A child awaiting hematopoietic progenitor cell transplant requires platelet transfusion support. Which option is the best?

In the scenario of a child awaiting hematopoietic progenitor cell transplant who requires platelet transfusion support, the best option is leukoreduced platelets.

Leukoreduction involves the removal of white blood cells (leukocytes) from the platelet preparation. This process is important because it has been shown to reduce the risk of febrile non-hemolytic transfusion reactions and other complications, such as transmission of certain infections. For a patient undergoing or awaiting a transplant, minimizing transfusion reactions and preserving the immune system is vital, especially in the context of a compromised immune state.

Leukoreduced platelets can also help prevent the development of alloimmunization to HLA antigens, which can be particularly problematic for patients who will need subsequent transfusions as part of their treatment regimen. In the setting of transplantation, mitigating alloimmunization is crucial for future donor match likelihood, as it can affect engraftment and result in complications.

Although HLA-matched platelets could be considered a careful choice in cases with severe bleeding or significant risk of alloimmunization, they are not always readily available and are typically reserved for situations where there is a known history of refractoriness to platelet transfusions due to