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Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N. Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions? Anesth Analg 2019; 126:2135-2138. [PMID: 29099432 DOI: 10.1213/ane.0000000000002600] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Majed A Refaai
- From the Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester Medical Center, Rochester, New York
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Hult AK, Dykes JH, Storry JR, Olsson ML. A and B antigen levels acquired by group O donor-derived erythrocytes following ABO-non-identical transfusion or minor ABO-incompatible haematopoietic stem cell transplantation. Transfus Med 2017; 27:181-191. [DOI: 10.1111/tme.12411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/14/2017] [Indexed: 11/26/2022]
Affiliation(s)
- A. K. Hult
- Clinical Immunology and Transfusion Medicine, Division of Laboratory Medicine, Office of Medical Services; Lund University; Lund Sweden
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine; Lund University; Lund Sweden
| | - J. H. Dykes
- Clinical Immunology and Transfusion Medicine, Division of Laboratory Medicine, Office of Medical Services; Lund University; Lund Sweden
| | - J. R. Storry
- Clinical Immunology and Transfusion Medicine, Division of Laboratory Medicine, Office of Medical Services; Lund University; Lund Sweden
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine; Lund University; Lund Sweden
| | - M. L. Olsson
- Clinical Immunology and Transfusion Medicine, Division of Laboratory Medicine, Office of Medical Services; Lund University; Lund Sweden
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine; Lund University; Lund Sweden
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Valsami S, Dimitroulis D, Gialeraki A, Chimonidou M, Politou M. Current trends in platelet transfusions practice: The role of ABO-RhD and human leukocyte antigen incompatibility. Asian J Transfus Sci 2015; 9:117-23. [PMID: 26420927 PMCID: PMC4562128 DOI: 10.4103/0973-6247.162684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
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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Affiliation(s)
- Serena Valsami
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Department of Propedeutic Surgery, Laiko Hospital, Athens University Medical School, Athens, Greece
| | - Argyri Gialeraki
- Haematology Laboratory and Blood Bank Department, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Maria Chimonidou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
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Emergency use of prethawed Group A plasma in trauma patients. J Trauma Acute Care Surg 2013; 74:69-74; discussion 74-5. [DOI: 10.1097/ta.0b013e3182788f8e] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Refaai MA, Carter J, Henrichs KF, Davidson DC, Pollock SJ, Casey AE, Spinelli SL, Phipps RP, Francis CW, Blumberg N. Alterations of platelet function and clot formation kinetics after in vitro exposure to anti-A and -B. Transfusion 2012; 53:382-93. [PMID: 22624532 DOI: 10.1111/j.1537-2995.2012.03718.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND ABO-mismatched platelets (PLTs) are commonly transfused despite reported complications. We hypothesized that because PLTs possess A and B antigens on their surface, ABO-mismatched transfused or recipient PLTs could become activated and/or dysfunctional after exposure to anti-A or -B in the transfused or recipient plasma. We present here in vitro modeling data on the functional effects of exposure of PLTs to ABO antibodies. STUDY DESIGN AND METHODS PLT functions of normal PLTs of all ABO types were assessed before and after incubation with normal saline, ABO-identical plasma samples, or O plasma samples with varying titers of anti-A and anti-B (anti-A/B). Assays used for this assessment include PLT aggregation, clot kinetics, thrombin generation, PLT cytoskeletal function, and mediator release. RESULTS Exposure of antigen-bearing PLTs to O plasma with moderate to high titers of anti-A/B significantly inhibits aggregation, prolongs PFA-100 epinephrine closure time, disrupts clot formation kinetics, accelerates thrombin generation, reduces total thrombin production, alters PLT cytoskeletal function, and influences proinflammatory and prothrombotic mediator release. CONCLUSIONS Our findings demonstrate a wide range of effects that anti-A/B have on PLT function, clot formation, thrombin generation, PLT cytoskeletal function, and mediator release. These data provide potential explanations for clinical observations of increased red blood cell utilization in trauma and surgical patients receiving ABO-nonidentical blood products. Impaired hemostasis caused by anti-A/B interacting with A and B antigens on PLTs, soluble proteins, and perhaps even endothelial cells is a potential contributing factor to hemorrhage in patients receiving larger volumes of ABO-nonidentical transfusions.
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Affiliation(s)
- Majed A Refaai
- Department of Pathology and Laboratory Medicine, the James P. Wilmot Cancer Center, University of Rochester, Rochester, New York 14642, USA.
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Fontaine MJ, Mills AM, Weiss S, Hong WJ, Viele M, Goodnough LT. How we treat: risk mitigation for ABO-incompatible plasma in plateletpheresis products. Transfusion 2012; 52:2081-5. [DOI: 10.1111/j.1537-2995.2012.03596.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, Heal JM, Blumberg N. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion 2012; 52:635-40. [PMID: 21895675 PMCID: PMC3235249 DOI: 10.1111/j.1537-2995.2011.03329.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are multiple benefits to transfusing only ABO-identical blood components. Historically our institution routinely transfused ABO-nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO-identical components whenever feasible, regardless of outdating or logistic considerations. STUDY DESIGN AND METHODS Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO-identical PLTs, ABO-compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001-2004) and subsequent (2006-2009) to implementation. RESULTS In the year after implementation, only 11 of 410 surgical patients received ABO-nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO-identical components was associated with significant reductions in febrile (-46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (-23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (-50% by 2009; p = 0.03). CONCLUSIONS Providing ABO-identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO-identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.
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Affiliation(s)
- Kelly F Henrichs
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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Rowley SD, Donato ML, Bhattacharyya P. Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplant 2011; 46:1167-85. [DOI: 10.1038/bmt.2011.135] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Refaai MA, Fialkow LB, Heal JM, Henrichs KF, Spinelli SL, Phipps RP, Masel E, Smith BH, Corsetti JP, Francis CW, Bankey PE, Blumberg N. An association of ABO non-identical platelet and cryoprecipitate transfusions with altered red cell transfusion needs in surgical patients. Vox Sang 2011; 101:55-60. [PMID: 21414009 DOI: 10.1111/j.1423-0410.2010.01464.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Transfusion of ABO non-identical plasma, platelets and cryoprecipitate is routine practice even though adverse effects can occur. METHODS AND MATERIALS Our hospital changed transfusion practice in 2005 and adopted a policy of providing ABO-identical blood components to all patients when feasible. We retrospectively compared the transfusion requirements, length of stay and in-hospital mortality in relation to ABO blood group in surgical patients who received platelet transfusions before and after this change to determine whether it resulted in any benefit. RESULTS Prior to the change in practice, both group B and AB patients received more ABO non-identical platelet transfusion (P=0·0004), required significantly greater numbers of red cell transfusions (P=0·04) and had 50% longer hospital stays (P=0·039) than group O and A patients. Following the policy change, there was a trend for fewer red cell transfusions (P=0·17) and length of stay in group B and AB patients than group O or A patients. Overall, the mortality rate per red cell transfusion decreased from 15·2 per 1000 to 11·0 per 1000 (P=0·013). CONCLUSIONS These results, in the context of previous findings, suggest that providing ABO-identical platelets and cryoprecipitate might be associated with reduction in transfusion requirements and improve outcomes in surgical patients.
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Affiliation(s)
- Majed A Refaai
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
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Blumberg N, Heal JM, Phillips GL. Platelet transfusions: trigger, dose, benefits, and risks. F1000 MEDICINE REPORTS 2010; 2:5. [PMID: 20502614 PMCID: PMC2874899 DOI: 10.3410/m2-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the last half century, platelet transfusion has been an effective therapy for the prevention and treatment of bleeding, particularly in patients with hematologic malignancies. Recent randomized trials have demonstrated that current practices may be suboptimal in a number of ways. The rationale for parsimony in the use of this powerful therapy includes previously described severe and fatal adverse outcomes (including refractoriness, hemolysis from ABO-mismatched transfusions, acute lung injury, and bacterial sepsis), newly described serious potential risks (including thrombosis and earlier leukemic recurrence), difficulty in maintaining adequate supplies of platelets, the need to place volunteer donors on cell separators to provide the product, and cost. Recent findings demonstrate that the platelet count threshold for prophylactic transfusion can be as low as 10,000/µL, and a therapeutic rather than a prophylactic strategy of transfusion for bleeding manifestations only may be equally safe for most patients. Another recently completed study suggests that very low doses of platelet transfusions (the equivalent of half a unit of apheresis platelets or two to three units of whole blood-derived platelets) are as effective at preventing bleeding as much higher doses. One question for which there are no randomized trial data is at what threshold prophylactic platelet transfusion should be given before invasive procedures or major surgery. The typically recommended threshold of 50,000/µL is based only on expert opinion, and substantial observational data indicate that this threshold leads to many transfusions that are likely unnecessary and therefore represent risk with little or no additional benefit.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine Unit, Department of Pathology & Laboratory Medicine, University of Rochester Medical Center601 Elmwood Avenue, Box 608, Rochester, NY 14642USA
| | - Joanna M Heal
- Transfusion Medicine Unit, Department of Pathology & Laboratory Medicine, University of Rochester Medical Center601 Elmwood Avenue, Box 608, Rochester, NY 14642USA
| | - Gordon L Phillips
- Hematology-Oncology Unit, Department of Medicine, JP Wilmot Cancer Center, University of Rochester Medical Center601 Elmwood Avenue, Box 704, Rochester, NY 14642USA
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Shanwell A, Andersson TML, Rostgaard K, Edgren G, Hjalgrim H, Norda R, Melbye M, Nyrén O, Reilly M. Post-transfusion mortality among recipients of ABO-compatible but non-identical plasma. Vox Sang 2009; 96:316-23. [PMID: 19254234 DOI: 10.1111/j.1423-0410.2009.01167.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The consequences of ABO-compatible non-identical plasma for patient outcome have not been studied in randomized clinical trials or large cohort studies and use varies widely in the absence of evidence-based policies. We investigated if transfusion with compatible instead of identical plasma confers any short-term survival disadvantage on the recipients. MATERIALS AND METHODS The cohort of all 86 082 Swedish patients who received their first plasma transfusion between 1990 and 2002 was followed for 14 days and the risk of death in patients exposed to compatible non-identical plasma compared to recipients of only identical plasma. RESULTS After adjustment for potential confounding factors, there was an increased mortality associated with exposure to ABO-compatible non-identical plasma, with the excess risk mostly confined to those receiving 5 or more units (relative risk, 1.15; 95% confidence interval, 1.02-1.29). Stratification by blood group indicated higher risks in group O recipients, especially when the compatible plasma was from a group AB donor. CONCLUSIONS This study suggests that ABO-compatible non-identical plasma is less safe than identical plasma. Subanalyses by blood group suggest a role for circulating immune complexes. Our findings may have policy implications for improving transfusion safety.
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Affiliation(s)
- A Shanwell
- Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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Caiazzo M, Alessandrini A, Facci P. A highly selective, biofunctional surface for molecule/cell sorting. ACS APPLIED MATERIALS & INTERFACES 2009; 1:514-518. [PMID: 20353244 DOI: 10.1021/am800175h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We report in this paper an approach to the effective capture of IgM antibodies from antisera and solutions based on the formation of a carpet of molecules exposing thiols off a surface. Surfaces of different nature, such as OH-exposing (glass, SiO(2), metal oxides, etc.) and noble metal ones (Au, Ag, etc.), have been first functionalized in the liquid phase by suitable chemistry [3-(mercaptopropyl)trimethoxysilane or 1,4-benzenedimethanethiol]. The resulting exposed SH moieties have been further used for binding anti-A, -B, and -D IgM molecules from goat sera via a thiol exchange reaction involving the J chain and other disulfide bonds present in the IgM molecular structure. Antibodies preserve their functional activity at the surface and appear to be able to bind specifically erythrocytes of the proper group in a fast and reliable way. These results can be generalized to the use of any kind of IgM antibody and can be valuable in surface biofunctionalization in the fields of biosensors and immunoassays.
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Affiliation(s)
- Marialuisa Caiazzo
- Department of Physics, University of Modena and Reggio Emilia, Via G. Campi 213/A, Modena, Italy
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Blumberg N, Heal JM, Liesveld JL, Phillips GL, Rowe JM. Platelet transfusion and survival in adults with acute leukemia. Leukemia 2007; 22:631-5. [PMID: 17805333 DOI: 10.1038/sj.leu.2404920] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Harris SB, Josephson CD, Kost CB, Hillyer CD. Nonfatal intravascular hemolysis in a pediatric patient after transfusion of a platelet unit with high-titer anti-A. Transfusion 2007; 47:1412-7. [PMID: 17655585 DOI: 10.1111/j.1537-2995.2007.01283.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the pediatric population, hemolysis after out-of-group platelet (PLT) transfusion is a potentially fatal event that is thought to be underrecognized. Group A patients transfused with group O single-donor PLTs (SDPs) with "high-titer" anti-A are at greatest risk for hemolysis. STUDY DESIGN AND METHODS A clinical and serologic evaluation of a pediatric patient with hemolysis of initially unknown etiology was conducted. Retrospective testing for anti-A titer of an admission sample and a transfused group O SDP was performed. RESULTS The group A patient (previously group O) was found to have a history of engrafted major ABO-mismatched hematopoietic peripheral blood progenitor cell transplant (HPBPCT). Immune-mediated intravascular hemolysis with a delayed presentation was determined. Testing identified passive anti-A in the patient's plasma and high-titer anti-A (IgG 4096, IgM 256) in the group O SDP unit. CONCLUSION Hemolysis after out-of-group SDP transfusion may be delayed in presentation and, thus, clinically unrecognized. When evaluating these cases, the limitations of routine type and screen for detection of passive anti-A must be considered. Group A individuals with a history of engrafted major ABO-mismatched HPBPCT potentially have increased susceptibility to hemolysis from group O SDP transfusion due to their lack of tissue and soluble A antigen.
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Affiliation(s)
- Shealynn B Harris
- Transfusion Medicine Program, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
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