Incompatible crossmatch: First sign of a hemolytic transfusion reaction due to out-of-group platelet transfusion

Abstract

Platelet (PLT) transfusion is undertaken in a variety of clinical settings with thrombocytopenia, with or without bleeding. Since PLTs are most often stored in donor plasma, group-specific PLT transfusions are preferred to out-of-group transfusions. PLTs adsorb ABO antigens over their surface from the plasma. In major ABO-incompatible PLT transfusions, anti-A/B from the patient plasma react with the ABO antigens on transfused PLTs and can potentially cause adverse reactions or PLT refractoriness. Transfusion of PLTs with major ABO incompatibility, though effective in preventing clinical bleeding, is associated with reduced posttransfusion PLT count increments. In minor incompatible PLT transfusion transfused, anti-A/B can cause hemolytic transfusion reaction (HTR) which is not always related to a high titer of anti-A/B in the donor. Although attempts are made to practice ABO identical PLT transfusion, most centers practice out-of-group random donor platelets (RDPs) as well as single-donorplatelets (SDP) transfusion. The limited PLT shelf life does not always permit ABO identical PLT transfusion. At our center, ABO-specific PLT transfusions are practiced where possible, and in case of minor ABO-incompatible transfusions, antibody titers are not done. Here, we report a case of HTR due to out-of-group SDP transfusion, detected in the laboratory after an incompatible red blood cell (RBC) crossmatch.

Severe acute haemolytic transfusion reaction secondary to a plasma incompatible group B platelet transfusion

“…7 Other than universal donor isohemagglutinin titre measurement, options to reduce the risk of AHTR include platelet washing, plasmareduction and plasma replacement with platelet additive solution (PAS). 24,25 Some reports also suggest that washed platelets are associated with improved patient outcome in patients with acute myeloid leukaemia. 26,27 These methods however do not eliminate the risk of AHTR and cases of AHTR have been published despite plasma reduction and PAS.…”