Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO‐incompatible plasma

Yazer, Mark H.; Seheult, Jansen N.; Kleinman, Steven; Sloan, Steven R.; Spinella, Philip C.

doi:10.1111/trf.14415

Cited by 42 publications

(42 citation statements)

References 40 publications

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“…The observation that AB type TTP patients did not experience any clinical or laboratory exacerbation of hemolysis when a combination of AB and low titer A plasma was used is not surprising. Transfusion of ABO incompatible platelets is a common practice in medicine; hemolysis events from this ABO‐minor incompatibility is very rare and is further reduced when O group titered platelets are used . Group A plasma has been safely used in bleeding trauma patients and “Safety of the use of group A plasma in trauma: the STAT study” showed no difference in clinical outcomes between ABO identical group (A type patients that received A plasma) and ABO minor incompatible group (B/AB patients that received A plasma) .…”

Section: Discussionmentioning

confidence: 99%

“…The volume of incompatible plasma in a unit of platelets can be as high as 300 mL‐350 mL per apheresis unit. The minimal risk of hemolysis may be even further decreased with the use of low titer O platelet units …”

Section: Introductionmentioning

confidence: 99%

“…The minimal risk of hemolysis may be even further decreased with the use of low titer O platelet units. 8 In addition, trauma patients and patients receiving platelet transfusions, AB group patients requiring multiple therapeutic plasma exchange (TPE) procedures with plasma is another patient population in whom group A type plasma transfusions may be advantageous.…”

Section: Introductionmentioning

confidence: 99%

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Low titer A plasma in three AB patients for therapeutic plasma exchange

Kaplan

Sevcik

Kiss

2018

J of Clinical Apheresis

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Background Currently, low titer A plasma is used on a routine basis in bleeding trauma patients of unknown AB type. Three AB non‐bleeding apheresis patients are presented here who safely received a combination of AB and low titer A plasma during therapeutic plasma exchange (TPE). One control AB patient received AB plasma only. Methods Data was obtained retrospectively on number of procedures, volume replaced, total plasma, and A plasma volumes including hemolysis laboratory data. Average A plasma volume and % of A plasma out of total plasma volume used were calculated. Results Two female AB patients were treated for thrombotic thrombocytopenic purpura (TTP) with TPE and a third female AB patient was treated for microangiopathic hemolytic anemia. Patient 1 received a total of 12 procedures, 10/12 with AB+A plasma (average 916.3 ±84.6 mL). Patient 2 received a total of 12 procedures, 4/12 with AB+A plasma (average 1210.5 ±27.9 mL). Patient 3 received a total of six procedures, four out of six procedures with AB+A plasma (average 1009.8 ±80.3 mL). Patient 4, control, received AB plasma only. Percent of A plasma volume exchanged ranged between 23.8% and 47.8%. Haptoglobin, LDH, hemoglobin, and total bilirubin were monitored and trends were comparable with the control patient. The patients had a negative follow up direct antiglobulin test, adequate platelet recovery and a favorable clinical outcome with treatments. Conclusions TPE was effectively performed without evidence of increased hemolysis using up to 47.8% of low titer A plasma. This approach can reduce strains on limited supplies of AB plasma whereas providing a vital treatment alternative for AB patients undergoing TPE with plasma replacement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low titer A plasma in three AB patients for therapeutic plasma exchange

Kaplan

Sevcik

Kiss

2018

J of Clinical Apheresis

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“…A full discussion of these issues is beyond the scope of this review, and has been reviewed elsewhere, but several key points should be mentioned. At the moment, a gold standard method for performing antibody titers does not exist and it is known that the method of performing the titer affects the results.…”

Section: Immunohematologic Considerations For Transfusing Group O Wbmentioning

confidence: 99%

How do I implement a whole blood program for massively bleeding patients?

et al. 2018

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Building on the successful military experience, interest has been rekindled in transfusing whole blood (WB) early in the resuscitation of traumatically injured civilians, often before their ABO group is known. WB efficiently provides treatment for shock and coagulopathy, as well as platelet hemostatic function, to patients losing large volumes of blood. Unlike group O uncrossmatched red blood cells (RBCs), group O WB contains a substantial amount of plasma, which is incompatible with the RBCs of all non-group O recipients. Thus, when implementing a WB program, it is important to decide how to mitigate the risk of immune-mediated hemolysis. Other questions that a hospital needs to answer before implementing a WB program include determining which patients will be eligible for this product, how many units eligible patients can receive, for how long it should be stored and under what conditions, and how to monitor for adverse events. The donor center needs to consider if the WB should be leukoreduced, how to comply with the AABB's transfusion-related acute lung injury risk mitigation standard, and into which storage solution it should be collected. This report describes the multidisciplinary approach taken to implementing a civilian WB program at a multihospital health care system in the United States.

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“…To mitigate the risk of hemolysis from the transfusion of potentially ABO‐incompatible plasma‐containing products, some centers issue these products only when the titer of the potentially incompatible antibodies are below a certain threshold . For example, all of the surveyed US centers that provide LTOWB for trauma patients use units with antibodies that are below a certain threshold .…”

mentioning

confidence: 99%

Comparison of titer results obtained using immediate spin one‐dilution techniques to a reference method

et al. 2019

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BACKGROUND Many transfusion services determine the titer of potentially incompatible plasma‐containing products by performing a one‐dilution titer at their selected titer threshold. This study compared the results of immediate spin (IS) one‐dilution titers determined by three methods with a reference standard method. METHODS Plasma‐containing products from group A and O donors were titered using the participant's routine IS one‐dilution titer method. No time or temperature incubations were performed, and antihuman globulin reagent was not used. The samples were then tested using a reference method, which was a saline tube test with a 1‐hour room temperature incubation; antihuman globulin was not used in the reference method. The results of the one‐dilution titer were then compared to that obtained in the reference method. RESULTS Nine centers participated in this study. There were 698 antibodies from 374 units tested by the manual IS tube one‐dilution titer method; sensitivity was 0.88 (95% confidence interval [CI], 0.83–0.92), and specificity was 1.00 (95% CI, 0.98–1.00). There were 412 antibodies from 206 units tested by the manual and automated IS buffered gel card one‐dilution titer method; sensitivity was 0.95 (95% CI, 0.91–0.98), and specificity was 0.87 (95% CI, 0.81–0.91). There were 98 antibodies from 49 units tested by an automated microplate IS one‐dilution titer method; sensitivity was 0.76 (95% CI, 0.71–0.93), and specificity was 0.96 (95% CI, 0.92–0.99). All three methods had an accuracy rate of 90% or greater. CONCLUSION The manual and automated one‐dilution titer methods are suitable for screening plasma‐containing units, although more evaluation of the automated microplate method might be required.

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Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO‐incompatible plasma

Cited by 42 publications

References 40 publications

Low titer A plasma in three AB patients for therapeutic plasma exchange

Low titer A plasma in three AB patients for therapeutic plasma exchange

How do I implement a whole blood program for massively bleeding patients?

Comparison of titer results obtained using immediate spin one‐dilution techniques to a reference method

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