Transfusion of Platelets Containing Abo-Incompatible Plasma: A Survey of 3156 North American Laboratories (Report)

Transfusion of Platelets Containing Abo-Incompatible Plasma: A Survey of 3156 North American Laboratories (Report)

Platelet transfusions are indicated in patients with clinically significant bleeding attributable to thrombocytopenia or abnormal platelet function. Alternatively, prophylactic platelet transfusions may benefit severely thrombocytopenic patients in whom even small amounts of hemorrhage may be life-threatening (eg, in the central nervous system). (1) Under ideal circumstances, patients should receive ABO-identical platelets. However, when ABO-identical platelets are not available, there may be confusion and variation about the selection of non-ABO-identical platelet products. Platelets have on their surface the carbohydrate antigens of the ABO blood group. (2,3) The donor plasma associated with platelet concentrates contains naturally occurring antibodies against A or B antigens that are lacking in the donor. For example, a group A patient would have A antigen expression on his or her platelets and anti-B in his or her plasma. A group O patient would have no A or B antigen expression on platelets and anti-A, anti-B, and anti-A,B in plasma. Major ABO incompatibility of platelets refers to the presence of anti-A or anti-B in the patient or recipient that is incompatible with donor A or B antigens present on the surface of the transfused platelets (ie, group A donor platelets for a group O patient). (4) Minor ABO-incompatibility of platelets refers to the presence of anti-A or anti-B in the donor plasma that would be incompatible with the A or B antigens present on the patient’s own red blood cells (ie, group O donor platelets for a group A patient). (4) Of interest are the observations that platelets from [A.sub.2] donors lack detectable A antigen expression and therefore can be considered “universal.” (5) Both major and minor ABO incompatibility is minimized in [A.sub.2] donors; thus, [A.sub.2] could be considered a reasonable alternative to ABO-identical platelets. However, [A.sub.2] subgroup typing of group A platelet donors is not routinely performed.

Transfusion of Platelets Containing Abo-Incompatible Plasma: A Survey of 3156 North American Laboratories (Report)

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