The precautionary principle and use of Group A plasma in recipients of unknown ABO blood group

ABO blood group antigens and differential glycan expression: Perspective on the evolution of common human enzyme deficiencies

“…Although anti-human leukocyte antigen (HLA) and platelet-specific alloimmune responses can accelerate platelet clearance following transfusion ( Arthur et al., 2016 ; Hod and Schwartz, 2008 ), ABO(H) antigens on platelets can also affect transfused platelet survival in incompatible transfusion settings ( Cooling, 2007 ). As noted earlier, ABO incompatibility may drive additional underrecognized complications ( Blumberg et al., 2018 ; McRae et al., 2021 ; Refaai et al., 2018 ; Sahai et al., 2017 ). Although ABO(H) barriers can now be crossed for solid organ transplantation (which has greatly increased donor availability) ( Irving et al., 2012 ; Tyden et al., 2012 ; Urschel et al., 2013 ), pre-existing anti-ABO(H) antibody titers largely dictate whether successful transplantation occurs ( Dean et al., 2018 ; Janatpour et al., 2008 ; Lee-Sundlov et al., 2020 ; Shirey et al., 2010 ; Urschel and West, 2016 ).…”

“…Although conflicting data and practices exist ( Fung et al., 2007 ; Lozano and Cid, 2003 ), detection of high anti-ABO(H) antibody levels in whole blood, platelet, and plasma donor units may reduce ABO(H)-related complications ( Dunbar et al., 2015 ; Harm and Dunbar, 2019 ; Josephson et al., 2004 , 2010 ; Simmons and Savage, 2015 ; Strandenes et al., 2014 ). Alternatively, some studies suggest that washing blood products prior to ABO(H) discrepant transfusions can improve outcomes ( Blumberg et al., 2018 ; Refaai et al., 2018 ; Sahai et al., 2017 ).…”

The Evolution of Blood Product Use in Trauma Resuscitation: Change Has Come

“…This seems very counterintuitive as ABO-compatibility is drilled into us starting in medical school! Using donors with low titers of anti-A and anti-B certainly helps reduce the risk of hemolysis [61-64], but some have speculated that administering ABO-incompatible or non-identical plasma can make things worse for recipients [65-70]. However, in two large (albeit retrospective) studies of trauma patients, no differences in mortality were observed between those who received ABO-identical or compatible plasma versus those who received ABO-incompatible plasma [71, 72].…”