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$Ahmed Alotaibi: Platelet Refractory, But HLA-negative – What Are You Missing?$

Ahmed Alotaibi/LinkedIn

Oct 22, 2026, 06:25

Ahmed Alotaibi: Platelet Refractory, But HLA-negative – What Are You Missing?

Ahmed Alotaibi, Senior Specialist (Blood bank and blood transfusion) at Afif General Hospital – Riyadh Third Health Cluster (Ministry of Health), shared a post on LinkedIn:

“Platelet refractory, but HLA-negative. What are you missing?

A 2026 Vox Sanguinis report highlights an uncommon but important cause: anti-CD36 alloimmunisation.

The reported patient had severe platelet transfusion refractoriness, with platelet counts remaining lt;5 × 10⁹/L and absent corrected count increments despite repeated ABO-compatible platelet transfusions.

Immunohaematology testing showed:

Anti-HLA class I: negative
HPA antibodies: negative
Anti-CD36/GPIV: positive

Flow cytometry showed absent CD36 expression on the patient’s platelets, and molecular testing identified variants associated with CD36 deficiency.

The transfusion challenge was major.

All available platelet units were crossmatch incompatible, including a unit from an HLA-identical sibling, because the sibling expressed normal CD36.

That is the key blood-bank lesson:

HLA matching does not solve every case of immune platelet refractoriness.

CD36 deficiency is reported more frequently in Asian, African and Arabian populations, so anti-CD36 deserves consideration when severe refractoriness persists despite negative HLA testing.

A practical investigation pathway is:

Clinical/non-immune causes – HLA – HPA – consider CD36

Reference:

Conserva RDA, et al. Vox Sanguinis. 2026.”

$Ahmed Alotaibi: Platelet Refractory, But HLA-negative - What Are You Missing? 1$