Evaluation of Anti-A and Anti-B Alloisogglutinin Titer in Group O Plateletpheresis Donors

Abstract

Platelet (PLT) transfusions need to take into account the issues that arise due to significant amounts of ABO antigen being present on the platelets surface and anti-ABO alloisogglutinins being present in the donor's plasma. Although relatively rare, acute intravascular haemolytic transfusion reactions (AHTRs) have been caused by passive transfer of anti-A and anti-B antibodies, present in apheresis platelets (APs) of group O donors, across a minor ABO incompatibility (group A, B and AB recipients). To date, improving safety of group O PLT transfusions has focused either on establishing a safe level of alloisogglutinin titer or on reducing the volume of incompatible plasma administered. In this current study we evaluated anti-A and anti-B titers in 70 plasma samples from group O APs donors. Sixty (60) were male donors and ten (10) were female donors. Their age ranged from 20 to 58years old (mean age: 39.8±1.1). The determination of anti-A and anti-B antibodies, was performed using the method of direct agglutination, specifying IgM antibodies (Gel reagent, Ortho BioVue System). Our results showed that, anti-A titers ranged from 2 to 1024 (mean titer: 64), while anti-B titers ranged from 2 to 256 (mean titer: 32). Anti-A titers were significantly higher than anti-B (p<0.01). The critical value of "high-titer" for anti-A and anti-B antibodies, based on our method and internationally accepted criteria, was defined to be at least 64. The frequency of group O APs donors, with "high-titer" anti-A and anti-B was relatively high, 55.8% and 47.2% respectively. There was no statistically significant difference between the donors, when they were divided into two age groups: over/under 40years (p>0.857 and p>0.861). In conclusion, the risk of haemolysis from ABO-incompatible PLT components, due to passive transfused anti-A and/or anti-B alloisogglutinins, is small but present. Transfusion Service Personnel and Clinicians should be aware of the potential risk and they should always be alert and vigilant when it comes to ABO-incompatible platelet transfusions.

Role of antibody screening in high titre group O donors

“…A similar study by Mavichak et al conducted in same setting demonstrated some tendency of higher anti-A and anti-B titers in female than male though not statistically significant. 9 The age of the donor in present study was 18-60 years. In the present study, it has been shown that young population between 20-30-and 30-40-years age group showed high titre.…”

Platelet Additive Solutions as an Alternative Storage Medium of Apheresis Platelets to Reduce ABO Antibody Titer for ABO-Incompatibility Platelet Transfusion

“…This can quickly destroy the transfused platelets, causing poor post-transfusion platelet recovery. The second type is minor ABO-incompatibility, which occurs when the donor's plasma has antibodies against the recipient's ABO antigen on RBC [6][7][8][9].…”

“…In platelet transfusion, there are two types of ABO incompatibility [ 6 ]. The first is major incompatibility, which occurs when the recipient's plasma contains antibodies against the donor's ABO antigen on the platelets.…”

“…Few studies have shown that platelets suspended in plasma from blood donors tend to have higher levels of anti-B antibodies compared to levels of anti-A antibodies [ 15 ]. Another study by Kavallierou et al found that platelets stored in plasma from group O donors had higher levels of anti-A antibodies compared to anti-B antibodies [ 6 ]. This aligns with what has been documented in the literature regarding instances of HTRs that occur due to the passive transfer of anti-A and anti-B antibodies [ 16 ].…”

“…However, their plasma has high levels of anti-A, anti-B, and anti-AB antibodies. These antibodies can cause the destruction of red blood cells in non-group O recipients, leading to HTRs [ 6 ]. Reducing the plasma in the platelet units has been shown to reduce anti-A and anti-B titers.…”