ABO Incompatible Plasma in Platelets

[SusanM]

I apologize if this has been discussed before, i didn't have time to read through a lot of stuff....

How do people deal with platelets and infants???

I am referring to the CAP TRM.40740 Is there a policy to limit the administration of ABO-incompatible donor plasma in platelets given to infants?

The note goes on to suggest removing the plasma and resuspending them in saline or albumin.

In an ideal world, we would use ABO specific random platelets. We are the only hospital that uses randoms from our supplier, so they don't always have the right group available. We went to asking them to 'wash' nongroup specific, but have met with some serious resistance to doing that. I don't think it's a good product anyway.... Is anyone willing to share their experiences?

Susan

[rcurrie]

We plasma reduce if we don't have ABO compatible platelets for infants. It is a simple process if you have a component centrifuge, and we have quite a few, being a combination donor center/transfusion service. We do NOT resuspend in saline. We issue the dry platelet button for transfusion, and it is resuspended in saline at the time of transfusion:

a. Centrifuge product using the following parameters:

1) Temperature = ~20-24C

2) Speed = ~ 550 RPM

3) Time = ~ 20 minutes

4) Brake = 0

b. Remove platelets from centrifuge very carefully and place on plasma extractor without disturbing the platelet button.

c. Open tubing and transfer of all but minimal* plasma from the platelet button into the empty platelet collection bag.

* Express plasma until the two plates of the expressor have completely compressed the platelet bag and maximum plasma removal has occurred.

d. Seal off bag with plasma and discard.

e. Remove bag containing platelet button from expressor and lay it on counter, label face down, to rest without agitation for approximately 20 minutes.

BC

[John C. Staley]

We have worked out a deal with our supplier. They have a group of AB donors and the supplier draws apheresis platelets from them for our babies. We have one AB pheresis on the rotator at all times and any baby that needs some get it from that unit. It has work very well for us.

[pdavenport]

We also use aliquots from AB pheresis for infants. The standard dose is 10 ml/kg.

[bbbirder]

We have transfused an infant with PLTs once in 15 years, so our situation is a little different than most of the posts. Since we don't keep many PLTs on hand and we are 2 hours from our supplier and we'd be doing this in an emergency, volume reduction isn't a viable option for us.

I got information from posts on the AABB forum and one suggestion was to determine the titer of anti-A and/or anti-B in Group O PLTs if you had to use them. If the titer is less than 1:50, group O Platelets could be considered safe to use in a non-O baby. (Add a drop of platelet product to 50 drops of saline and use that dilution to test for agglutination IS macroscopically using reverse A and/or B cells.)

Since reported cases of hemolysis due to ABO-incompatible platelets have all been due to group O platelets, you could use Group A or Group B (if you had them) if AB wasn't available to minimize the risk of hemolysis.

Linda Frederick