion platelet count increment:

(1) percentage platelet recovery (PPR)

(2) corrected count increment (CCI): reported in platelets per 10^ platelets transfused per meter square BSA

Criteria for Inadequate Increase in the Post-Transfusion Platelet Count


Using the PPR

Using CCI

at 1 hour

< 30%

< 7,500

at 20 hours

< 20%

< 5,000


In the ASCO clinical practice guidelines for platelet transfusions (Schiffer et al), the platelet products should be:

(1) ABO compatible

(2) stored less than 72 hours

before the patient is considered refractory. However, I am not sure if I have ever encountered platelets being transfused that were > 72 hours old.


To read more or access our algorithms and calculators, please log in or register.