Platelet transfusion refractoriness (PTR) is a conditioikb1n where platelet counts fail to increase adequately in several transfusions, often found in hemato-oncological situations. PTR poses life-threatening risks to patients, especially in cases when the platelet is very low, and transfusion is life-saving. It can be differentiated into immune or non-immune causes. While non-immune causes predominate, immune factors, particularly anti-HLA antibodies, are also notable in many cases. Accurately determining if platelet transfusion failure originates from an immune or non-immune cause is vital due to differing treatments, particularly the need for HLA-compatible platelets with immune causes. Yet, a lack of consensus exists regarding the diagnostic methods and treatment modalities. Therefore, this review aims to explore the origins, mechanisms, diagnostic criteria, and management approaches concerning PTR.