Abstract: Objectives To observe the differential impact of platelet autoantibodies and alloantibodies on the complexity of platelet cross-matching procedures and the subsequent efficacy of transfusions. Methods We retrospectively analyzed 106 patients with platelet transfusion refractoriness (PTR) who underwent platelet antibody identification at our laboratory from July 2021 to September 2023. Based on the type of platelet antibody detected, the patients were divided into two groups: the observation group of 20 patients with autoantibodies and the control group of 86 patients with alloantibodies. We compared key outcomes between the two groups, including the percentage of successful matching attempts, the proportion of compatible donors, the 24-hour corrected count increment (CCI) values following cross-matched and random platelet transfusions, and the overall transfusion effectiveness. Additionally, we tracked the changes in autoantibody levels within the observation group. Results The observation group exhibited significantly higher percentages of matching times and matching donors than those in the control group (P<0.05). There was no significant difference in the CCI values or tranfusion effectiveness between cross-matched and random platelets in the observation group (P>0.05), while in the control group transfusions of cross-matched platelets yielded significantly higher 24-hour CCI values and effectiveness rates than those with random platelets (P<0.001). Although the 24-hour CCI values of crossed-matched platelet recipients and effectiveness rates in the control group exceeded those in the observation group (P<0.05), no significant difference was detected between random platelet recipients across both groups (P>0.05). Over time, autoantibody levels in the observation group generally decreased. Conclusion Platelet autoantibodies exert a lesser influence on the challenges associated with platelet crossed-matching and transfusion outcomes compared to alloantibodies. The intensity of platelet autoantibodies shows a pattern of gradually decreasing and even disappearing over time. In clinical practice, management of autoantibody-positive patients should prioritize the identification of underlying causes and the implementation of targeted therapies. When platelet transfusion is indicated, random donor platelets could be a viable option, especially in autoantibody-positive cases.

Key words: Platelet autoantibody, Platelet transfusion refractoriness(PTR), Platelet cross-matching, Solid phase agglutination(SPA)