typing a patient for platelets?

[lalamb]

I thought typing a pt was unneccessary for issuing platelets?, yet I have seen some people post that they do.

[Lcsmrz]

The recent literature seems to suggest that group-specific platelets are optimum for the patient. On the Rh side, you should give Rh-neg platelets to an Rh-neg childbearing female -- or some RhIg afterwards. So, knowing the ABO/Rh of the recipient is necessary, even if no ABO-specific, Rh-compatible platelet is available.

Some sites also limit the number of ABO-incompatible platelets that a patient can receive in a 24-hr period.

However, for outpatient platelet transfusions, our HemOnc patients have been tested so many times that another one is rather redundant. We order the products from historical records, but since all of our patients require BBK banding, we retest on the day of transfusion just before issue.

[David Saikin]

Very nicely said. The literature goes into immune complex formation due to ABO ags/abs in patient and platelet plasmas. It is nice in theory but the reality is that I can only get group A or O plts so my B/AB pts are out of luck on this point.

[rravkin@aol.com]

I read an article a while back in Transfusion Mag where the researchers here showed that some type O SDP's can contain elevated concentrations of Anti A, B and have shown a detrimental outcome for the type A, B, or AB recipient. When transfusing SDP's I try to give ABO/Rh type specific when possible. I am not aware of any commonly practiced proceedure for determining Anti A, B concentration in type O plasma.

[adiescast]

As has been stated elsewhere in this forum, with apheresis platelets, you have to consider the large volume of plasma that is riding along with the platelet transfusion. You wouldn't give 200 ml of incompatible ffp...

[lalamb]

As has been stated elsewhere in this forum, with apheresis platelets, you have to consider the large volume of plasma that is riding along with the platelet transfusion. You wouldn't give 200 ml of incompatible ffp...

You are right-and that has always bugged me. How 2000ml of ffp has to be type compatible but not plts?

Talked w/my pathologist yesterday and he will sign a policy change to do aborh and absc on all ffp recipients. Asked him about platelets and he was aware of concerns and recent publications regarding type.

Now, can I get my blood provider to give me more type specific plts??...

Thank you all so much for your input, for this post and others.

[David Saikin]

WE wouldn't give ABO incompatible ffp but the reality of transfusion medicine for us small hospitals is that we have to give that volume with our plt pheresis products. The means to volume reduce is unavailable - would make an interesting study, though.

[Mary**]

:surrenderWhy do you need an antibody screen for platelets?

Good luck on always being able to obtain ABO/Rh specific platelets. I do agree with type specific, but they are not always available.

[clmergen]

We do require blood types to be on record but not from current admission.

As for choosing platelets, I always look at my first expiring and then the blood types. However, if I had a larger volume platelet, I give those type specifically whenever possible. But sometimes in an emergency, it may go to an out of type patient.

[AMcCord]

When we have to give non-type platelets (which is often), we try not to give type O platelets to non-type O patients. Actually, it's difficult for me to even get type O platelets at times.

[tubeshaker]

Hi lalamb,

The current issue of Transfusion has a relevant article:

Katerina Pavenski, Theodore E. Warkentin, Hua Shen, Yang Liu, Nancy M. Heddle

Posttransfusion platelet count increments after ABO-compatible versus ABO-incompatible platelet transfusions in noncancer patients: an observational study (p 1552-1560). Volume 50 Issue 7 (July 2010). Link (for those with online access to Transfusion): http://www3.interscience.wiley.com/cgi-bin/fulltext/123304739/HTMLSTART

There is also an abstract available on PubMed ahead of print for another paper that should make Transfusion soon for a screening technique:

Quillen K, Sheldon SL, Daniel-Johnson JA, Lee-Stroka AH, Flegel WA. A practical strategy to reduce the risk of passive hemolysis by screening plateletpheresis donors for high-titer ABO antibodies. Transfusion. 2010 Jun 23. [Epub ahead of print]. Link: http://www.ncbi.nlm.nih.gov/pubmed/20576015

Excuse the formatting variations, I'm cutting and pasting the citations from the web.

The facility I worked in previously screened group O platelets for isoagglutinin titers less than 1:200, greater than this the product would be labeled "High titer anti-A/B" and given to a group O recipient only (with the previously mentioned caveats for RhD). I wasn't sure where this cutoff came from at the time, but I do note it's the midpoint of evaluated dilutions in the Quillen article.

Cheers,

JD