Regional
Construction and clinical application of platelet gene bank in Zhejiang, China
Xianguo Xu
Blood Center of Zhejiang Province, China
Heqiong Liu
Blood Center of Zhejiang Province, China
Platelet transfusion is a crucial therapeutic approach for patients with thrombocytopenia or platelet dysfunction. However, repeated transfusions can lead to immune-mediated platelet transfusion refractoriness (iPTR), severely impacting patient treatment and recovery, increasing medical costs, and compromising patients' quality of life.
The establishment of a platelet gene bank of blood donors, coupled with genetic matching transfusion between donors and recipients, represents an effective strategy to address iPTR. The Blood Center of Zhejiang Province has dedicated itself to resolving this issue by constructing a platelet gene bank and implemented clinical applications through technological improvements, database sharing, process optimization, matching strategy formulation, information management, and other means.
Since 2010, the Blood Center of Zhejiang Province has initiated the construction of a platelet gene bank, incorporating regular blood donors who have donated platelets more than three times within a year into the database. Through extensive promotion, mobilization, and informed consent, numerous platelet donors have joined the platelet gene bank, agreeing to donate platelets promptly when needed by specific patients. As of November 2024, the center's platelet gene bank has completed the entry of HLA gene data for 25,399 donors and HPA gene data for 4,286 donors, establishing the largest platelet gene single-bank in China. Now at the Blood Center of Zhejiang Province, averages of 105 donors donate apheresis platelets daily, with approximately 60% of these platelets having HLA (and HPA) gene data.
The larger the platelet gene bank, the greater the probability of patients receiving effective transfusion. Given the limited capacity of a single-bank, the Blood Center of Zhejiang Province began exploring province-wide platelet gene bank sharing in 2019, leading 12 regional blood stations across the province to establish the Zhejiang Platelet Gene Bank Collaboration Group. As of November 2024, the province-wide bank included gene data from 80,307 donors. In 2021, the Blood Center of Zhejiang Province spearheaded the establishment of the China Platelet Gene Database Collaboration Group, comprising 32 provincial blood centers and municipal blood stations nationwide, to promote the construction of national platelet gene banks. By December 2023, member units of the national collaboration group had collectively entered HLA genotyping data for 102,913 donors, HPA genotyping data for 54,967 donors, and pCD36 negative data for 735 donors.
While establishing the database and sharing data, the Institute of Transfusion Medicine of the Blood Center of Zhejiang Province has kept abreast of international advancements, updated detection technologies and methods, and focused on tackling key technologies related to database constructing, patient testing, and fully automated electronic matching, achieving integrated innovation in detection and matching technologies. It has established precise molecular technology platforms for joint detection of HLA and HPA loci, second- and third-generation HLA sequencing platforms, and constructed a series of method for single-specificity identification of platelet antibodies.
Since 2020, the Blood Center of Zhejiang Province has implemented information management of platelet gene matching, independently developing a full-process information management system for the platelet gene bank to achieve interconnectivity among various business modules within blood stations and between platelet gene banks of different blood stations. By integrating transfusion medicine with information technology, it has realized a closed-loop, full-process information management system for clinical application, platelets matching, blood supply, transfusion, and effect feedback. Leveraging information technology, it has fused transfusion medicine with information technology to genuinely achieve digital cross-matching of blood, embodying the service concepts of "no need to run for blood services" and "put patient first" with clinical service satisfaction ranking among the top domestically.
Meanwhile, the matching strategy for the clinical application of the platelet gene bank has been continuously improved. To shorten patients' waiting time for blood, the search process has shifted from initial donor recruitment and appointment-based donation to electronic retrieval and information locking of platelet product inventories. Based on strategies such as HLA antigen-antibody and epitope matching, after identifying the target platelets in the gene bank, the information system immediately locks them and automatically issues a matching report, reducing patients' waiting time from an initial 5.4±5.3 days (median of 5 days) to current 1.2±2.3 days (median of 3 hours).
It is foreseeable that a cross-regional, collaborative, shared, and digital platelet platform is gradually taking shape. Existing and newly collected platelet gene data from more regions will be incorporated into this system, enabling larger-scale matching, and clinical use interconnectivity. With the combined efforts of blood workers, clinicians, and blood donors, it will open up more possibilities in transfusion science in the future, enabling every bag of platelet to maximize its life-saving effectiveness.
