Research on immune mechanisms and clinical management strategies of platelet transfusion refractoriness in immune thrombocytopenia

Jiang Wenwen; Feng Qi; Bao Jizhang

doi:10.3760/j.issn.1673-4777.2026.03.034

Abstract：Immune thrombocytopenia(ITP)is an autoimmune disease characterized by thrombocytopenia and bleeding tendency,and clinical platelet transfusion refractoriness(PTR)is a crucial factor affecting therapeutic efficacy.This study aimed to explore the immune mechanisms of PTR in ITP and their impacts on clinical manage-ment,with a focus on analyzing the distinct mechanisms of antibody-mediated and T cell-mediated PTR.Through literature review,we found that antibody-mediated PTR is mainly induced by specific antibodies such as human leukocyte antigen and anti-platelet membrane glycoprotein Ⅱ b/Ⅲ a antibodies.These antibodies clear transfused platelets via complement activation and phagocytosis by macrophages,significantly increasing the risk of bleeding.In contrast,T cell-mediated PTR involves the abnormal activation of CD8+T cells,which inhibits megakaryocyto-poiesis and leads to a chronic disease course.Based on these mechanisms,this study proposed a strategy of"mechanism-oriented classified diagnosis and treatment".It is suggested that human leukocyte antigen-matched transfusion combined with immunoglobulin therapy be adopted for antibody-mediated PTR,while the combined intervention of thrombopoietin receptor agonists and immunosuppressants be applied for T cell-mediated PTR.Future research should focus on the application of dynamic immune monitoring technologies,the development of bifunctional biological agents and the realization of individualized precision medicine,so as to significantly improve the therapeutic efficacy and quality of life of ITP patients.This study provides an important theoretical basis and practical guidance for the individualized treatment of ITP.