TRM.40700 from CAP states that patients must receive ABO Compatible plasma products. Occasionally, the only platelets that are available are ABO incompatible. I am interested in learning how others handle this.:fingerscr

I don't think that CAP considers platelets to be a "plasma product."

We will give non-group specific platelets when necessary. (Exception: We will give only group-specific platelets to infants.)

Donna

We give ABO group specific to children beacuse of their small blood volume: there is no dilutional effect on the antibodies.

We give Rh (D) negative apheresis platelets to ladies who are Rh (D) negative and in the child-bearing age.

We give ABO compatible to children under 12 and RH neg to females of child-bearing potential. Because we have an adult and a children's hospital often the adults end up getting ABO incomp due to us saving the A, B and AB for kids. Infants under 4 months old get AB platelets. We use all apheresis products, no random platelets.

I can only get group A plts (rarely group O) and I can't send them back, so my patients are "stuck" with the plasma. which may be ABO incompatible, and/or the plts, which may have decreased survivial due to the pts ABO isoagglutinins. This would include children/infants (fortunately I have not had to deal with that issue YET!).

And, David, despite that, just how many of your patients have actually suffered - not many, if any, I am prepared to bet.

I have only seen one pt develop a +DAT from ABO discrepant plts (actually a random pool) in my career (decades).

We give ABO compatible pheresed platelet products whenever possible. I do not understand why it is not OK to give 200 cc of ABO incompatible plasma to a patient but it is OK to give a platelet pheresis containing 200 cc of ABO incompatible plasma.

I have seen several patients develop a positive DAT from receiving out of type platelets. Usually we make sure they get matched platelets after that until they clear the DAT.

I have seen a couple of patients who did not get a good response to ABO incompatible platelets but I can't say whether that was because the platelets were out of type (although they did respond better to type matched).

Edited July 15, 201114 yr by adiescast
Additional thoughts

We give ABO compatible pheresed platelet products whenever possible. I do not understand why it is not OK to give 200 cc of ABO incompatible plasma to a patient but it is OK to give a platelet pheresis containing 200 cc of ABO incompatible plasma.

.............................).

I getted asked that question by an MLT or MT student several times each year. My reply to them is "Good question!", then we talk about something else. Seriously, that is a good question and I don't have the answer. Plasma is more likely to be given in greater numbers of units than pheresis platelets I suppose, but that's the only thought I have on that. Anyone???

1. We don't consider the plasma from the platelet phereis a plasma product. Since there is a separate section in TRM for platelets and plasma, I don't believe they do either. However, I have seen the recommendation and I tried for 1 month to obtain ABO compatable products from our supplier. About 20% of the time, not able unless waiting an XX day for product processing. We have 3 NICU's and a children's hospital in town and they get all the AB product. We transfuse about 75 pher/ month so that would be a lot of pathology phone calls.

2. 24 yrs never seen a provable adverse reaction from incomptable plasma. Most of these patients are so ill, and getting red cells.

So what we are saying is that it really is all right to give out of type plasma in most circumstances because we have had to do that with platelet pheresis (due to lack of product) and it turned out OK. Sometimes we give patients several units of out of type platelet pheresis. But we still freak out over a unit of out of type plasma that has the same volume as a platelet pheresis. Why isn't it OK to give out of type plasma when we don't have in type available? Inquiring minds (who have experienced just this dilemma) want to know!

As to incompatable plasma, I too cringe if the patient gets lots of product. But, I have had a pathologist question why we get a patient stuck for an ABO "just to give plasma". Years ago a patient was mistyped and received 2 FFP of the wrong type without adverse results. I suppose folks alot smarter than me have decided not to make it a hard and fast requirement because they realize the low risk of reaction and the high risk plt product won't be available under many circumstances.

whenever we give ABO incompatible apheresis platelets, we do anti-A &/or anti-B titer. If titer is >64, we do not give that PLT. In reality the plasma volume in PLT is same as FFP.

This is interesting if you would like to read it:

"ABO-mismatched transfusions are not over-represented in febrile non-haemolytic transfusion reactions to platelets"

M. H. Yazer, J. S. Raval, D. J. Triulzi and N. Blumberg, online: 22 JUL 2011