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Axay Tomar: The Hidden Challenges of Platelet Transfusion Refractoriness in India
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Oct 31, 2026, 15:29

Axay Tomar: The Hidden Challenges of Platelet Transfusion Refractoriness in India

Axay Tomar, Associate Professor at Indian Army, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Indian Journal of Hematology and Blood Transfusion, adding:

“A few of us in transfusion medicine kept running into the same wall.

A patient with thrombocytopenia isn’t responding to platelets.

We suspect refractoriness.

But then what?

In many of our centers, there’s no HLA or HPA antibody testing, no crossmatching, no clear protocol.

So we do what we can, often empirically, and move on.

We wondered how widespread this really was.

So we asked.

Thirty tertiary care centers across India responded to our survey, and the picture that emerged was both familiar and sobering.

Over half encounter suspected refractoriness weekly or monthly.

Seven in ten have no in-house specialized testing.

Only a quarter have institutional guidelines.

Many of us are managing immune refractoriness without being able to confirm it.

But there was something encouraging too.

Crossmatch-compatible platelets, selected through SPRCA, have quietly become the most common first-line strategy, ahead of HLA-matched platelets.

It’s a practical workaround, and it works in most cases where it’s available.

For anyone dealing with platelet refractoriness, the message is simple.

You’re not alone in finding this hard.

The gaps are systemic, not personal.

And the path forward is clearer than it seems: expand crossmatching where you can, build regional reference laboratories for the rest, and push for national guidelines so that the next clinician facing this isn’t starting from scratch.

Grateful to every center that took the time to share their reality with us.”

Title: Platelet Transfusion Refractoriness in Indian Tertiary Care Centres: A National Cross-Sectional Survey of Diagnostic Capacity and Clinical Practices

Authors: Akshaya Tomar, Anoop Sharma, Anurag Gairola, Amit Ajay Pawar, Neerja Kushwaha

Axay Tomar: The Hidden Challenges of Platelet Transfusion Refractoriness in India

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Amit Ajay Pawar Anoop Sharma Anurag Gairola Axay Tomar Health Hematology Hemostasis Hemostasis News Hemostasis Today Indian Journal of Hematology and Blood Transfusion Medicine Neerja Kushwaha Platelet transfusion
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