Giving group AB platelets to non group AB neonate

[YorkshireExile]

Does anyone have a specific reference for a table referring to the choice of platelet group to give a neonate if the patients own group is not available? I am specifically wanting group AB platelets to be included in that table. The only reference table I can find is the BCSH amended guidelines (2006) for neonatal transfusions. In that table, group AB platelets are not specifically mentioned as it is assumed they will be in short supply. They are only mentioned in a note below the table.

I have a very pedantic neonatal consultant who wants written reference proof in a table that AB platelets are one of the choices to give to a non-group AB neonate. Thanks.

[emadlabs]

platelets AB + first your favourite choice give the same group AB+ if you have no AB+ you can give AB- The seconed choice , and if no AB+ & AB- third choice you can give A or B group and the last choice you can give platelets O + to AB + patient

[YorkshireExile]

Thanks Emad,

But I`m looking for a specific reference for a table that includes AB as one of the group choices to give. The choice of AB is not in the BCSH guidelines table.

[Malcolm Needs ☆]

Thanks Emad,

But I`m looking for a specific reference for a table that includes AB as one of the group choices to give. The choice of AB is not in the BCSH guidelines table.

That is because we do not make AB platelets!

:disbelief:disbelief:disbelief:disbelief:disbelief

[YorkshireExile]

Malcolm,

I recently read your article in the BBTS journal concerning correct terminology, so I know I`ll have to tread very carefully here.

I suppose I should have termed the platelets "Group AB Platelet concentrates". Is that correct, or am I missing something else?

[Malcolm Needs ☆]

Malcolm,

I recently read your article in the BBTS journal concerning correct terminology, so I know I`ll have to tread very carefully here.

I suppose I should have termed the platelets "Group AB Platelet concentrates". Is that correct, or am I missing something else?

Sorry BoroCliff - for once in my life I wasn't trying to be pedantic.

What I was trying to say is that the NHSBT does not produce group AB platelet concentrates (either pooled or by apheresis). In other words, all of the group AB babies under our "care" (if you will excuse the loose phrasing!) are given platelets that are NOT group AB.

:imslow::imslow::imslow::imslow::imslow:

[Yanxia]

Sorry BoroCliff - for once in my life I wasn't trying to be pedantic.

What I was trying to say is that the NHSBT does not produce group AB platelet concentrates (either pooled or by apheresis). In other words, all of the group AB babies under our "care" (if you will excuse the loose phrasing!) are given platelets that are NOT group AB.

:imslow::imslow::imslow::imslow::imslow:

Malcolm, will you plasma reduced the platelet or wash it to avoid hemolysis?

[Malcolm Needs ☆]

No, neither, but the donor is tested to ensure that no high titre ABO antibodies are present.

[BankerGirl]

That is because we do not make AB platelets!

:disbelief:disbelief:disbelief:disbelief:disbelief

Why do you not make AB platelets? Are platelets that plentiful in the UK that you can turn away AB donors? We frequently receive AB platelets over here, which amazes me since there aren't that many AB people in this neck of the woods.

[Malcolm Needs ☆]

Why do you not make AB platelets? Are platelets that plentiful in the UK that you can turn away AB donors? We frequently receive AB platelets over here, which amazes me since there aren't that many AB people in this neck of the woods.

As a red cell serologist (patient side of things), rather than someone dealing with the donor side of things, I honestly do not have a clue; but will make it my task to find out!

:confuse::confuse:

[YorkshireExile]

I wonder the same thing as BankerGirl. Why are AB platelets not made in the UK? Are AB donors specifically reserved for FFP and/or Cryo?

Bankergirl - can I ask you my original question? Do you have a specific reference that says it is okay to give AB platelets to a non-group AB neonate?

Malcolm, you mentioned platelets are tested to make sure no ABO high titre antibodies are present. What is the definition of "high" in this case? What would the titre level have to be before it would be considered unsafe to transfuse? Are there different cut-off levels if the platelet is going to an adult as compared to a neonate?

[BankerGirl]

BoroCliff,

I have nothing other than the AABB Technical Manual (16th edition, page 650) that says "When possible, the platelet component should be ABO group-specific and should not contain clinically significant unexpected red cell antibodies. Transfusion of ABO-incompatible plasma should be avoided in pediatric patients and especially in infants because of their small blood plasma volumes." Type AB plasma is the universal plasma donor type, so it would be ABO-compatible with any blood type.

[Malcolm Needs ☆]

I wonder the same thing as BankerGirl. Why are AB platelets not made in the UK? Are AB donors specifically reserved for FFP and/or Cryo?

Bankergirl - can I ask you my original question? Do you have a specific reference that says it is okay to give AB platelets to a non-group AB neonate?

Malcolm, you mentioned platelets are tested to make sure no ABO high titre antibodies are present. What is the definition of "high" in this case? What would the titre level have to be before it would be considered unsafe to transfuse? Are there different cut-off levels if the platelet is going to an adult as compared to a neonate?

Again, I will make it my task to find out the definitive answer (but I think it is if there is no reaction at a dilution of 1 in 32 - mind you, I do know that this figure - whatever it may really be - differs, not only in Europe, but in the UK!!!!!!!!!!).

:ohmygod::ohmygod:

By the way, I'm on a half day's annual leave tomorrow (lazy devil), so may not get a chance to find out tomorrow. If I should forget to find out in the next few days after tomorrow, PLEASE REMIND ME.

[YorkshireExile]

Thanks Malcolm,

I`ll remind you if necessary! Enjoy your half days leave - why not make it a full day?

[vilma_mt]

Does anyone have a specific reference for a table referring to the choice of platelet group to give a neonate if the patients own group is not available? I am specifically wanting group AB platelets to be included in that table. The only reference table I can find is the BCSH amended guidelines (2006) for neonatal transfusions. In that table, group AB platelets are not specifically mentioned as it is assumed they will be in short supply. They are only mentioned in a note below the table.

I have a very pedantic neonatal consultant who wants written reference proof in a table that AB platelets are one of the choices to give to a non-group AB neonate. Thanks.

The first choice is always type specific. The only time AB platelets are preferred is when the neonate have a passive ABO antibodiies. Same goes for what plasma ABO type to give. Although for adults it's ok to give a type "O" platelet to a type "A" patient, we can't do it for neonates because of the blood volume. If there is no available AB platelets, some hospital perform plasma reduction or washed platelets (not sure if washing is still an acceptable practice)

[shelleyk482]

Check out page 10 of "Pediatric Transfusion: A Physician's Handbook", 2nd edition. It is a table that gives this information. The column does not say "platelets" specifically, it says "Plasma-Containing Components" which does include platelets.

[ckcheng]

There are several things needed to consider when transfusing platelet.

(1) Platelet possess A and B antigens, but lacks D antigen. Major mistmatch shortens platelet survival.

(2) Anti-A and/or anti-B present in donor plasma. Minor mismatch causes red cells DAT positive

(3) Major mismatch vs minor mismatch if group specific platelet is not avalible.

(4) Purpose of the transfusion. OT bleeding patients or hematological patients for prophalaxis.

(5) age of the recipient, pay extra caution if it is a pediatric patient cuz small blood volume.

When group specific platelet is not available for neonatal, I will give group AB platelet. I agreed with the practice of vilma_mt.

Also, there is an article you may find interesting.

Apperesis platelet transfusions: does ABO matter?

Jay H Herman, & Karen E King. Transfusion, Vol 44, Issue 6, June 2004, Page 802-4

Hope that helps.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

Oct 14, 2010

[MsDuffy]

Would the AABB Technical Manual, 16th Edition work?

On page 448, there is a general table (Table 15-5) that states, with regard to platelets, that "All ABO groups are acceptable. Although ABO-identical platelets are preferred, components compatible with the recipient's red cells are recommended." Then on page 650 about half way down in the first column it states "Transfusion of ABO-incompatible plasma should be avoided in pediatric patients and especially in infants becaue of their small blood and plasma volumes."

[Malcolm Needs ☆]

Again, I will make it my task to find out the definitive answer (but I think it is if there is no reaction at a dilution of 1 in 32 - mind you, I do know that this figure - whatever it may really be - differs, not only in Europe, but in the UK!!!!!!!!!!).

:ohmygod::ohmygod:

By the way, I'm on a half day's annual leave tomorrow (lazy devil), so may not get a chance to find out tomorrow. If I should forget to find out in the next few days after tomorrow, PLEASE REMIND ME.

Sorry to have taken so long; I came back to an Everest of work.

We do reserve the AB plasma for those who require it (although all of the FFP for the use of children up to 16 is imported from the USA, because of our vCJD problem), but the only group AB platelets that we produce are as a biproduct of HLA matching, when the HLA matched donor just happens to be group AB.

As you know, platelets do not have a "proper" ABO group as such, but do adsorb A and B soluble substances from the plasma. This, therefore, effectively makes them A, B or AB (depending upon which plasma they are in). Therefore, I can't quite understand the need for AB platelets for babies, as, surely, they would be better off receiving platelets that would not, potentially, be destroyed by any maternal IgG ABO antibody in the baby's circulation?

It turns out that I was correct about the titre of 32, by the way. Sometimes a lucky guess works out (wish I could do that with the national lottery numbers)!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

:boogie::boogie:

[YorkshireExile]

Hi Malcolm,

Unfortunately here in Abu Dhabi it can be very difficult sometimes to get group specific platelets. Sometimes the only group I can get is AB. It`s better than giving no platelets at all for my sick neonates.

Well done in remembering the titre value of 1:32. Are you sure you`re not the person who has just won all that money on the euro lottery?;)

[Malcolm Needs ☆]

Hi Malcolm,

Unfortunately here in Abu Dhabi it can be very difficult sometimes to get group specific platelets. Sometimes the only group I can get is AB. It`s better than giving no platelets at all for my sick neonates.

Well done in remembering the titre value of 1:32. Are you sure you`re not the person who has just won all that money on the euro lottery?;)

IF ONLY, IF ONLY!!!!!!!!!!!!!!!!

:please::please::please::please::please:

[vilma_mt]

The first choice is always type specific. The only time AB platelets are preferred is when the neonate have a passive ABO antibodiies. Same goes for what plasma ABO type to give. Although for adults it's ok to give a type "O" platelet to a type "A" patient, we can't do it for neonates because of the blood volume. If there is no available AB platelets, some hospital perform plasma reduction or washed platelets (not sure if washing is still an acceptable practice)

I'm surprised nobody corrected me on second/third/fourth sentence of my post....I got my red cell/plasma/platelet transfusion all mixed up.

May I redeem myself....Type specific platelets always first choice. When there is no available AB Platelet for AB type neonates, plasma volume reduction or platelet wash usually done.

[Malcolm Needs ☆]

Nobody's prefect!!!!!!!!!!!

[ckcheng]

Malcolm, you are right, that is the disadvantage of transfusing major mismatch platelet , it will not survive good. In pediatric case, however, if you transfuse incompatible plasma to the tiny baby, transfused platelet will survive better BUT patient red cells will become DAT positive. You have to weigh it - major or minor mismatch?? Transfuse with caution in baby less than 1 year old and those premature ones with very low birth weight. Always give group specific platelet whenever possible, otherwise, consider the plasma compatiblilty to patient red cells.

CK Cheng, MSc, SBB(ASCP), CQA(ASQ)

[John Hansen]

Don't forget that the minor mismatch is very minor in the case of a neonate, since a neonoate should not have an appreciable titer of A or B antibodies until later in life, and may have little to none of Mom's antibodies