jayinsat

@Neil Blumberg, I wish we had you at all of our facilities to educate our medical staff. Sadly, convincing Hematologists and Oncologists (at least here in America) that it is better to postpone platelet transfusions than give ABO incompatible platelets is, more often than not, rejected, especially in light of the fact that many patients are having to wait because of lack of platelet inventory to begin with. 
What we really need is a push for better transfusion therapy education in medical school. Along with this, continuing education for practitioners needs to become a priority. It is, however, quite difficult to get time with these practitioners. Even when we convince our laboratory medical directors to advocate for these issues, in my experience, clinicians rarely change. 
All that said to say, in the "trenches," the practice will likely continue to prioritize inventory over safety. 

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

Absolutely! It is in our policy in accordance with CAP and AABB standards.

Medical directors REVIEW policies every two years to ensure they are current and appropriate then sign, which is evidence of review. Staff read and sign when changes have been made. 

Do you do QC on your expired panels when you use them as selected cells? I was just curious. Thank you

I had this very scenario about a year ago and it turned out mom had an anti-Dia. It was not on any of our in lot screening or panel cells. I did as I suggested and ran a select panel against mother's plasma using expired panel cells and identified the Dia. The eluate on the baby was eluted the Dia also. 

I have frequently seen Rh discrepancies like this with hospital hoppers.  If we have (or can get) last hospital history one phone call resolves issue (plus weak D test). However We have had problems when the patient is adamant they are Rh pos (or neg) and we report the other. This has caused long delays for patients to get or accept the explanations and give consent (or re-consent) to be transfused. The added tech time for these situations can be frustrating on occasion. 

We would label the child rh+. The only problem this might cause is if the child returns to our hospital as an adult (we do not treat pediatrics in my facility) and required blood. The initial blood type might seem like a discrepancy since, conceivably, they would initially type rh negative but their historical record would say positive. Of course, we would simply verify this by looking at the previous testing results stored in our LIS.

Vacation???? I'd settle for a day off without being called in because we have no staff coverage in the blood bank. 

We do the same.  We have a test that simply asks how many antigens were tested and the technologist enters a number.  This is how many charges will go to the billing module.

Vacation???? I'd settle for a day off without being called in because we have no staff coverage in the blood bank. 

We do the same as @MAGNUM. Our database is downloaded daily as a background job. It is also downloaded to a network drive so it can be accessed by anyone that has access privilege to the drive from any networked computer. 

I download all the patient histories to a desktop file on Monday, Wednesday, and Friday every week. I also have an encrypted flash drive that I download to and write over the previous data. There is a computer somewhere in the laboratory that is not down that can be used for checking histories.

Have your LIS person set up the History Backup Client.  This will backup all files and then automatically backup any new or edited files every hour.  We have ours backed up to our network and a portable hard drive that we can access if the network is also down.

If the baby is not anemic and has no evidence for hemolysis, I'd just leave it at that.  There are variant plasma antigens that can elicit antibodies and these can be hard to identify using red cell serologic techniques. If the eluate is negative against panel red cells, this is high probability.  Perhaps mom is sensitized to a paternal immunoglobulin variant and these immune complexes are adhering to red cells.  There are no standardized tests for such anti-plasma protein antigens, to my knowledge.  Not very satisfying, but the clinical findings are the most important issues here, not the serologic issues.

I did forget to mention that I did do this prior to performing the eluate and testing against the Father's RBC's. I was able to find 8 low frequency antigens (Dia was included) but they all came out to be negative. Unfortunately that was all the low frequency antigens I could find on the panels that we have available here.

I had this very scenario about a year ago and it turned out mom had an anti-Dia. It was not on any of our in lot screening or panel cells. I did as I suggested and ran a select panel against mother's plasma using expired panel cells and identified the Dia. The eluate on the baby was eluted the Dia also. 

Nancy,
I echo everything you said, but I am experiencing the same things in a 400 bed hospital in downtown San Antonio. This is not sustainable and some sort of major intervention needs to happen very soon. After 37 years, I want out of this field. 

There could be a number of reasons for this. My first thought is mom could have an antibody against one of the low frequency antigens (Cw, V, Diego, Bg, etc). If you really want to figure it out, you could perform an eluate on the cord blood and a select cell panel on the mom's plasma. You will need to run the cord eluate against that select panel as well. 
Of course, by select panel, I mean finding panel cells that are positive for the low frequency antigens.
That's my thoughts
 

There could be a number of reasons for this. My first thought is mom could have an antibody against one of the low frequency antigens (Cw, V, Diego, Bg, etc). If you really want to figure it out, you could perform an eluate on the cord blood and a select cell panel on the mom's plasma. You will need to run the cord eluate against that select panel as well. 
Of course, by select panel, I mean finding panel cells that are positive for the low frequency antigens.
That's my thoughts
 

There could be a number of reasons for this. My first thought is mom could have an antibody against one of the low frequency antigens (Cw, V, Diego, Bg, etc). If you really want to figure it out, you could perform an eluate on the cord blood and a select cell panel on the mom's plasma. You will need to run the cord eluate against that select panel as well. 
Of course, by select panel, I mean finding panel cells that are positive for the low frequency antigens.
That's my thoughts