Providing ABO‐identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

Abstract

Background There are multiple benefits to transfusing only ABO identical blood components. Historically our institution routinely transfused ABO non-identical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO identical components whenever feasible, regardless of outdating/logistic considerations. Methods Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO identical PLTs ABO compatible platelets were washed to remove incompatible plasma. Data on outdating were collected for eighteen months before and after implementation. We compared transfusion reaction and red cell alloimmunization incidence for four years preceding (2001–2004) and subsequent (2006–2009) to implementation. Results In the year following implementation, only 11 of 410 surgical patients received ABO non-identical platelets (2.7%). There was a 5.6% increase in outdating of platelets. Transfusing ABO identical components was associated with significant reductions in febrile (−46%; 8.0 to 4.3 per 10,000 components; p<0.0001) and allergic transfusion reactions (−23%; from 7.0 to 5.4 per 10,000 components; p=0.025). A progressive reduction in de novo red cell alloimmunization incidence also occurred (−50% by 2009; p=0.03). Conclusions Providing ABO identical platelets to almost all patients was feasible in our setting by changing ordering and inventorying procedures, and making the ABO identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions, and red cell alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.

Platelet Transfusion - the Art and Science of Compromise

“…In contrast, a recent study reviewed the incidence of transfusion reactions prior to and after implementing a policy of providing only ABO identical or washed PLTs [60]. The authors demonstrated that in the period after implementation of the ABO identical or washed PLT transfusion policy there were 46% fewer FNHTRs to PLT transfusions compared to the period when ABO mismatched PLTs were routinely issued.…”

CD40 ligand (CD154) involvement in platelet transfusion reactions

“…An immunological-minded alteration of platelet transfusion practice through providing ABO-identical platelets to recipients was implemented to decrease the incidence of reactions. In a study spanning 9 years with 36 months of data collection, febrile and allergic transfusion reactions were significantly reduced after implementation of transfusion with only ABO-identical platelet components (8). …”

Exposure to ABO‐nonidentical blood associated with increased in‐hospital mortality in patients with group A blood

“…Confirmation of our study's provocative findings—that ABO‐nonidentical blood is associated with worsened mortality outcomes in group A patients—could pose a dilemma for blood supply and inventory management. Prompted by reports of harm after exposure to nonidentical PLTs and cryoprecipitate, some centers have changed ordering and inventorying procedures and now provide solely identical PLTs and cryoprecipitate to patients (in addition to existing policies of providing ABO‐identical RBCs in situations where the patient's blood group is known) . These policy changes have been associated with statistically and clinically significant reductions in febrile and allergic reactions and RBC alloimmunization.…”

“…Prompted by reports of harm after exposure to nonidentical PLTs and cryoprecipitate, some centers have changed ordering and inventorying procedures and now provide solely identical PLTs and cryoprecipitate to patients (in addition to existing policies of providing ABO-identical RBCs in situations where the patient's blood group is known). 17,18 These policy changes have been associated with statistically and clinically significant reductions in febrile and allergic reactions and RBC alloimmunization. However, translating this approach to RBCs is not straightforward.…”