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Platelet Immunobiology
7)MNSFUSION lV1EDICINE ~VIEWS
Vo/IV, No 2
Apri/1990
GUEST EDITORIAL
Platelet Immunobiology RANSFUSlON Medicine is a specialty in rapid transition: basic science investigations are almost immediately converted into diagnostic techniques to be used in the laboratory testing and selection of optimal and safe blood products. Thus, the knowledge gained at both the basic and the applied (work) bench is quickly translated into improved patient support. The focus of Transfusion Medicine remains (and should remain) on the patient. The intent is to provide the precise type and amount of the safest blood product for that particular patient. These exciting, and sometimes revolutionary, changes are occurring across the breadth of Transfusion Medicine, but some of the most rapid changes involve platelets. Indeed, the rate of the change in platelet technology and the impact of this technology has been so dramatic that several years ago the Canadian Red Cross Blood Transfusion Service (CRCBTS) instituted a series of platelet immunobiology conferences. The purpose of these conferences was to ensure that the members in the Canadian Red Cross were kept·abreast of the changing technology involved in platelet immunobiology and the implications of the changes in this technology. The Third Canadian Conference on Platelet Immunobiology was held in Montreal, Quebec, on February 13 and 14, 1989. The intent of this conference was to review, via a wet workshop, the techniques used to investigate platelet antigens and to highlight, via a scientific conference, recent information conceming platelet antigen detection, characterization, and the implications of this information for Transfusion Medicine specialists. The organizers of this conference included the guest
T
Transfusion Medicine Reviews, VoIIV, No 2 (April), 1990: pp 85-86
editors, Francine Decary and myself, Noel Buskard (Medical Director of the CRCBTS, Vancouver Centre), Marlis Schroeder (Medical Director of the Winnipeg Centre for the CRCBTS), and Ines Bonacossa also of the Winnipeg Centre. The Third Canadian Conference on Platelet Immunobiology consisted oftwo parts, a "wet workshop" and a symposium of invited·speakers. The results of the wet workshop are described in the first report by Bonacossa. It is interesting to note that compared with the first two wet workshops held in 1985 and 1987, the participating laboratories have become better able to detect the most. important platelet alloantigen system (PlAl). The percent positivity of all laboratories for the detection of alloantibodies against the PIAI system has increased from 60% in 1985 to 80% in 1987 to the current level of 90%. This high sensitivity of detection has been achieved by using an ever increasing number of platelet typing techniques. In 1985, only a few techniques were used for platelet typing, whereas this year over 10 different typing techniques were used. And yet, there still is no consensus as to the best technique for detecting platelet specific alloantigens. The more experienced laboratories seemed to have the highest level of success. Failure to detect and characterize platelet specific alloantigens reflects more the experience of a particular laboratory in platelet testing rather than the technology used. There was general agreement that the ability to detect the less common alloantigens such as Pen or Bak required a panel of well characterized platelets. The lack of availability of such paneis is one of the main hindrances to many laboratories in achieving a high level of competence in platelet typing. 85
86
At this year's platelet immunobiology conference, the emphasis also changed from specifics of laboratory technology (dry workshops) to scientific discussions. The CRCBTS was fortunate in attracting a number of high quality investigators, and the results of these investigators' presentations are the substance of this issue of Transfusion Medicine Reviews. These topics inc1ude platelet structure-function relationships, platelet antigens, platelet antibody testing, and, finally, the application of platelet antibody tests to platelet transfusions.
GUEST EDITORIAL
The planning committee of this conference elected to have the proceedings published in Transfusion Medicine Reviews because of the very short interval between the conference taking place and the publication ofthe proceedings. This helped ensure that the published proceedings would be as up-to-date as possible in this rapidly changing field. John G. Kelton McMaster University Hamilton, Ontario, Canada
Vo/IV, No 2
Apri/1990
GUEST EDITORIAL
Platelet Immunobiology RANSFUSlON Medicine is a specialty in rapid transition: basic science investigations are almost immediately converted into diagnostic techniques to be used in the laboratory testing and selection of optimal and safe blood products. Thus, the knowledge gained at both the basic and the applied (work) bench is quickly translated into improved patient support. The focus of Transfusion Medicine remains (and should remain) on the patient. The intent is to provide the precise type and amount of the safest blood product for that particular patient. These exciting, and sometimes revolutionary, changes are occurring across the breadth of Transfusion Medicine, but some of the most rapid changes involve platelets. Indeed, the rate of the change in platelet technology and the impact of this technology has been so dramatic that several years ago the Canadian Red Cross Blood Transfusion Service (CRCBTS) instituted a series of platelet immunobiology conferences. The purpose of these conferences was to ensure that the members in the Canadian Red Cross were kept·abreast of the changing technology involved in platelet immunobiology and the implications of the changes in this technology. The Third Canadian Conference on Platelet Immunobiology was held in Montreal, Quebec, on February 13 and 14, 1989. The intent of this conference was to review, via a wet workshop, the techniques used to investigate platelet antigens and to highlight, via a scientific conference, recent information conceming platelet antigen detection, characterization, and the implications of this information for Transfusion Medicine specialists. The organizers of this conference included the guest
T
Transfusion Medicine Reviews, VoIIV, No 2 (April), 1990: pp 85-86
editors, Francine Decary and myself, Noel Buskard (Medical Director of the CRCBTS, Vancouver Centre), Marlis Schroeder (Medical Director of the Winnipeg Centre for the CRCBTS), and Ines Bonacossa also of the Winnipeg Centre. The Third Canadian Conference on Platelet Immunobiology consisted oftwo parts, a "wet workshop" and a symposium of invited·speakers. The results of the wet workshop are described in the first report by Bonacossa. It is interesting to note that compared with the first two wet workshops held in 1985 and 1987, the participating laboratories have become better able to detect the most. important platelet alloantigen system (PlAl). The percent positivity of all laboratories for the detection of alloantibodies against the PIAI system has increased from 60% in 1985 to 80% in 1987 to the current level of 90%. This high sensitivity of detection has been achieved by using an ever increasing number of platelet typing techniques. In 1985, only a few techniques were used for platelet typing, whereas this year over 10 different typing techniques were used. And yet, there still is no consensus as to the best technique for detecting platelet specific alloantigens. The more experienced laboratories seemed to have the highest level of success. Failure to detect and characterize platelet specific alloantigens reflects more the experience of a particular laboratory in platelet testing rather than the technology used. There was general agreement that the ability to detect the less common alloantigens such as Pen or Bak required a panel of well characterized platelets. The lack of availability of such paneis is one of the main hindrances to many laboratories in achieving a high level of competence in platelet typing. 85
86
At this year's platelet immunobiology conference, the emphasis also changed from specifics of laboratory technology (dry workshops) to scientific discussions. The CRCBTS was fortunate in attracting a number of high quality investigators, and the results of these investigators' presentations are the substance of this issue of Transfusion Medicine Reviews. These topics inc1ude platelet structure-function relationships, platelet antigens, platelet antibody testing, and, finally, the application of platelet antibody tests to platelet transfusions.
GUEST EDITORIAL
The planning committee of this conference elected to have the proceedings published in Transfusion Medicine Reviews because of the very short interval between the conference taking place and the publication ofthe proceedings. This helped ensure that the published proceedings would be as up-to-date as possible in this rapidly changing field. John G. Kelton McMaster University Hamilton, Ontario, Canada