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Caitlin Raymond: Understanding Platelet Refractoriness Before Ordering More Platelets
Caitlin Raymond/ LinkedIn
Oct 13, 2026, 20:55

Caitlin Raymond: Understanding Platelet Refractoriness Before Ordering More Platelets

Caitlin Raymond, Assistant Professor of Pathology and Transfusion Medicine at University of Wisconsin-Madison, shared a post on LinkedIn:

“It’s 2 a.m., you’re the fellow on call, and the platelet count didn’t move. Here’s the five-minute primer on what to do before you order more platelets.

Sometimes more platelets is the right call. Often it isn’t, and knowing the difference is the whole point of my new post on The Curious BloodBanker.

  • No post-transfusion count, no diagnosis. ‘Seems refractory’ is an impression, not something you can act on.
  • One low increment is a data point. Two sequential low CCIs is when you start believing it.
  • Most refractory cases are non-immune (60 to 80%). Check for fever, sepsis, bleeding, DIC, splenomegaly, and drugs like amphotericin B before ordering an antibody workup.
  • HLA and HPA are separate workups. A negative HLA screen doesn’t rule out HPA.
  • HLA-compatible is what you order. HLA-matched is closer to a theoretical ideal.

Sometimes the right answer is ‘differently selected platelets.’ More often it’s ‘not platelets at all, fix the fever.’

What’s the most useful thing your service has done to make sure the post-transfusion count actually gets drawn?”

Caitlin Raymond

Other posts featuring Caitlin Raymond on Hemostasis Today.

amphotericin B bleeding Blood Caitlin Raymond CCIS DIC Fever Health Hematology Hemostasis Hemostasis News Hemostasis Today HLA HPA Medicine Platelet Sepsis splenomegaly thrombocytopenia
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