title: Significant numbers of apheresis-derived group O platelet units have "high-titer" anti-A/A,B: implications for transfusion policy.
abstract: Transfusion of group O single-donor apheresis PLTs (SDP) to group A recipients has resulted in intravascular hemolysis and mortality. Owing to low availability of type-specific SDPs, transfusion services sometimes issue ABO-mismatched PLTs. After observing two cases of acute hemolysis following infusion of O SDPs to group A patients, where both recipient eluates revealed anti-A specificity, a prospective study to determine the prevalence of "high-titer" anti-A/A,B in group O SDPs was commenced. One hundred group O SDP samples were tested. Titers of at least 64 and/or 256 from either buffered (generally reflective of IgM antibodies) or anti-IgG gel cards, respectively, were considered critically high. Twenty-eight and 39 percent of samples revealed critically high anti-A/A,B IgM and IgG titers, respectively. IgM titers were at 1:64 (18%), 128 (6%), and 256 (4%), whereas IgG titers were at 1:256 (28%), 512 (7%), 1024 (2%), and 2048 (2%). The prevalence of critical anti-A/A,B titers in group O SDPs is relatively high. Thus, the risk of minor side ABO mismatch and potential intravascular hemolysis during group O SDP transfusion to group A recipients may be significant. Based on these data, a policy was instituted to test anti-A/A,B titers in O SDPs prior to "out-of-group" transfusion.
authors.affiliation: Transfusion Medicine Program, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA. cjoseph@emory.edu
authors.forename: C D
authors.initials: CD
authors.lastname: Josephson
authors.forename: N C
authors.initials: NC
authors.lastname: Mullis
authors.forename: C
authors.initials: C
authors.lastname: Van Demark
authors.forename: C D
authors.initials: CD
authors.lastname: Hillyer
mesh_terms: D000017:ABO Blood-Group System / Q000032:analysis* / Q000276:immunology; D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology* / Q000517:prevention & control; D000918:Antibody Specificity; D001787:Blood Group Incompatibility / Q000150:complications* / Q000276:immunology / Q000628:therapy; D001793:Blood Preservation; D001803:Blood Transfusion; D003362:Cost-Benefit Analysis; D006388:Hemagglutinins / Q000097:blood* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007938:Leukemia / Q000097:blood / Q000628:therapy; D016134:Organizational Policy; D010949:Plasma / Q000276:immunology; D017713:Platelet Transfusion / Q000009:adverse effects* / Q000191:economics; D010983:Plateletpheresis; D012306:Risk
chemical_list: D000017:ABO Blood-Group System; D006388:Hemagglutinins; D007074:Immunoglobulin G; D007075:Immunoglobulin M