Transfusion efficacy of ABO major‐mismatched platelets (PLTs) in children is inferior to that of ABO‐identical PLTs

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.

Section: Part 1: Plt Transfusion and Abo Compatibilitymentioning

confidence: 99%

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

“…In the present study, the prospectively registered transfusion efficacy of APCs was analyzed retrospectively by reviewing the records of all patients having received at least one APC between January 2004 and December 2010 at the Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Bern, Switzerland. This data set included the data of our two former prospective trials evaluating the effects of high-yield thrombocytapheresis on the quality of APCs [16] and the influence of ABO blood group matching between PLT donor and recipient on post-transfusion PLT increment [17]. In addition to the 1-hour percent PLT recovery (PPR 1h ), side effects of PLT transfusions and data on the production process of APCs were recorded.…”

Section: Methodsmentioning

confidence: 99%

“…With a random intercept per patient, LME accounts for the correlation among multiple transfusions given to the same patient. For multivariate analysis, storage time, applied apheresis procedure, apheresis yield, ABO transfusion constellation, body weight of recipients, and PLT count before transfusion were used as covariates [16,17]. Two-sided tests were used throughout, and p values < 0.050 were considered significant.…”

Section: Methodsmentioning

confidence: 99%

“…The impact of gamma irradiation of PLT concentrates on their transfusion efficacy in vivo is poorly investigated, and the results are inconsistent [11,12,13,15,16]. Therefore, taking into account all significant covariates affecting transfusion efficacy from our previous work [16,17], the aim of the present study was to investigate whether gamma irradiation of APCs adversely affects transfusion efficacy and whether the timing of irradiation has an effect on transfusion efficacy.…”

Section: Introductionmentioning

confidence: 99%

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Transfusion Efficacy of Apheresis Platelet Concentrates Irradiated at the Day of Transfusion Is Significantly Superior Compared to Platelets Irradiated in Advance

Julmy

Ammann

Fontana

et al. 2014

Self Cite

Background: Gamma irradiation is currently the standard care to avoid transfusion-associated graft-versus-host disease. Guidelines on gamma irradiation of blood components state that platelets (PLTs) can be irradiated at any stage in their 5-day storage and can thereafter be stored up to their normal shelf life of 5 days after collection. In this study, we explored whether the timing of irradiation has an effect on transfusion efficacy of apheresis PLT concentrates (APCs). Methods: Based on the 1-hour percent PLT recovery (PPR_1h), transfusion efficacy of 1,000 eligible APCs transfused to 144 children were evaluated retrospectively. PPR_1h was compared in transfused APCs irradiated at the day of transfusion and APCs irradiated in advance. Results: In univariate analysis, transfusion efficacy of APCs irradiated in advance was significantly lower than that of APCs irradiated at the day of transfusion (mean PPR_1h 27.7 vs. 35.0%; p = 0.007). This was confirmed in multivariate analysis (p = 0.030). Compared to non-irradiated APCs, transfusion efficacy of APCs irradiated at the day of transfusion was not significantly inferior (mean difference -2.8%; 95% CI -6.1 to 0.5%; p = 0.092), but APCs irradiated in advance were clearly less efficient (mean difference -8.1%; 95% CI -12.2 to -4.0%; p < 0.001). Conclusion: Our data strongly support that APCs should not be irradiated in advance, i.e., ≥24 h before transfusion.

“…An impact of ABO mismatching on transfusion efficacy in terms of lower platelet count increments has been described [14,15,23]. Yet, only a few studies have focused in endpoints such as patient survival or bleeding rates.…”

Section: Discussionmentioning

confidence: 99%

The Blood Group A Genotype Determines the Level of Expression of the Blood Group A on Platelets But Not the Anti-B Isotiter

Lehner

Eichelberger

Jungbauer

et al. 2015

Background: The extent of expression of the blood group A on platelets is controversial. Further, the relation between platelets' blood group A expression and the titers of isoagglutinins has not been thoroughly investigated, so far. Methods: We evaluated the relation between the genotype with platelets' blood group A and H expression estimated by flow cytometry and the titers of isoagglutinins. Results: The A expression varied between genotypes and within genotypes. However, the expression in A₁ was stronger than in all other genotypes (p < 0.0001). An overlap of expression levels was apparent between homozygous A₁A₁ and heterozygous A₁ individuals. Still, The A₁A₁ genotype is associated with a particularly high antigen expression (p = 0.009). Platelets' A expression in A₂ versus blood group O donors was also significant (p = 0.007), but there was again an overlap of expression. The secretor status had only little influence on the expression (p = 0.18). Also, isoagglutinin titers were not associated with genotypes. Conclusion: To distinguish between A₁ and A₂ donors may reduce incompatible platelet transfusions and therefore be favorable on platelet transfusion increment. Clinical data are needed to support this notion.