Preparation of single donor platelet with low antibody titers for all patients

Romphruk, Amornrat; Cheunta, Siriluk; Pakoate, Lamoon; Kumpeera, Pravee; Sripara, Poonsup; Paupairoj, Chintana

doi:10.1016/j.transci.2012.01.006

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…This practice of adding a non-group O whole blood PLT unit in order to decrease the anti-A or anti-B titer should be used with caution as there is a potential for the formation of immune complexes, PLT activation, and an increase in PLT microaggregates which, in small studies, have been implicated in causing adverse clinical outcomes (discussed in more detail below) [26,27]. Another study demonstrated that volume reducing group O apheresis PLTs followed by resuspension in group AB plasma reduced the anti-A and anti-B titers to ≤8 thereby creating a ‘universal donor PLT' [28]. However, as discussed previously, PLTs are activated after centrifugation, and the authors did not report on the hemostatic potential of the PLTs after resuspension and storage in AB plasma.…”

Section: Part 1: Plt Transfusion and Abo Compatibilitymentioning

confidence: 99%

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

Transfus Med Hemother

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Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of ‘high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.

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Section: Part 1: Plt Transfusion and Abo Compatibilitymentioning

confidence: 99%

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

Transfus Med Hemother

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“…Because these patients often require multiple PLT transfusions, some PLT donations collected will be HLA-compatible but not ABO-compatible. 20 Strategies to reduce the risk of PLT associated HTRs include screening donor plasma for "high-titer" antibodies, volume reduction -substitution, washed PLTs and setting a maximum volume of incompatible plasma to be transfused to a patient in a defined period of time. Various methods of determining titers include tube saline agglutination with or without indirect antiglobulin testing, micro-column agglutination, automated microplate technology and in vitro haemolysis assays.…”

Section: Discussionmentioning

confidence: 99%

“…Controversially, Cid et al 27 remarks that PLT manipulation results in activation after centrifugation. Romphruk et al 20 demonstrated that volume reducing group O APs followed by resuspension in group AB plasma reduced the anti-A and anti-B titers to <8 thereby creating a universal donor. Karafin et al 31 managed to lower the risk of HTRs in adults, by limiting the volume of transfused plasma incompatible apheresis products to 600 cc in a 24hour period.…”

Section: Discussionmentioning

confidence: 99%

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

Bazigou¹,

Lempesopoulos²,

Kavallierou³

et al. 2015

HTIJ

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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.

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“… Screening platelet donors for high titer ABO antibodies,[ 36 ] Encourage instrument manufacturers to develop and validate automated anti-A and anti-B titer screening,[ 34 ] Wash and resuspend platelets in saline,[ 15 ] Reduce plasma volume of group O apheresis PLTs concentrates to 50 ml,[ 38 ] and Replace plasma with additive solutions or AB plasma after washing, (with the limitations described for the existing soluble A and B circulating antigens in AB plasma). [ 39 40 41 ] …”

Section: Transfusions Of Platelets With Minor Abo-incompatibilitymentioning

confidence: 99%

Current trends in platelet transfusions practice: The role of ABO-RhD and human leukocyte antigen incompatibility

Valsami

Dimitroulis²,

Gialeraki

et al. 2015

Asian J Transfus Sci

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Platelet transfusions have contributed to the revolutionary modern treatment of hypoproliferative thrombocytopenia. Despite the long-term application of platelet transfusion in therapeutics, all aspects of their optimal use (i.e., in cases of ABO and/or Rh (D incompatibility) have not been definitively determined yet. We reviewed the available data on transfusion practices and outcome in ABO and RhD incompatibility and platelet refractoriness due to anti-human leukocyte antigen (HLA) antibodies. Transfusion of platelets with major ABO-incompatibility is related to reduced posttransfusion platelet (PLT) count increments, compared to ABO-identical and minor, but still are equally effective in preventing clinical bleeding. ABO-minor incompatible transfusions pose the risk of an acute hemolytic reaction of the recipient that is not always related to high anti-A, B donor titers. ABO-identical PLT transfusion seems to be the most effective and safest therapeutic strategy. Exclusive ABO-identical platelet transfusion policy could be feasible, but alternative approaches could facilitate platelet inventory management. Transfusion of platelets from RhD positive donors to RhD negative patients is considered to be effective and safe though is associated with low rate of anti-D alloimmunization due to contaminating red blood cells. The prevention of D alloimmunization is recommended only for women of childbearing age. HLA alloimmunization is a major cause of platelet refractoriness. Managing patients with refractoriness with cross-matched or HLA-matched platelets is the current practice although data are still lacking for the efficacy of this practice in terms of clinical outcome. Leukoreduction contributes to the reduction of both HLA and anti-D alloimmunization.

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Preparation of single donor platelet with low antibody titers for all patients

Cited by 15 publications

References 19 publications

Platelet Transfusion - the Art and Science of Compromise

Platelet Transfusion - the Art and Science of Compromise

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

Current trends in platelet transfusions practice: The role of ABO-RhD and human leukocyte antigen incompatibility

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