Prophylactic strategies for acute hemolysis secondary to plasma-incompatible platelet transfusions: correlation between qualitative hemolysin test and isohemagglutinin titration

Abstract

ObjectiveBrazilian legislation has recently suggested the use of the qualitative hemolysin test instead of isohemagglutinin titers as prophylaxis for acute hemolysis related to plasma-incompatible platelet transfusions. The efficacy of this test in preventing hemolytic reactions has never been evaluated while isohemagglutinin titers have been extensively studied. The main objective of this study was to evaluate the correlation between the results of these two tests. The impact of each type of prophylaxis on the platelet inventory management and the ability of the qualitative hemolysin test to prevent red cell sensitization after the transfusion of incompatible units were also studied.MethodsA total of 246 donor blood samples were evaluated using both isohemagglutinin titers and the qualitative hemolysin test, and the results were statistically compared. Subsequently, 600 platelet units were tested using the hemolysin assay and the percentage of units unsuitable for transfusion was compared to historical data using isohemagglutinin titers (cut-off: 100). Moreover, ten patients who received units with minor ABO incompatibilities that were negative for hemolysis according to the qualitative hemolysin test were evaluated regarding the development of hemolysis and red cell sensitization (anti-A or anti-B).ResultsIsohemagglutinin titration and the results of qualitative hemolysin test did not correlate. The routine implementation of the qualitative hemolysin test significantly increased the percentage of platelet units found unsuitable for transfusions (15–65%; p-value <0.001). Furthermore the qualitative hemolysin test did not prevent red blood cell sensitization in a small exploratory analysis.ConclusionQualitative hemolysin test results do not correlate to those of isohemagglutinin titers and its implementation as the prophylaxis of choice for hemolysis associated with plasma-incompatible platelet transfusions lacks clinical support of safety and significantly affects platelet inventory management.

Dangerous universal donors: the reality of the Hemocentro in Belo Horizonte, Minas Gerais

“…If this is not possible, it is recommended that the plasma volume of the blood component and the presence of clinically relevant anti-A and anti-B hemagglutinins (hemolysin) is evaluated when the transfusion of non-isogroup platelet concentrates is necessary 13 . However, according to a recent study by Landim et al, 12 there is no correlation between hemolysin and the risk of clinical hemolysis or hemagglutinin titers reinforcing the importance of analyzing hemagglutinins, which is considered the gold standard prophylaxis against hemolysis related to plasma-incompatible platelet transfusions.…”

Complement activating ABO IgM/IgG act synergistically to cause erythrophagocytosis: implications among minor ABO incompatible platelet transfusions

“…Landim et al [24] saw no correlation between ABO isohemagglutinin titer and hemolysin activity. In addition, they found that using both isohemagglutinin titer and hemolysin activity as exclusion criteria increased the percentage of platelet units which were otherwise found unsuitable for minor ABO incompatible transfusions, and that such an approach lacked clinical support as an implementation strategy.…”

“…Our in vitro erythrophagocytosis data is in agreement with Landim. [24] High titer IgG and the ability to activate complement do not cause significant erythrophagocytosis, and hemolysin activity is not a predictor of complement-dependent erythrophagocytosis. However, we found that both high titer IgM and IgG along with the ability to activate complement are factors that result in significant erythrophagocytosis.…”

ABO isohemagglutinin titration or hemolysin test: what should we do to reduce the risk of passive hemolysis?

“…In this issue, there is an important study on the correlation between isohemagglutinin titration and the qualitative hemolysin test as prophylactic tests to prevent HTRs. 6 The authors evaluated the impact of each prophylaxis on platelet inventory management and the ability of the hemolysin test to avoid red blood cell (RBC) sensitization after the transfusion of incompatible units. 6 In this study, they demonstrate that the results of isohemagglutinin titration are not related to the results of the hemolysin qualitative test and the absence of hemolysis does not prevent RBC sensitization.…”

“… 6 The authors evaluated the impact of each prophylaxis on platelet inventory management and the ability of the hemolysin test to avoid red blood cell (RBC) sensitization after the transfusion of incompatible units. 6 In this study, they demonstrate that the results of isohemagglutinin titration are not related to the results of the hemolysin qualitative test and the absence of hemolysis does not prevent RBC sensitization. They also conclude that the implementation of the hemolysin test as the prophylaxis of choice for hemolysis significantly affects the platelet inventory management.…”