CASE REPORT article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Case Study: HLA incompatible platelet infusion to allow emergency salvage HCT in a patient with primary graft failure due to donor specific HLA antibody
Provisionally accepted
- Australian Red Cross Lifeblood, Sydney, Australia
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A patient with myelodysplasia received a haploidentical hematopoietic stem cell transplant (HCT). Pre-transplant HLA antibody screening showed no detectable donor-specific antibodies (DSAs). Post-transplant, the patient developed an anti-HLA-A2 antibody, likely due to a memory B-cell response. This immune response led to platelet transfusion refractoriness and graft failure. The patient engrafted following a second stem cell infusion from the same haploidentical donor, using both HLA compatible platelets, to support initial platelet transfusion refractoriness (PTR) following primary stem cell infusion, and HLA-A*02 expressing platelets, to adsorb the circulating anti-A2 prior to the re-infusion.
Keywords: donor specific antibody2, infusion5, platelet1, refractoriness4, stem cell transplantation3
Received: 24 Nov 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Goddard, Moses, Chu and Carroll. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Louise Goddard
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