How we treat: risk mitigation for ABO‐incompatible plasma in plateletpheresis products

Fontaine, Magali J.; Mills, Anne M.; Weiss, Susan; Hong, Wan‐Jen; Viele, Maurene; Goodnough, Lawrence T.

doi:10.1111/j.1537-2995.2012.03596.x

Cited by 36 publications

(36 citation statements)

References 21 publications

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“…Products from such donors can lead to a fatal intravascular HTR if minor ABO-incompatible PLT transfusions are attempted. [1316] We explored the advantages of using a microplate method for performing titers. Literature cites column agglutination technology (CAT) and tube techniques for the same.…”

Section: Discussionmentioning

confidence: 99%

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Antibody titers in Group O platelet donors

Tendulkar

Jain

Velaye

2017

Asian J Transfus Sci

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BACKGROUND AND OBJECTIVES:The occurrence of hemolysis due to transfusion of ABO plasma-incompatible platelets (PLTs) is challenging. There has been no consensus for critical antibody titers in the transfusion community. This study was conducted to understand the trends of anti-A and anti-B antibody titer levels in O group donors and to identify any specific patterns of distribution in relation to age and gender.MATERIALS AND METHODS:A total of 1635 Group O PLT donors were randomly selected for this prospective study. Serial 2-fold doubling dilutions were prepared for each sample to calculate the titer of anti-A and anti-B in a standard 96 well micro-plate. Tube technique was used for comparison with the microplate method for 100 samples.RESULTS:Out of 1635 donors, 1430 (87.46%) were males and 205 (12.54%) were females. The median titer for anti-A and anti-B was 128 with range from 4 to 2048. Spearman's correlation coefficient for microplate versus tube technique was estimated to be 0.803 (P < 0.01, two-tailed). 57.12% and 51.19% of all donors had titers ≥128 for anti-A and anti-B, respectively. The geometric mean of anti-A and anti-B was 155.7 and 137.28, respectively. The titers were significantly higher (P < 0.001) in female donors. An inverse relation between titer levels and age was seen.CONCLUSION:Microplate can be used to perform titers in resource-constrained settings. Screening for critical titers in O group donors is essential as they are more implicated in hemolytic transfusion reactions. In the absence of a global consensus on this topic, institutes may need to formulate their own guidelines on handling ABO plasma-incompatible PLT transfusions.

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Section: Discussionmentioning

confidence: 99%

“…However, volume reduction needs time, technical expertise, and causes PLT loss. [13] This study screens Group O PLT donors for anti-A and anti-B titers. Our O group donor population is 40%, and many can be high titer.…”

mentioning

confidence: 99%

Antibody titers in Group O platelet donors

Tendulkar

Jain

Velaye

2017

Asian J Transfus Sci

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“…5 Not all complications of receiving ABO incompatible plasma are theoretical. Acute immune hemolysis with severe renal failure has occurred in adult group A patients receiving 250 ml of incompatible O plasma during platelet transfusion 6 . Further, a recent study has shown a higher incidence of death from necrotizing enterocolitis (NEC) in group AB neonates at a facility that routinely transfuses group O RBCs to neoneates.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcomes of Group O vs Non–Group O Premature Neonates Receiving Group O RBC Transfusions

Boral

Staubach

Leeuw

et al. 2013

American Journal of Clinical Pathology

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Background At some institutions all babies requiring red blood cell (RBC) transfusions in neonatal intensive care units (NICUs) receive group O RBCs. Although transfused O plasma is minimized in packed RBCs, small amounts of residual anti-A, anti-B and anti-A, B in group O packed RBCs may bind to the corresponding A and B antigens of non-group O RBCs, possibly hemolyzing their native RBCs and thereby releasing free hemoglobin theoretically resulting in hypercoagulability and promoting bacterial growth from free iron. Study Design and Methods Transfused group O and non- group O premature infants in the University of Kentucky Children’s Hospital NICU database were compared for a number of severity markers to determine if transfused non-group O patients had worse outcomes than those of group O. Results 724 neonates in this sample of NICU babies received at least one blood component. There were no significant differences between group O and non-group O babies with regard to final disposition or complications. Conclusions This reassuring finding validates the longstanding neonatal transfusion practice of using group O packed red cells for NICU babies of all blood groups. However, because a recent study shows increased mortality from NEC in AB neonates receiving only group O RBC and suggests a change in neonatal transfusion practice to ABO group specific red cells, more studies may be warranted

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“…For example, a transfusion service may decide on a maximum volume of ABO incompatible plasma that can be transfused to a patient over a certain period of time [5,23]. If the recipient reaches the designated upper limit, then only ABO identical PLTs or ABO-major mismatched PLTs would be issued.…”

Section: Part 1: Plt Transfusion and Abo Compatibilitymentioning

confidence: 99%

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

Transfus Med Hemother

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Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of ‘high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.

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How we treat: risk mitigation for ABO‐incompatible plasma in plateletpheresis products

Cited by 36 publications

References 21 publications

Antibody titers in Group O platelet donors

Antibody titers in Group O platelet donors

Comparison of Outcomes of Group O vs Non–Group O Premature Neonates Receiving Group O RBC Transfusions

Platelet Transfusion - the Art and Science of Compromise

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