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Das N, Prakash S, Sahu A, Panigrahi A, Mishra D, Mukherjee S. Impact of dose and storage duration of platelet concentrates on platelet recovery between ABO identical and ABO non-identical random donor platelet transfusions in hemato-oncology patients. Hematol Transfus Cell Ther 2024; 46:228-236. [PMID: 36941173 PMCID: PMC11221252 DOI: 10.1016/j.htct.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/11/2022] [Accepted: 01/16/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES It is challenging to adopt a policy of ABO identical platelet transfusion in hemato-oncological patients because of the high demand. Moreover, there are no global standards for the management of ABO non-identical platelet transfusions due to limited evidence. The current study compared the impact of dose and storage duration of platelets on percent platelet recovery (PPR) at 1 h and 24 h between ABO identical and ABO non-identical platelet transfusions in hemato-oncological conditions. The other objectives were to assess the clinical efficacy and compare adverse reactions between the two groups. METHODS A total of 130 random donor platelet transfusion episodes (81 ABO identical and 49 ABO non-identical) were evaluated in 60 eligible patients with different malignant, as well as non-malignant, hematological conditions. All analysis was performed using two-sided tests, and p-values <0.05 were considered significant. RESULTS The PPR at 1 h and 24 h was significantly higher in ABO identical platelet transfusion. Platelet recovery and survival were not affected by the gender, dose or storage duration of platelet concentrate. Aplastic anemia and myelodysplastic syndrome (MDS) disease conditions were observed to be independent risk predictors for 1-h post-transfusion refractoriness. CONCLUSION ABO identical platelets have higher platelet recovery and survival. Both ABO identical and ABO non-identical platelet transfusions have similar efficacy in controlling bleeding episodes up to World Health Organization (WHO) grade two. Assessment of other factors, such as platelet functional properties in the donor, anti-HLA and anti-HPA antibodies, may be needed to better understand the platelet efficacy of platelet transfusions.
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Affiliation(s)
- Niladri Das
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashutosh Panigrahi
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debasish Mishra
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
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Bienz M, Gupta A, Goldstein J, Kennedy J, Lin Y. Severe acute haemolytic transfusion reaction secondary to a plasma incompatible group B platelet transfusion. Transfus Med 2022; 33:188-193. [PMID: 36380475 DOI: 10.1111/tme.12938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report a rare case of acute hemolytic transfusion reaction (AHTR) following an ABO plasma incompatible group B platelet transfusion. BACKGROUND AHTR is an uncommon, but potentially fatal event. Most reported cases of platelet transfusions associated with AHTR involve group O donors. CASE REPORT A 34-year-old man, recipient of a group AB haploidentical haematopoietic stem cell transplantation (HSCT), had received re-induction chemotherapy for leukaemia relapse. A group B whole blood-derived buffy coat platelet pool was transfused. He developed rigours/fever, profound hemolytic anaemia, and hemodynamic instability. Serological investigations revealed AHTR from passive transfer of high titre anti-A (256 for IgM and 8192 for IgG). DISCUSSION This case highlights the potential risks associated with ABO-mismatched transfusions, and the complexity associated with transfusing HSCT recipients and red cell transfusion recipients with dual populations of circulating red cells. The literature on minor ABO plasma incompatible transfusions, challenges in establishing local policies to limit the risks of AHTR and risk mitigation strategies are discussed. CONCLUSION Clinicians must maintain a high level of suspicion for AHTR after ABO plasma incompatible platelet transfusions. Patients must be aware of the risks of AHTR, and early recognition and diagnosis of this complication may be lifesaving.
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Affiliation(s)
- Marc Bienz
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
| | - Akash Gupta
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Precision Diagnostics and Therapeutics Program Sunnybrook Health Sciences Centre Toronto Ontario Canada
- University of Toronto Quality in Utilization Education and Safety in Transfusion (QUEST) Research Program Toronto Ontario Canada
| | - Jenette Goldstein
- Precision Diagnostics and Therapeutics Program Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - James Kennedy
- Division of Medical Oncology and Haematology, Department of Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Ontario Canada
- Precision Diagnostics and Therapeutics Program Sunnybrook Health Sciences Centre Toronto Ontario Canada
- University of Toronto Quality in Utilization Education and Safety in Transfusion (QUEST) Research Program Toronto Ontario Canada
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3
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Assessing the risks of haemolysis as an adverse reaction following the transfusion of ABO incompatible plasma-containing components - A scoping review. Blood Rev 2022; 56:100989. [PMID: 35871104 DOI: 10.1016/j.blre.2022.100989] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022]
Abstract
Background The limited supply of universal plasma has resulted in transfusion of ABO incompatible plasma to patients. As the need to implement whole blood transfusion in pre-hospitals setting rises, the lowest cut-off for anti-A/anti-B that does not cause haemolysis remains unknown. In this first scoping review, we aimed to determine the lowest ABO titre and volume reported in the literature to cause haemolysis from ABO incompatible plasma transfusions (plasma, platelets, cryoprecipitate, and whole blood). Methods We searched several databases from inception to April 2022, including all study types. Three independent reviewers extracted and reviewed the data. Primary outcome was the anti-A and anti-B titre (measured by IgM or IgG) that resulted in measurable haemolysis following ABO incompatible plasma transfusion. Results We identified 5681 citations, of which 49 studies were eligible, reporting a total of 62 cases (34 adults, 14 children and 14 did not specify age). The methods for antibody measurement and antibody type (IgG or IgM) varied significantly between studies. Component volumes were poorly reported. The most common component responsible for the haemolysis was apheresis platelets followed by pooled platelets and whole blood. Most haemolytic cases reported were due to anti-A. The lowest anti-A titre reported to cause haemolysis (children and adults) was 32 (IgG), while for anti-B it was 512 (IgG and IgM) for adults, 16,384 for paediatrics (IgG and IgM) and 128 (IgM) in cases where the age was not specified. The lowest reported volume associated with haemolysis were 100 ml (adults) and 15 ml (children). Of the 62 15 (24%) died. Conclusion The lowest titre reported to cause haemolysis was an anti-A of 32. ABO mismatch plasma transfusion may be associated with significant mortality. There is a need to agree/standardise methods for ABO titration measurement internationally for plasma components and agree the lowest anti-A/anti-B titre for transfusing ABO mismatched plasma.
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4
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Chowdhry M, Agrawal S, Prakash B, Thakur UK, Mishra M. Platelet additive solution suspended apheresis platelets in a tertiary care hospital: A step toward universal single donor platelets. Asian J Transfus Sci 2022; 16:238-244. [PMID: 36687537 PMCID: PMC9855201 DOI: 10.4103/ajts.ajts_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/14/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Transfusion of ABO-compatible single donor platelets (SDP) is preferable for better outcomes over group switchover SDP. The use of SDP containing ABO-incompatible plasma is associated with a risk of allergic and acute hemolytic transfusion reactions. Moreover, high titer O group donors SDP impose a further threat to patient safety. Platelet additive solution (PAS) is used worldwide for the storage of platelets which reduces plasma volume available in SDP. SSP + (Macopharma) is one such PAS which can provide improved availability, logistical management, decrease wastage, and improvement in patient safety. The aim of this study was to assess the feasibility of using PAS to obtain low titer SDP units which can be utilized across a larger patient population and to study quality control parameters of these units. MATERIALS AND METHODS The study was performed in the department of Transfusion Medicine from June 2017 to January 2018 after clearance from the Institutional Review Board. The study design comprised two cohorts (A and B). In cohort A, the temporal trend of in-vitro changes in the quality parameters was tested and analyzed for PAS modified and unmodified products on days 1, 5 and 7. In cohort B, the original plasma from the SDP donors of all blood group donors except the AB group was tested for antibody titers before (prepreparation) and after modification (postpreparation) by PAS. RESULTS In cohort A, in the control group, there was a significant change in the mean platelet volume, potassium, and bicarbonate levels from day 1 to day 7, whereas no significant change in the biochemical parameters was noted in the study group where PAS was used. In cohort B, on comparing the anti-A and anti-B, before and after modification of SDP with PAS, there was a significant reduction in the median titers across all the groups studied. CONCLUSION PAS added SDP is an efficient strategy to reduce the ABO-antibody levels significantly. PAS added SDP also helps in the better inventory management of available groups.
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Affiliation(s)
- Mohit Chowdhry
- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Soma Agrawal
- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Bindu Prakash
- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Uday Kumar Thakur
- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Manoj Mishra
- Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, India
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5
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Chopra P, Bhardwaj S, Samkaria A, Amoli A, Arora A. Evaluation of Erythrocytes Magnetized Technology for Measurement of ABO Isoagglutinin Titers. J Lab Physicians 2021; 14:132-138. [PMID: 35982875 PMCID: PMC9381308 DOI: 10.1055/s-0041-1732808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background
A variation in the measurement of ABO antibody titer has been seen among different laboratories due to lack of standardization. In our study, we aim to evaluate automated ABO isoagglutinin titer measurements by erythrocytes magnetized technology (EMT) and compare with conventional tube technique (TT).
Methods
We performed ABO isoagglutinin titration on samples received in a reference laboratory during a period of 2 months. A total of 134 tests for immunoglobulin G (IgG) titer and 116 for immunoglobulin M (IgM) for anti-A or anti-B were included in the study. Samples were processed for ABO isoagglutination titers by both TT and EMT by QWALYS-3 (DIAGAST, France). Microsoft Excel was used to compile data, for all calculations, and to draw graphs and plots. The number and percentage of cases within ±1, ±2, or ±3 titer difference (TT-EMT) were calculated.
Results
Median titers and their ranges obtained by EMT were higher or equal to those by TT for all IgM and IgG ABO-antibodies in all blood group (BGs), except anti-A IgM in (BG) O that was lower by EMT (32 [4:128]) than TT (48 [8:256]). One twenty one (121/134, 90.3%) cases of IgG titer showed an agreement by both methods (within ± one titer difference). One hundred seven cases (107/116, 92.2%) for IgM titer were within one titer difference by both the methods.
Conclusion
Results of titration by EMT-based automated instrument QWALYS-3 and conventional TT may vary by one titer dilution in the majority of cases. Use of consistent method for patient management is, therefore, advised.
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Affiliation(s)
- Parul Chopra
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunanda Bhardwaj
- Department of Hematology and Immunology, Dr. Lal PathLabs Ltd., National Reference Lab, New Delhi, India
| | | | - Asha Amoli
- Department of Hematology and Immunology, Dr. Lal PathLabs Ltd., National Reference Lab, New Delhi, India
| | - Anil Arora
- Department of Hematology and Immunology, Dr. Lal PathLabs Ltd., National Reference Lab, New Delhi, India
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6
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Cardigan R, New HV, Estcourt L, Zhiburt E, Dubey R, Bengtsson J, Jöud M, Castillo C, Cid J, Lozano M, Gounder D, Flanagan P, Morley S, Clarke G, Devine D, Hindawi S, AlOtaibi A, Bub CB, Kutner JM, Ikeda T, Goto N, Okazaki H, Fontaine MJ, Pasion J, Song L, Latham T, Kerkhoffs JL, de Haas M, Zwaginga JJ, Gathof BS, Ommer K, Pirenne F, Raba M, Francois A, Daly J, Powley T, Dunbar N. International Forum on Policies and Practice for Transfusion of ABO and RhD Non-Identical Platelets: Summary. Vox Sang 2021; 117:136-144. [PMID: 34258783 DOI: 10.1111/vox.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023]
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7
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Reeves HM, Goodhue Meyer E, Harm SK, Lieberman L, Pyles R, Rajbhandary S, Whitaker BI, Delaney M. Neonatal and pediatric blood bank practice in the United States: Results from the AABB pediatric transfusion medicine subsection survey. Transfusion 2021; 61:2265-2276. [PMID: 34110629 DOI: 10.1111/trf.16520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/05/2021] [Accepted: 04/21/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are limited standards guiding the selection and processing of blood components specific for neonatal and pediatric transfusions. Therefore, blood banks (BBs) and transfusion services must create their own policies and procedures. STUDY DESIGN AND METHODS The American Association of Blood Banks (AABB) Pediatric Transfusion Medicine Subsection Committee developed a 74-question survey to capture neonatal and pediatric BB practices in the United States. RESULTS Thirty-five centers completed the survey: a response rate 15.8%. Responses indicated that most carry a mixed inventory of red blood cells (RBCs); 94.2% allow more than one type of RBC product for small-volume (SV) and large-volume (LV) transfusions to neonatal and pediatric patients. Many had storage age thresholds for RBCs transfused to neonates (SV = 60%, LV = 67.7%) but not older pediatric patients. The use of Group O for nonurgent RBC transfusion in neonates was common (74.2%). Responses related to special processing of RBCs and platelets indicated that 100% RBC and platelets are leukocyte-reduced (LR) for neonates and 97% for non-neonates. Irradiation of RBCs and platelets was commonly performed for neonatal transfusion (88.6%). Providing cytomegalovirus (CMV) seronegative products, volume reduction, and washing were variable. All centers transfused single-donor apheresis platelets; 20% allowed pathogen reduction (PR). The majority of centers have strategies limiting the amount of incompatible plasma transfused; however, few titrate ABO isoagglutinins in plasma-containing products (20% for platelets and 9.1% for plasma). CONCLUSIONS Variability exists in BB practice for neonatal and pediatric transfusion. Future studies are needed to understand and define best BB practices in these patient populations.
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Affiliation(s)
- Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Erin Goodhue Meyer
- American Red Cross Biomedical Services, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah K Harm
- University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Ryan Pyles
- SSM Health Cardinal Glennon Children's Hospital, Fenton, Missouri, USA
| | | | - Barbee I Whitaker
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine Division, Children's National Medical Center, Washington, DC, USA.,Pathology and Pediatrics Departments, The George Washington University, Washington, DC, USA
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8
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Impacts of ABO-incompatible platelet transfusions on platelet recovery and outcomes after intracerebral hemorrhage. Blood 2021; 137:2699-2703. [PMID: 33649761 DOI: 10.1182/blood.2020008381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Acute platelet transfusion after intracerebral hemorrhage (ICH) given in efforts to reverse antiplatelet medication effects and prevent ongoing bleeding does not appear to improve outcome and may be associated with harm. Although the underlying mechanisms are unclear, the influence of ABO-incompatible platelet transfusions on ICH outcomes has not been investigated. We hypothesized that patients with ICH who receive ABO-incompatible platelet transfusions would have worse platelet recovery (using absolute count increment [ACI]) and neurological outcomes (mortality and poor modified Rankin Scale [mRS 4-6]) than those receiving ABO-compatible transfusions. In a single-center cohort of consecutively admitted patients with ICH, we identified 125 patients receiving acute platelet transfusions, of whom 47 (38%) received an ABO-incompatible transfusion. Using quantile regression, we identified an association of ABO-incompatible platelet transfusion with lower platelet recovery (ACI, 2 × 103cells per μL vs 15 × 103cells per μL; adjusted coefficient β, -19; 95% confidence interval [CI], -35.55 to -4.44; P = .01). ABO-incompatible platelet transfusion was also associated with increased odds of mortality (adjusted odds ratio [OR], 2.59; 95% CI, 1.00-6.73; P = .05) and poor mRS (adjusted OR, 3.61; 95% CI, 0.97-13.42; P = .06); however, these estimates were imprecise. Together, these findings suggest the importance of ABO compatibility for platelet transfusions for ICH, but further investigation into the mechanism(s) underlying these observations is required.
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9
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Inoue H, Sakamoto R, Nishimiya H, Sakamoto H, Terasu S, Aminaka R, Koh Y, Takihara Y, Hirayama F, Kuroishi A. Minor impact of patient alloantibodies against human platelet antigen (HPA)-15 in the effectiveness of platelet transfusion: A pilot study. Transfusion 2020; 61:738-743. [PMID: 33166416 DOI: 10.1111/trf.16181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alloantibodies against human platelet antigen (HPA)-15 are sometimes detected in patients with platelet transfusion refractoriness (PTR); however, little is known about their impact on PTR. STUDY DESIGN AND METHODS Two patients who possessed HPA-15 alloantibodies (Patient 1, anti-HPA-15b; Patient 2, anti-HPA-15a) and human leukocyte antigen (HLA) antibodies were enrolled. The efficacy of HPA-15-compatible vs -incompatible platelet transfusion was compared by focusing on ABO- and HLA-matched transfusions on the basis of the 24-hour corrected count increment (CCI-24 hours) for platelets. The titers of HPA-15 antibodies in the patients' sera were also monitored. RESULTS The patients received 71 and 12 ABO-compatible, HLA-matched platelet transfusions, respectively, during the monitoring periods. Among these transfusions, CCI-24 hours could be calculated in 27 and 10 transfusions, respectively, and the HPA-15 genotype of the donors was determined. There were no significant differences in the CCI-24 hours between the HPA-15 compatible and incompatible transfusions in both patients (P = .30 and .56, respectively, Mann-Whitney U test). There was no significant change in the HPA-15b antibody titer in Patient 1 during the monitoring period, while the HPA-15a antibody level in Patient 2 was undetectable at the end of the monitoring period, although the titer was low at the beginning. CONCLUSION The efficacy of HPA-15-incompatible platelet transfusions was not necessarily inferior to that of HPA-15 compatible ones. Although the case number was limited, our results suggest that HPA-15 antibodies do not have a significant impact on the effects of platelet transfusion.
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Affiliation(s)
- Hiroko Inoue
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Rumi Sakamoto
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | | | - Hiroe Sakamoto
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Shota Terasu
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Ryota Aminaka
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Yangsook Koh
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | | | | | - Ayumu Kuroishi
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
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Valsami S, Pouliakis A, Gavalaki M, Argyrou A, Triantafillou E, Arvanitopoulou E, Girtovitis F, Voulgaridou V, Megalou A, Chronopoulou P, Papachronis A, Sakellarakis G, Zervou E, Batsi C, Fountouli K, Athanasopoulos A, Kyriakou E, Cheropoulou A, Livada A, Lebessopoulos K, Papakonstantinou M, Gafou A, Katopi D, Martinis G, Dendrinou I, Katharopoulou H, Politou M, Papadopoulou M, Papadopoulou P, Manaka E, Paneta K, Alepi C, Damaskos C, Garmpis N, Stamoulis K, Grouzi E. Platelets transfusion in Greece: Where, when, why? A national survey. Asian J Transfus Sci 2020; 14:158-166. [PMID: 33767543 PMCID: PMC7983137 DOI: 10.4103/ajts.ajts_72_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Platelet transfusion is among the most useful therapeutic tools in modern clinical settings which mean that ensuring an adequate supply is of paramount importance. AIM The aim of our study was to record the use and wastage of platelet concentrates (PCs) in Greece, so as to come up with evidence-based interventions. METHODS The study was conducted during May and June 2015. We evaluated the use of random-donor platelets (RDPs) and single-donor apheresis platelets (SDPs). We analyzed such parameters as hospital department and diagnosis, indication for transfusion, PCs' age at the time of transfusion, and wastage rate. RESULTS We used data from 21 hospitals across the country. A total of 12,061 RDPs and 1189 SDPs were transfused, with an average of 4.84 (±2.72) and 1.12 (±2.73) units per episode, respectively. Most patients had been admitted to the internal medicine and hematology departments. The transfusions were mostly given prophylactically, usually in cases of acute leukemia, and mostly on the day before expiration. Wastage rate was 16.75% for RPDs and 2.70% for SDPs, primarily because of the expiration of the use-by date. CONCLUSIONS This is the first national survey regarding platelet transfusion in Greece. Since most patients were admitted in internal medicine and hematology departments, we recommend that the staff of the abovementioned departments should undergo training on contemporary transfusion guidelines. Platelet discard rate could further be lowered through the centralization of inventory management along with the extension of the lifetime of PCs by means of emerging technologies.
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Affiliation(s)
- Serena Valsami
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Patras, Greece
| | - Maria Gavalaki
- Department of Blood Transfusion, Laiko General Hospital, Patras, Greece
| | - Aspasia Argyrou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | | | | | - Fotios Girtovitis
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Virginia Voulgaridou
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Megalou
- Department of Blood Transfusion, Evangelismos Hospital, Patras, Greece
| | | | | | | | - Eleftheria Zervou
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Christina Batsi
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Kalliopi Fountouli
- Department of Blood Transfusion, University Hospital of Heraklion, Heraklion, Greece
| | | | - Elias Kyriakou
- Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, National and Kapodistrian Athens, Patras, Greece
| | | | - Anastasia Livada
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
| | | | | | - Anthi Gafou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | - Despina Katopi
- Department of Blood Transfusion, General Hospital Alexandra, Patras, Greece
| | - George Martinis
- Department of Blood Transfusion, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioanna Dendrinou
- Department of Blood Transfusion, General Hospital Nea Ionia “Agia Olga”, Patras, Greece
| | - Hrysanthi Katharopoulou
- Department of Blood Transfusion, “Hatzikosta” General Hospital of Ioannina, Ioannina, Greece
| | - Marianna Politou
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | | | | | - Ekaterini Manaka
- Department of Blood Transfusion, General Hospital of Messologgi, Messologgi, Greece
| | - Konstantina Paneta
- Department of Blood Transfusion, General Hospital of Pirgos, Pirgos, Greece
| | - Chrissoula Alepi
- Department of Blood Transfusion, General Hospital “Tzaneio” of Piraeus, Patras, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | | | - Elisavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
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11
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Solves Alcaina P. Platelet Transfusion: And Update on Challenges and Outcomes. J Blood Med 2020; 11:19-26. [PMID: 32158298 PMCID: PMC6986537 DOI: 10.2147/jbm.s234374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022] Open
Abstract
Platelet transfusion is a common practice in onco-hematologic patients for preventing or treating hemorrhages. Platelet concentrates can be transfused with therapeutic or prophylactic purposes. With the aim to help clinicians to take the decisions on platelet transfusion, some guidelines have been developed based on the current scientific evidence. However, there are some controversial issues and available scientific evidence is not enough to solve them. There is little information about what is the best platelet product to be transfused: random platelets or single donor apheresis platelets, and plasma-suspended or additive solution suspended platelets. Platelets are often transfused without respecting the ABO compatibility, but influence of this practice on platelet transfusion outcome is not well established. In the prophylactic platelet transfusion set there are some questions unsolved as the platelet threshold to transfuse prior to specific procedures or surgery, and even if platelet transfusion is necessary for some specific procedures as autologous hematopoietic stem cell transplantation. A challenging complication raised from multiple platelet transfusions is the platelet transfusion refractoriness. The study and management of this complication is often disappointing. In summary, although it is a widespread practice, platelet transfusion has still many controversial and unknown issues. The objective of this article is to review the current evidence on platelet transfusion practices, focusing on the controversial issues and challenges.
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Affiliation(s)
- Pilar Solves Alcaina
- Blood Bank, Hematology Service, Hospital Universitari I Politècnic La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
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12
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Gottschall J, Wu Y, Triulzi D, Kleinman S, Strauss R, Zimrin AB, McClure C, Tan S, Bialkowski W, Murphy E, Ness P. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion 2019; 60:46-53. [PMID: 31850522 DOI: 10.1111/trf.15637] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the Recipient and Donor Epidemiology Study-III (REDS-III) recipient and donor databases, we performed a retrospective analysis of platelet use in 12 US hospitals that were participants in REDS-III. STUDY DESIGN AND METHODS Data were electronically extracted from participating transfusion service and blood center computer systems and from medical records of the 12 REDS-III hospitals. All platelet transfusions from 2013 to 2016 given to patients aged 18 years and older were included in the analysis. RESULTS There were 28,843 inpatients and 2987 outpatients who were transfused with 163,719 platelet products (103,371 apheresis, 60,348 whole blood derived); 93.5% of platelets were leukoreduced and 72.5% were irradiated. Forty-six percent were transfused to patients with an International Classification of Diseases, 9th/10th Revision (ICD-9/10) diagnosis of leukemia, myelodysplastic syndrome (MDS), or lymphoma. The general ward and the intensive care unit (ICU) were the most common issue locations. Only 54% of platelet transfusions were ABO identical; and 60.6% of platelet transfusions given to Rh-negative patients were Rh positive. The most common pretransfusion platelet count range for inpatients was 20,000 to 50,000/μL, for outpatients it was 10,000 to 20,000/μL. Among ICU patients, 35% of platelet transfusion episodes had a platelet count of greater than 50,000/μL; this was only 8% for general ward and 2% for outpatients. The median posttransfusion increment, not corrected for platelet dose and/or patient size, ranged from 12,000 to 20,000/μL for inpatients, and from 17,000 to 27,000/μL for outpatients. CONCLUSIONS These data from one of the largest reviews of platelet transfusion practice to date provide guidance for where to focus future clinical research studies and platelet blood management programs.
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Affiliation(s)
| | - YanYun Wu
- Bloodworks Northwest, Seattle, Washington
| | | | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald Strauss
- LifeSource/Institute for Transfusion Medicine, Chicago, Illinois
| | | | | | - Sylvia Tan
- RTI International, Raleigh, North Carolina
| | | | - Edward Murphy
- University of California San Francisco, San Francisco, California
| | - Paul Ness
- Johns Hopkins University, Baltimore, Maryland
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13
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Gavva C, Barroso J, Gernsheimer T, Metcalf RA, Warner P, Pagano MB. Response to random apheresis platelets versus HLA-selected platelets versus pooled platelets in HLA-sensitized patients. Transfusion 2019; 59:2276-2281. [PMID: 31032968 DOI: 10.1111/trf.15333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is unknown how pooled platelets (PPs) compare to random apheresis platelets (RAPs) when HLA-selected platelets (PLTs) are unavailable for HLA-sensitized patients. The aim of this study was to compare patient responses to RAPs, HLA-selected PLTs, and PPs in HLA-sensitized patients. STUDY DESIGN AND METHODS This is a single-institution retrospective study of patients from January 2014 to April 2017 with a class I calculated panel-reactive antibody of 60% or more. Response to transfusion was determined by a corrected count increment (CCI) up to 1 hour after completion of transfusion. A CCI of 5 or more was considered successful. RESULTS Seventy-seven units of RAPs, 412 units of HLA-selected PLT, and 388 units PPs were transfused. Mean CCIs when transfusing RAPs, HLA-selected PLTs, and PPs were 2.82, 11.44, and 4.77, respectively (p < 0.0001). Posttest comparison between RAPs and PPs revealed no significant difference in mean CCI while there was a significant difference between HLA-selected PLTs versus RAPs and HLA-selected PLTs versus PPs. The success rates of RAPs, HLA-selected PLTs, and PPs were 31%, 80%, and 35% respectively. There was no significant association of type of PLT and success rate when comparing RAPs versus PPs (p = 0.51) while there was a significant association between success rate and type of PLT transfusion when comparing HLA-selected PLTs with RAPs and PPs. CONCLUSION HLA-selected PLTs resulted in higher mean CCIs and more successful transfusions. There was no significant difference in mean CCI or success rate when transfusing RAPs versus PPs to HLA-sensitized patients. Future studies should assess clinical outcomes in HLA-sensitized patients receiving each type of PLT product.
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Affiliation(s)
- Chakri Gavva
- Pathology Associates of Albuquerque, Albuquerque, New Mexico.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington.,Bloodworks Northwest, Seattle, Washington
| | - Jeffrey Barroso
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Terry Gernsheimer
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Ryan A Metcalf
- ARUP Laboratories, University of Utah, Salt Lake City, Utah
| | | | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
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14
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Beddard R, Ngamsuntikul S, Wafford T, Aranda L. Immunoglobulin M anti-A and anti-B titers in South Texas group O D+ male donors. Transfusion 2019; 59:2207-2210. [PMID: 30897224 DOI: 10.1111/trf.15273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND The success of whole blood (WB) in damage control resuscitation on the battlefield has generated interest in its use for civilian trauma. Blood centers must maintain a committed donor pool with low isoagglutinin titers to provide this product. Information regarding isoagglutinin titers in different donor populations will help with targeted recruitment of these donors. STUDY DESIGN AND METHODS Sequential O D+ male donors with a history of two or more donations at a fixed site were tested for immunoglobulin (Ig)M anti-A and anti-B using a single titer cutoff of 256. Donors testing negative at this cutoff were considered "low titer" while positive donors were considered "high titer." Age and self-identified race/ethnicity were retrospectively obtained from the blood establishment computer system. Fisher's exact analysis was used for statistical analysis with a p value of less than 0.05 considered significant. RESULTS Of 3274 donors, 426 tested as high titer, while 2848 tested as low titer. The data show an association of donor age and prevalence of high titers with older age groups showing a lower prevalence of high titers. In addition, different races/ethnicities have different prevalences of high titers with the Caucasian/white group showing a lower prevalence of high-titer donors versus the Hispanic and undeclared race groups. CONCLUSION The prevalence of high-titer IgM anti-A or -B donors varies by age group and race/ethnicity in our data set. This information will provide information on what donor groups to target for collection of low-titer O WB.
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Affiliation(s)
| | | | - Tiffany Wafford
- Immunohematology Reference Laboratory, QualTex Laboratories, San Antonio, Texas
| | - Lorena Aranda
- Immunohematology Reference Laboratory, QualTex Laboratories, San Antonio, Texas
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15
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Nellis ME, Goel R, Karam O, Cushing MM, Davis PJ, Steiner ME, Tucci M, Stanworth SJ, Spinella PC. Effects of ABO Matching of Platelet Transfusions in Critically Ill Children. Pediatr Crit Care Med 2019; 20:e61-e69. [PMID: 30422914 PMCID: PMC6709973 DOI: 10.1097/pcc.0000000000001779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. DESIGN Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. SETTING Eighty-two PICUs in 16 countries. PATIENTS Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). CONCLUSIONS No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
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Affiliation(s)
- Marianne E Nellis
- Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Peter J Davis
- Paediatric Intensive Care Unit, Department of Pediatrics, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marie E Steiner
- Divisions of Pediatric Critical Care and Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Marisa Tucci
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Philip C Spinella
- Department of Pediatrics, Division Critical Care, Washington University in St Louis, St Louis, MO
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16
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Rajadhyaksha BS, Desai DP, Navkudkar AA. Platelet refractoriness. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_45_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Doughty H, Rackham R. Transfusion emergency preparedness for mass casualty events. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant; Birmingham UK
- NIHR Surgical Reconstruction and Microbiology Research Centre; Queen Elizabeth Hospital; Birmingham UK
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18
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Potential impact of complement regulator deficiencies on hemolytic reactions due to minor ABO-mismatched transfusions. Blood Adv 2017; 1:1977-1982. [PMID: 29296844 DOI: 10.1182/bloodadvances.2017008805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022] Open
Abstract
Minor ABO-mismatched transfusions are a common occurrence, although infrequent transfusion reactions occur. We sought to investigate the regulation of complement C3 activation induced by anti-A. In vitro complement C3 activation was observed with 10 of 30 group O samples and correlated with immunoglobulin M (IgM) anti-A titers. We developed an in vitro paroxysmal nocturnal hemoglobinuria (PNH) model of hemolysis in which group A1 red blood cells (RBCs) were chemically treated with 2-aminoethylisothiouronium (AET) to alter regulators of complement C3 activation. Intravascular hemolysis was simulated by incubating an IgG nonhemolytic group O plasma (titer = 32) with A1 RBCs. IgG was detected on the RBCs, but hemolysis was observed with AET-treated RBCs only. When treated and untreated RBCs were tested together (1:4), we determined that the failure to observe C3b/d deposition on RBCs was due to the complete hemolysis of the AET-treated minor RBC population. A group O patient with a 9% CD59-deficient PNH clone was sensitized with an IgM anti-I. Hemolysis, with a weak positive direct antiglobulin test (DAT) resulting from C3b/d, was observed after incubation with fresh AB serum. Flow cytometry showed an 86% reduction of the PNH clone. Our work indicates that the transfusion of minor ABO-mismatched plasma could cause hemolysis with a negative DAT C3b/d. We propose that the presence of a PNH clone is 1 possible cause of unexplained anemia for recipients of ABO-mismatched product. This work suggests that other acquired or inherited defects of decay-accelerating factor and membrane inhibitor of reactive lysis could be responsible for infrequent but clinically important hemolysis after ABO-mismatched transfusions.
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19
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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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20
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Transfusion of ABO non-identical platelets does not influence the clinical outcome of patients undergoing autologous haematopoietic stem cell transplantation. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:411-6. [PMID: 25761311 DOI: 10.2450/2015.0195-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are ABO antigens on the surface of platelets, but whether ABO compatible platelets are necessary for transfusions is a matter of ongoing debate. We retrospectively reviewed the ABO matching of platelet transfusions in a subset of patients undergoing autologous haematopoietic progenitor cell transplantation during a 14-year period. Our aim was to analyse the characteristics and outcomes of patients who received platelet transfusions that were or were not ABO identical. MATERIAL AND METHODS We analysed 529 consecutive patients with various haematological and non-haematological diseases who underwent 553 autologous progenitor stem cell transplants at the University Hospital la Fe between January 2000 and December 2013. We retrospectively analysed and compared transfusion and clinical outcomes of patients according to the ABO match of the platelet transfusions received. The period analysed was the time from transplantation until discharge. RESULTS The patients received a total of 2,772 platelet concentrates, of which 2,053 (74.0%) were ABO identical and 719 (26.0%) ABO non-identical; of these latter 309 were compatible and 410 incompatible with the patients' plasma. Considering all transplants, 36 (6.5%) did not require any platelet transfusions, while in 246 (44.5%) cases, the patients were exclusively transfused with ABO identical platelets and in 47 (8.5%) cases they received only ABO non-identical platelet transfusions. The group of patients who received both ABO identical and ABO non-identical platelet transfusions had higher transfusion needs and worse clinical outcomes compared to patients who received only ABO identical or ABO non-identical platelets. DISCUSSION In our hospital, patients undergoing autologous haematopoietic stem cell transplantation who received ABO identical or ABO non-identical platelet transfusions had similar transfusion and clinical outcomes. The isolated fact of receiving ABO non-identical platelets did not influence morbidity or survival.
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21
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Katus MC, Szczepiorkowski ZM, Dumont LJ, Dunbar NM. Safety of platelet transfusion: past, present and future. Vox Sang 2014; 107:103-13. [PMID: 24650183 DOI: 10.1111/vox.12146] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/31/2014] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
Platelet components became routinely available to many institutions in the late 1960s and since then utilization has steadily increased. Platelets are produced by three principal methods and their manufacturing process is regulated by multiple agencies. As the field of platelet transfusion has evolved, a broad array of strategies to improve platelet safety has developed. This review will explore the evolution of modern platelet component therapy, highlight the various risks associated with platelet transfusion and describe risk reduction strategies that have been implemented to improve platelet transfusion safety. In closing, the reader will be briefly introduced to select investigational platelet and platelet-mimetic products that have the potential to enhance platelet transfusion safety in the near future.
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Affiliation(s)
- M C Katus
- Department of Pathology, Transfusion Medicine Service, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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22
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Cid J, Harm SK, Yazer MH. Platelet transfusion - the art and science of compromise. Transfus Med Hemother 2013; 40:160-71. [PMID: 23922541 PMCID: PMC3725020 DOI: 10.1159/000351230] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
SUMMARY 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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Affiliation(s)
- Joan Cid
- Apheresis Unit, Department of Hemotherapy-Hemostasis, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah K. Harm
- Department of Pathology, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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23
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Abstract
PURPOSE OF REVIEW The importance of ABO blood group system compatibility in platelet transfusion is a subject of ongoing debate. Although there are theoretical advantages to pursuing a strict policy of providing exclusively ABO-compatible products, resource challenges may make this untenable for many transfusion services. Moreover, data supporting a net clinical benefit for this practice have been lacking. This review summarizes recent developments in the area of ABO compatibility and platelet transfusion and examines the risks and benefits associated with transfusion practices allowing for platelet ABO incompatibility. RECENT FINDINGS ABO-major incompatible transfusions are associated with lower platelet count increments than either ABO identical or minor incompatible transfusions and may lead to decreased intervals between platelet transfusions in thrombocytopenic patients. ABO-minor incompatible transfusions may rarely result in acute hemolytic reactions that are not predicted by isohemagglutinin titers. Yet published evidence to date does not clearly demonstrate improvements in clinical outcomes for patients receiving ABO-identical or ABO-compatible platelets. Adherence to a strict policy of transfusing exclusively ABO-identical platelets may lead to an increase in product wastage and challenges in maintaining adequate platelet availability. SUMMARY There is presently limited data and no consensus on the best approach for managing ABO compatibility in platelet transfusions. Well designed, sufficiently powered randomized clinical trials are urgently needed. These studies must examine not only safety and efficacy of various ABO matching strategies but also clinical benefit and resource utilization in order to identify optimal platelet transfusion strategies.
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24
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Berséus O, Boman K, Nessen SC, Westerberg LA. Risks of hemolysis due to anti-A and anti-B caused by the transfusion of blood or blood components containing ABO-incompatible plasma. Transfusion 2013; 53 Suppl 1:114S-123S. [PMID: 23301963 DOI: 10.1111/trf.12045] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The increasing use of fresh blood group O whole blood in acute trauma medicine makes it important to reevaluate the issue of hemolytic reactions related to the transfusion of ABO-incompatible plasma. STUDY DESIGN AND METHODS This review summarizes and evaluates published articles and case reports concerning hemolytic reactions in connection with the transfusion of group O whole blood or blood products to nongroup O recipients. RESULTS In 1945-1986, 15 nonmilitary publications reported hemolytic transfusion reactions with group O blood/blood products. All patients recovered except for two fatalities. Late in World War II and during the Korean and Vietnam wars and onward in Iraq and Afghanistan only "low anti-A, anti-B titer" group O whole blood has been used as universal blood. In spite of a large number of units transfused, there are no reports of hemolytic reactions. Twenty-five publications report hemolytic reactions after transfusion of group O platelets to nongroup O recipients. In all patients but one, the titer of the implicated A- or B-antibody was >100 (saline) or >400 (antiglobulin) and all cases with an infused volume of incompatible plasma <200 mL were related to anti-A or anti-B antiglobulin titers >1000. CONCLUSION In emergency lifesaving resuscitation, the risk of hemolytic transfusion reactions from transfusion of group O blood to nongroup O recipients constitutes risk that is outweighed by the benefits. A low titer of anti-A/B will minimize the risk for a hemolytic reaction, particularly if the screening is repeated after an immunization episode, e.g., blood transfusion, vaccination, or pregnancy.
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Affiliation(s)
- Olle Berséus
- Department of Transfusion Medicine, Örebro University Hospital, Örebro, Sweden.
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25
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Quillen K. Hemolysis from platelet transfusion: call to action for an underreported reaction. Transfusion 2012; 52:2072-4. [DOI: 10.1111/j.1537-2995.2012.03839.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Luban NL, McBride E, Ford JC, Gupta S. Transfusion medicine problems and solutions for the pediatric hematologist/oncologist. Pediatr Blood Cancer 2012; 58:1106-11. [PMID: 22238206 PMCID: PMC3328596 DOI: 10.1002/pbc.24077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/21/2011] [Indexed: 01/19/2023]
Abstract
Blood component transfusion is an integral part of the care of children with oncologic and hematologic conditions. The complexity of transfusion medicine may however lead to challenges for pediatric hematologists/oncologists. In this review, three commonly encountered areas of transfusion medicine are explored. The approach to the investigation and management of suspected platelet refractoriness is reviewed. The unique transfusion related challenges encountered by children undergoing stem cell transplantation are also discussed. Finally, issues arising out of the care of children with hemoglobinopathies are explored, with an emphasis on the incidence of allo- and autoimmunization.
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Affiliation(s)
- Naomi L.C. Luban
- Division of Laboratory Medicine and Hematology, Children’s National, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Eileen McBride
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Jason C. Ford
- Department of Pathology and Laboratory Medicine, B.C. Children’s Hospital and the University of British Columbia, Vancouver, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
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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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28
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Delaney M, Warner P, Nelson K, Gleckler C, Price T, Madeleine M. Humoral immunomodulatory effect of influenza vaccine in potential blood donors: implications for transfusion safety. Transfus Med 2011; 21:378-84. [DOI: 10.1111/j.1365-3148.2011.01097.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fontaine MJ, Kuo J, Chen G, Galel SA, Miller E, Sequeira F, Viele M, Goodnough LT, Tyan DB. Complement (C1q) fixing solid-phase screening for HLA antibodies increases the availability of compatible platelet components for refractory patients. Transfusion 2011; 51:2611-8. [DOI: 10.1111/j.1537-2995.2011.03194.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Abstract
Single-donor hyperconcentrated plateletapheresis (dry-platelets) collection has been introduced in the 90's as a part of the newly developed multi-component collection strategy. This approach allowed to safely collect multiple components from a single apheresis donation, i.e. RBC, FFP and/or plateletpheresis units. Dry-platelets are usually resuspended in additive solution to maintain an adequate pH during the storage period until use. Some concern existed about possible higher degrees of platelet activation in dry-platelets units when compared to standard concentration (1.0-1.6 × 10(6)/μL platelets) units and its possible correlation with lower in vivo efficiency and/or survival of the former units. Several authors investigated this specific issue, and dry-platelets units proved to be equally effective than standard concentration plateletpheresis units in recipients. The use of dry-platelets units may reduce (i) the risk of passive infusion of naturally occurring ABO-related hemolytic antibodies when donor O platelets are given to group A, B, or AB recipient, (ii) the risk of TRALI when multiparous donors undergo plateletpheresis. Furthermore, dry-platelet collection may allow for an increased amount of FFP sent to industry. Finally, hyperconcentrated platelet units may be used for "niche" indications, such as intrauterine platelet transfusion or, in case of autologous dry-platelet collection, for further freezing for long term storage in selected patients within onco-hematological settings.
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