How do I implement an automated screen for high‐titer ABO antibody as an inventory management tool for ABO plasma–incompatible platelets?

Fontaine, Magali J.; Webster, Jan; Gomez, Samantha; Pham, Tho D.; Goodnough, Lawrence T.; Galel, Susan A.

doi:10.1111/trf.13374

Cited by 11 publications

(5 citation statements)

References 13 publications

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“…Prior publications and review articles have discussed what a “safe” isohemagglutinin titer may be . There is no definitive answer, and the variability of titers depending on method and technique utilized must be highlighted.…”

Section: Discussionmentioning

confidence: 99%

Fatal acute hemolytic transfusion reaction due to anti‐B from a platelet apheresis unit stored in platelet additive solution

et al. 2019

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BACKGROUND Hemolytic transfusion reactions from out‐of‐group plasma in platelet (PLT) transfusions are uncommon, with most involving passive transfer of anti‐A. Only rare reactions have ever been reported due to anti‐B. STUDY DESIGN AND METHODS An apheresis PLT product was donated by a blood group O male, processed using PLT additive solution, and pathogen reduced. Postreaction recipient testing included an antibody screen using gel technology, a direct antiglobulin test (DAT) using immunoglobulin G and C3, and an eluate against group O and B cells. Postreaction donor testing included measuring anti‐B titers in saline, with and without anti‐human globulin. RESULTS A 60‐year‐old blood group B patient with relapsed acute myeloid leukemia developed confusion, fever, and hypotension within hours after a blood group O PLT transfusion. The posttransfusion reaction evaluation was remarkable for a positive DAT 3+ for C3; the eluate showed anti‐B. Rapid extravascular hemolysis occurred, with a 50% decline in hemoglobin, a high lactate dehydrogenase, and a high bilirubin. She was resuscitated with fluids, blood products, pressors, and oxygen and died of asystole 60 hours later. The donor's anti‐B titers were 128 by tube testing at immediate spin and 512 at the anti‐human globulin phase. Notably, a group B patient at a different hospital received a split of the same apheresis unit, with no reaction. CONCLUSION To our knowledge, this is the first fatality reported from passively transfused anti‐B. The fact that one transfusion recipient died whereas another did not have any reported reaction highlights the potential importance of recipient variables in isohemagglutinin‐mediated hemolysis.

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Section: Discussionmentioning

confidence: 99%

Fatal acute hemolytic transfusion reaction due to anti‐B from a platelet apheresis unit stored in platelet additive solution

et al. 2019

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“…Automated testing is widely available and has been utilized within blood banks worldwide since the 1960s, though the ability to perform automated titres is a more recent improvement . Automation provides many advantages such as decreased dedicated tech time as well as consistency of methods with an unknown impact on reproducibility of results.…”

Section: Introductionmentioning

confidence: 99%

An exploration of the advantages of automated titration testing: low inter‐instrument variability and equivalent accuracy for ABO and non‐ABO antibody titres relative to tube testing

et al. 2020

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Background and objectives Obtaining IgM and IgG titres is important in numerous clinical situations, including solid-organ transplant, obstetrics, and for testing of out-of-group plasma-containing components. Tube method is the most prevalent testing modality, though it is both labour-intensive and known for intraand inter-laboratory variability. The utility of automated gel testing as a method to improve both inter-and intra-laboratory reproducibility is unknown.Materials and methods Two academic centres participated in a study evaluating automated gel titreing. Group O plasma samples were used to measure titres of antibodies against ABO (IgM) with buffered gel cards and 4 minor and minor red-blood-cell antigens (IgG) anti-IgG gel cards. Multiple ORTHO VISION automated analyzers were used to assess inter-instrument variation. A subset of ABO (IgM) samples were compared between laboratories to evaluate inter-laboratory variability. Multiple samples were titred by tube and by automated gel technology to determine similarity of results.Results Testing demonstrated no significant difference between analysers or between sites when performing automated titrations (P ≥ 0Á99). Non-ABO IgG titres were evaluated and demonstrated little inter-instrument variability. The IgM anti-A and -B titres obtained by automated gel testing were neither consistently higher nor lower than tube titres. Greater than 90% of titre values were within one dilution.

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“…These platelet modifications, however, can lead to significant increases in turnaround time, cost, and labor, and the manipulation can lead to decreased platelet recovery in vivo. 10 Hospital blood banks or blood suppliers could perform titers on platelet units, although it has been difficult to establish a universal definition of a high-titer ABO antibody. In addition, both tube and gel methods are used at various locations to perform titers, and these testing methods often generate different results, making comparison of values difficult.…”

Section: Discussionmentioning

confidence: 99%

Dilution is not the solution: acute hemolytic transfusion reaction after ABO-incompatible pooled platelet transfusion

et al. 2019

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The short shelf life of platelets makes providing ABO-compatible platelets a challenge, and many institutions issue ABOincompatible platelets when compatible units are not available. It is presumed that ABO antibodies that exist in donor plasma are diluted when platelets from multiple donors are combined to make a pooled product for transfusion. We present a case of a hemolytic transfusion reaction in a 73-year-old man with myelodysplastic syndrome who received an ABO-incompatible pooled platelet unit. This case report demonstrates that the dilution theory is not always true for pooled platelet units, and any patient receiving ABO-incompatible platelet transfusions must be closely monitored for potential hemolytic transfusion reactions. Immunohematology 2019;35:91-94.

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How do I implement an automated screen for high‐titer ABO antibody as an inventory management tool for ABO plasma–incompatible platelets?

Abstract: Implementation of an automated method to screen PLTs for high-titer ABO antibody at the donor center improves the inventory management of PLTs containing ABO-incompatible plasma at the hospital transfusion service.

Cited by 11 publications

References 13 publications

Fatal acute hemolytic transfusion reaction due to anti‐B from a platelet apheresis unit stored in platelet additive solution

Fatal acute hemolytic transfusion reaction due to anti‐B from a platelet apheresis unit stored in platelet additive solution

An exploration of the advantages of automated titration testing: low inter‐instrument variability and equivalent accuracy for ABO and non‐ABO antibody titres relative to tube testing

Dilution is not the solution: acute hemolytic transfusion reaction after ABO-incompatible pooled platelet transfusion

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