title: ABO-immune complex formation and impact on platelet function, red cell structural integrity and haemostasis: an in vitro model of ABO non-identical transfusion.
abstract: BACKGROUND
  Transfusion of ABO non-identical platelets has been associated with fatal haemolytic reactions, increased red cell transfusion needs and other adverse effects, but the practice of ABO matching in platelet transfusion is controversial. Immune complexes can be formed from the anti-A and/or anti-B antibodies and ABO soluble antigen(s) present in donor and recipient plasma after ABO non-identical transfusions. We hypothesized that these immune complexes affect recipient red cell structural integrity, platelet function and haemostasis.
  
  
  METHODS
  Haemolysis, platelet function and haemostatic function were assessed before and after incubation of recipient red cells, platelets and whole blood with normal saline controls, ABO-identical plasma controls or in vitro-generated ABO-immune complexes.
  
  
  RESULTS
  ABO-immune complexes caused significantly increased haemolysis (P < 0·001), inhibition of platelet function (P = 0·001) and disruption of clot formation kinetics (P < 0·005) in both group A and O recipient samples.
  
  
  CONCLUSIONS
  Substantial changes in platelet function, red cell integrity and haemostasis occur after in vitro exposure to immune complexes. These in vitro findings may explain, in part, previously observed associations of ABO non-identical platelet transfusions with adverse effects including increased red cell transfusion needs, organ failure and mortality.
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester Medicine, Rochester, NY, USA.|Department of Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Zaffuto
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Conley
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester Medicine, Rochester, NY, USA.|Department of Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Connolly
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: K F
authors.initials: KF
authors.lastname: Henrichs
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester Medicine, Rochester, NY, USA.|Department of Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Francis
authors.affiliation: James P. Wilmot Cancer Center, University of Rochester Medicine, Rochester, NY, USA.|Department of Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Heal
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Blumberg
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medicine, Rochester, NY, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Refaai
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000936:Antigen-Antibody Complex / Q000276:immunology*; D001777:Blood Coagulation; D001789:Blood Group Antigens / Q000276:immunology*; D001792:Blood Platelets / Q000378:metabolism*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000737:chemistry / Q000378:metabolism*; D006454:Hemoglobins / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D018448:Models, Immunological; D009102:Multiple Organ Failure / Q000209:etiology; D010974:Platelet Aggregation; D013916:Thrombelastography; D065227:Transfusion Reaction
chemical_list: D000017:ABO Blood-Group System; D000936:Antigen-Antibody Complex; D001789:Blood Group Antigens; D006454:Hemoglobins
keywords: haemolysis; immune complex; platelet aggregation; platelet transfusion; thromboelastography; transfusion complications