title: Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence.
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.
  
  
  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.
authors: Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
authors: Kelly F
authors: KF
authors: Henrichs
authors: Nedda
authors: N
authors: Howk
authors: Debra S
authors: DS
authors: Masel
authors: Mark
authors: M
authors: Thayer
authors: Majed A
authors: MA
authors: Refaai
authors: Scott A
authors: SA
authors: Kirkley
authors: Joanna M
authors: JM
authors: Heal
authors: Neil
authors: N
authors: Blumberg
mesh_terms: D000017:ABO Blood-Group System; D001771:Blood Banks / Q000458:organization & administration / Q000706:statistics & numerical data; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001787:Blood Group Incompatibility / Q000453:epidemiology / Q000517:prevention & control*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005169:Factor VIII / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005340:Fibrinogen / Q000008:administration & dosage* / Q000009:adverse effects; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000097:blood; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D015397:Program Evaluation; D000094902:Blood Banking / Q000379:methods*
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen