Neil Blumberg

I should add the good news is that when one starts prioritizing ABO identical platelets over inventory management, one reduces the platelet transfusions needed by perhaps 50%.  So our platelet shortages will disappear in large part if we stick with ABO identical as much as possible.  See attached randomized trial from eons ago :).  ABO identical reduces transfusion reactions as well, HLA and rbc alloimmunization.  Not to mention decreasing bleeding and mortality.
ABO randomized trial UR european j haematology 1993 copy.pdf ABO plt tx revisited cumulative effects.pdf Platelet transfusion worsens ICH Stroke 2020 copy.pdf

Short answer would be any ABO type if a one time thing, along with a prayer card for no hemolysis or post-transfusion purpura.
 
You could make a case for type A as the anti-B is likely to be lower titer, lower biologic activity than the anti-A in group O platelets (unless low titer) or group B platelets. But this is largely theoretical hand waving.

When the major hematology and transfusion medicine textbooks acknowledge the data showing that ABO mismatched transfusions don't provide hemostasis, actually increase bleeding, and increase platelet transfusion refractoriness, then hematologists will change their approach.  Probably some time before the heat death of the universe. Instead, one major textbook quotes methodologically unsound data from a study that classified platelet transfusions as ABO identical based upon the first transfusion, even if large numbers of  ABO mismatched transfusions were subsequently given to that patient. Total scientific nonsense.  
No doubt medical education is also to blame. I've been here 42+ years and haven't been invited to give a single talk to medical students about transfusions for many years (this is changing in 2023).  The curriculum bears little resemblance to what physicians need to know, unfortunately.  Highly dysfunctional when the single most frequently performed inpatient procedure, transfusion, doesn't have a major role in the curriculum. Ah well.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

When the major hematology and transfusion medicine textbooks acknowledge the data showing that ABO mismatched transfusions don't provide hemostasis, actually increase bleeding, and increase platelet transfusion refractoriness, then hematologists will change their approach.  Probably some time before the heat death of the universe. Instead, one major textbook quotes methodologically unsound data from a study that classified platelet transfusions as ABO identical based upon the first transfusion, even if large numbers of  ABO mismatched transfusions were subsequently given to that patient. Total scientific nonsense.  
No doubt medical education is also to blame. I've been here 42+ years and haven't been invited to give a single talk to medical students about transfusions for many years (this is changing in 2023).  The curriculum bears little resemblance to what physicians need to know, unfortunately.  Highly dysfunctional when the single most frequently performed inpatient procedure, transfusion, doesn't have a major role in the curriculum. Ah well.

"Since AB+ people are considered the "universal recipient" , we give them any type platelets, usually starting with the one with the closest out date. "
I grant you that this is widely shared idea in our field for decades. It is also seriously wrong.  It prioritizes inventory management over patient wellbeing.  Our approach to ABO and platelets is distinctly different from ABO and red cells with no rational basis.  Antibody and complement destroy red cells and platelets equally well.  The only difference is that instead of free hemoglobin being released, it's mediators such as VEGF, IL-6 and other platelet pro-inflammatory, immunomodulatory and pro-thrombotic granule contents are released.   
ABO mismatched platelet transfusions at least double the refractoriness rate in repetitively transfused patients (see attached for references), and actually increase bleeding and mortality. 
The answer to the question is ABO identical is by far most effective and safest.  If you have to give ABO mismatched, there is probably no good answer other than washed/volume depleted O's, A's or B's, where most of the incompatible plasma is removed.  If that's not possible, postponing platelet transfusion until ABO identical is available when feasible, giving half doses of ABO identical if two patients need the one available unit, etc. are also reasonable.
Sadly, ABO mismatched platelets are probably worse than no platelets at all. They provide little or no hemostatic benefit and increased risks of bleeding, organ injury and death for the patient.  If I were the attending physician, I would generally give no platelets if ABO identical or washed O's weren't available in a stable, non-bleeding patient with a count of over 5,000.
The good news is we can improve outcomes by just doing what we do for red cells. Do not transfuse ABO incompatible antigen or antibody. It's bad for red cells, platelets and endothelial cells, all of which have complement and Fc receptors that bind immune complexes, and all of which bear ABO antigens on their surfaces.
Carr ABO mismatched refractoriness copy.pdf ABO story expanded.docx ABO endothelial cell paper.docx NEJMc2034764 copy.pdf NEJMc2034764_appendix copy.pdf

When the major hematology and transfusion medicine textbooks acknowledge the data showing that ABO mismatched transfusions don't provide hemostasis, actually increase bleeding, and increase platelet transfusion refractoriness, then hematologists will change their approach.  Probably some time before the heat death of the universe. Instead, one major textbook quotes methodologically unsound data from a study that classified platelet transfusions as ABO identical based upon the first transfusion, even if large numbers of  ABO mismatched transfusions were subsequently given to that patient. Total scientific nonsense.  
No doubt medical education is also to blame. I've been here 42+ years and haven't been invited to give a single talk to medical students about transfusions for many years (this is changing in 2023).  The curriculum bears little resemblance to what physicians need to know, unfortunately.  Highly dysfunctional when the single most frequently performed inpatient procedure, transfusion, doesn't have a major role in the curriculum. Ah well.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

When the major hematology and transfusion medicine textbooks acknowledge the data showing that ABO mismatched transfusions don't provide hemostasis, actually increase bleeding, and increase platelet transfusion refractoriness, then hematologists will change their approach.  Probably some time before the heat death of the universe. Instead, one major textbook quotes methodologically unsound data from a study that classified platelet transfusions as ABO identical based upon the first transfusion, even if large numbers of  ABO mismatched transfusions were subsequently given to that patient. Total scientific nonsense.  
No doubt medical education is also to blame. I've been here 42+ years and haven't been invited to give a single talk to medical students about transfusions for many years (this is changing in 2023).  The curriculum bears little resemblance to what physicians need to know, unfortunately.  Highly dysfunctional when the single most frequently performed inpatient procedure, transfusion, doesn't have a major role in the curriculum. Ah well.

When the major hematology and transfusion medicine textbooks acknowledge the data showing that ABO mismatched transfusions don't provide hemostasis, actually increase bleeding, and increase platelet transfusion refractoriness, then hematologists will change their approach.  Probably some time before the heat death of the universe. Instead, one major textbook quotes methodologically unsound data from a study that classified platelet transfusions as ABO identical based upon the first transfusion, even if large numbers of  ABO mismatched transfusions were subsequently given to that patient. Total scientific nonsense.  
No doubt medical education is also to blame. I've been here 42+ years and haven't been invited to give a single talk to medical students about transfusions for many years (this is changing in 2023).  The curriculum bears little resemblance to what physicians need to know, unfortunately.  Highly dysfunctional when the single most frequently performed inpatient procedure, transfusion, doesn't have a major role in the curriculum. Ah well.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

Short answer would be any ABO type if a one time thing, along with a prayer card for no hemolysis or post-transfusion purpura.
 
You could make a case for type A as the anti-B is likely to be lower titer, lower biologic activity than the anti-A in group O platelets (unless low titer) or group B platelets. But this is largely theoretical hand waving.

I should add the good news is that when one starts prioritizing ABO identical platelets over inventory management, one reduces the platelet transfusions needed by perhaps 50%.  So our platelet shortages will disappear in large part if we stick with ABO identical as much as possible.  See attached randomized trial from eons ago :).  ABO identical reduces transfusion reactions as well, HLA and rbc alloimmunization.  Not to mention decreasing bleeding and mortality.
ABO randomized trial UR european j haematology 1993 copy.pdf ABO plt tx revisited cumulative effects.pdf Platelet transfusion worsens ICH Stroke 2020 copy.pdf

Another point.  Since group O whole blood has proven as safe or even safer than typical component therapy (A platelets, A or AB plasma) in massive transfusion of trauma patients, perhaps group O low titer platelets would be safer than group A or B platelets for an AB patient :)?  No one knows, but worth considering.  The big problem is probably giving non-O platelets to O patients. There is evidence this increases bleeding and mortality.  Just like red cells, only O platelets for O recipients is a good practice.  The AB patient may be less of a problem, since giving some small amount of antibody may be less dangerous. A risk of hemolytic reaction of about 1 in 700 or so.  The risk of mortality in transfusing an O patient with A platelets is probably 1 in 5 (see attached).
ABO incompatible platelets intracranial bleeding 2021.pdf ABO plasma incompatible platelets and hemolytic reactions.pdf

"Since AB+ people are considered the "universal recipient" , we give them any type platelets, usually starting with the one with the closest out date. "
I grant you that this is widely shared idea in our field for decades. It is also seriously wrong.  It prioritizes inventory management over patient wellbeing.  Our approach to ABO and platelets is distinctly different from ABO and red cells with no rational basis.  Antibody and complement destroy red cells and platelets equally well.  The only difference is that instead of free hemoglobin being released, it's mediators such as VEGF, IL-6 and other platelet pro-inflammatory, immunomodulatory and pro-thrombotic granule contents are released.   
ABO mismatched platelet transfusions at least double the refractoriness rate in repetitively transfused patients (see attached for references), and actually increase bleeding and mortality. 
The answer to the question is ABO identical is by far most effective and safest.  If you have to give ABO mismatched, there is probably no good answer other than washed/volume depleted O's, A's or B's, where most of the incompatible plasma is removed.  If that's not possible, postponing platelet transfusion until ABO identical is available when feasible, giving half doses of ABO identical if two patients need the one available unit, etc. are also reasonable.
Sadly, ABO mismatched platelets are probably worse than no platelets at all. They provide little or no hemostatic benefit and increased risks of bleeding, organ injury and death for the patient.  If I were the attending physician, I would generally give no platelets if ABO identical or washed O's weren't available in a stable, non-bleeding patient with a count of over 5,000.
The good news is we can improve outcomes by just doing what we do for red cells. Do not transfuse ABO incompatible antigen or antibody. It's bad for red cells, platelets and endothelial cells, all of which have complement and Fc receptors that bind immune complexes, and all of which bear ABO antigens on their surfaces.
Carr ABO mismatched refractoriness copy.pdf ABO story expanded.docx ABO endothelial cell paper.docx NEJMc2034764 copy.pdf NEJMc2034764_appendix copy.pdf

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

Short answer would be any ABO type if a one time thing, along with a prayer card for no hemolysis or post-transfusion purpura.
 
You could make a case for type A as the anti-B is likely to be lower titer, lower biologic activity than the anti-A in group O platelets (unless low titer) or group B platelets. But this is largely theoretical hand waving.

I should add the good news is that when one starts prioritizing ABO identical platelets over inventory management, one reduces the platelet transfusions needed by perhaps 50%.  So our platelet shortages will disappear in large part if we stick with ABO identical as much as possible.  See attached randomized trial from eons ago :).  ABO identical reduces transfusion reactions as well, HLA and rbc alloimmunization.  Not to mention decreasing bleeding and mortality.
ABO randomized trial UR european j haematology 1993 copy.pdf ABO plt tx revisited cumulative effects.pdf Platelet transfusion worsens ICH Stroke 2020 copy.pdf

Another point.  Since group O whole blood has proven as safe or even safer than typical component therapy (A platelets, A or AB plasma) in massive transfusion of trauma patients, perhaps group O low titer platelets would be safer than group A or B platelets for an AB patient :)?  No one knows, but worth considering.  The big problem is probably giving non-O platelets to O patients. There is evidence this increases bleeding and mortality.  Just like red cells, only O platelets for O recipients is a good practice.  The AB patient may be less of a problem, since giving some small amount of antibody may be less dangerous. A risk of hemolytic reaction of about 1 in 700 or so.  The risk of mortality in transfusing an O patient with A platelets is probably 1 in 5 (see attached).
ABO incompatible platelets intracranial bleeding 2021.pdf ABO plasma incompatible platelets and hemolytic reactions.pdf

"Since AB+ people are considered the "universal recipient" , we give them any type platelets, usually starting with the one with the closest out date. "
I grant you that this is widely shared idea in our field for decades. It is also seriously wrong.  It prioritizes inventory management over patient wellbeing.  Our approach to ABO and platelets is distinctly different from ABO and red cells with no rational basis.  Antibody and complement destroy red cells and platelets equally well.  The only difference is that instead of free hemoglobin being released, it's mediators such as VEGF, IL-6 and other platelet pro-inflammatory, immunomodulatory and pro-thrombotic granule contents are released.   
ABO mismatched platelet transfusions at least double the refractoriness rate in repetitively transfused patients (see attached for references), and actually increase bleeding and mortality. 
The answer to the question is ABO identical is by far most effective and safest.  If you have to give ABO mismatched, there is probably no good answer other than washed/volume depleted O's, A's or B's, where most of the incompatible plasma is removed.  If that's not possible, postponing platelet transfusion until ABO identical is available when feasible, giving half doses of ABO identical if two patients need the one available unit, etc. are also reasonable.
Sadly, ABO mismatched platelets are probably worse than no platelets at all. They provide little or no hemostatic benefit and increased risks of bleeding, organ injury and death for the patient.  If I were the attending physician, I would generally give no platelets if ABO identical or washed O's weren't available in a stable, non-bleeding patient with a count of over 5,000.
The good news is we can improve outcomes by just doing what we do for red cells. Do not transfuse ABO incompatible antigen or antibody. It's bad for red cells, platelets and endothelial cells, all of which have complement and Fc receptors that bind immune complexes, and all of which bear ABO antigens on their surfaces.
Carr ABO mismatched refractoriness copy.pdf ABO story expanded.docx ABO endothelial cell paper.docx NEJMc2034764 copy.pdf NEJMc2034764_appendix copy.pdf

I realize this is "fighting city hall" but is there a more useless requirement than having everyone review and sign off on procedures that haven't changed one iota?  In our laboratory, this is many hundreds of procedures (including the one on how to write a a procedure :). Bureaucratic make work of no value whatever.  An unfortunate example of the administrative/legal mindset versus the scientific/clinical mindset in our society.  Probably an early small sign of the coming end of our civilization when non-productive work receives such priority. Seriously.

Short answer would be any ABO type if a one time thing, along with a prayer card for no hemolysis or post-transfusion purpura.
 
You could make a case for type A as the anti-B is likely to be lower titer, lower biologic activity than the anti-A in group O platelets (unless low titer) or group B platelets. But this is largely theoretical hand waving.

I should add the good news is that when one starts prioritizing ABO identical platelets over inventory management, one reduces the platelet transfusions needed by perhaps 50%.  So our platelet shortages will disappear in large part if we stick with ABO identical as much as possible.  See attached randomized trial from eons ago :).  ABO identical reduces transfusion reactions as well, HLA and rbc alloimmunization.  Not to mention decreasing bleeding and mortality.
ABO randomized trial UR european j haematology 1993 copy.pdf ABO plt tx revisited cumulative effects.pdf Platelet transfusion worsens ICH Stroke 2020 copy.pdf