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A meta-analysis of risk factors associated with platelet transfusion refractoriness

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Abstract

Background

Platelet transfusion refractoriness (PTR) remains an intractable issue in clinical practice, and is common in hematological patients. At present, it is believed that both immune and non-immune factors play a role. We conducted a meta-analysis of various risk factors which may contribute to PTR.

Methods

PubMed, Embase, Cochrane library, and Web of Science were selected as research database platforms. Citations included were further assessed for quality and bias using the Newcastle–Ottawa Scale. All analyses were performed using Review Manager Version 5.4 and STATA 16.0.

Results

The preliminary search revealed 1069 publications, and 17 (5929 patients in total) were ultimately included in the quantitative analysis. The following variables were associated with the occurrence of PTR: fever (OR = 2.26, 95%CI 2.00–2.55, p < 0.00001), bleeding (OR = 2.10, 95%CI 1.36–3.24, p = 0.0008), female sex (OR = 2.06, 95%CI 1.13–3.75, p = 0.02), antibiotic use (OR = 2.94, 95%CI 1.54–5.59, p = 0.001), and infection (OR = 2.19, 95%CI 1.20–4.03, p = 0.01). Antibodies involved in immune activation were a higher risk factor (OR = 4.17, 95%CI 2.36–7.36, p < 0.00001), and splenomegaly was nearly significant (OR = 1.73, 95%CI 0.97–3.07, p = 0.06).

Conclusions

We identified some important risk factors for PTR, but further research is needed to identify the many other possible elements that may contribute to or mediate PTR.

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Data availability

Raw materials supporting the above-mentioned conclusions will be available without undue reservation if requested.

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Funding

This work was supported by the National Natural Science Foundation of China (81873432 and 82070143), grants from the Jiangsu Province of China (BE2021645), and the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).

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Authors and Affiliations

  1. National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China

    Xiaofei Song, Jiaqian Qi, Kun Fang, Xueqian Li & Yue Han

  2. Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

    Xiaofei Song, Jiaqian Qi, Kun Fang, Xueqian Li & Yue Han

  3. Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China

    Jiaqian Qi, Xueqian Li & Yue Han

  4. State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China

    Yue Han

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  1. Xiaofei Song
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  2. Jiaqian Qi
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Contributions

XFS did the retrieval of literatures. XFS and XQL extracted data from included studies. XFS, JQ Qi, and KF participated in data analysis and interpretation. XFS wrote the article. YH conceived of the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the submitted version.

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Correspondence to Yue Han.

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Song, X., Qi, J., Fang, K. et al. A meta-analysis of risk factors associated with platelet transfusion refractoriness. Int J Hematol 117, 863–875 (2023). https://doi.org/10.1007/s12185-023-03557-3

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