Dear all

I am confused, Please give me clear answer, when patient need platelets transfusion but we don’t have identical platelet group (same platelet group) for transfusion, what shall I consider in transfusion of platelets, antibody (even high titer or not high) in donor plasma against recipient RBCs or recipient Platelets, or consider antibody in recipient plasma against donor Platelets?

Thanks

I can only get group O or group A plts . . . I try not to get the O's but sometimes have no choice. I cannot volume reduce so my pts are stuck with whatever titer the donor has. Not much help but we can commiserate together.

Usually your patient will tolerate out of group platelets if you can't get group specific. We try to give group specific whenever possible, but can't always get them. We have never had a patient that had problems.

The only out-of-group consideration that we have is for O type platelets where we only transfuse a volume of <300 ml to non-O types and 300ml or greater to type O patients only; this is practiced do to potential a high titer anti A, B from an O donor. We do give Rh specific platelets.

I think the main concern with regards to transfusing out of type platelets is the antibodies in the donor unit potentially causing a hemolytic transfusion reaction in the recipient.

At our hospital we do try to give type & rh specific platelets whenever possible. Our guidelines are that neonates get AB or type specific. Patients <5 years old get type specific due to small body size. Adults get type specific if available. We transfuse 10-14 apheresed platelets a day on weekdays, fewer on the weekends; in the last 25 years or so we've only had one hemolytic reaction due to a platelet transfusion...a B patient received an O platelet. I can't remember off the top of my head what the titer of the platelet ended up being though...

The attached may be useful. It's a handy chart we use that lists donor ABO/Rh in terms of preference for each patient ABO/Rh. As has been stated, the main concern is potential hemolysis from minor side incompatibility between donor antibody in the plasma of the platelets directed against patient A or B antigens. A second consideration is that platelets do carry some A and B antigen, and in some cases a major side incompatibility between recipient isoagglutinins and platelet antigen can result in a lower post-transfusion recovery.

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Edited September 12, 201212 yr by Dr. Pepper
clarity and ssspelling

We give AB or if not available, typecompatible for neonates. Kids under 12 get ABO compatible or AB. Adults get type compatible if possible, although because we have so many kids getting platelets often the adults end up with Group O. No problems. We give Rh negative to Rh negative females of childbearing potential. If not possible we offer Rhogam.

I agree with Dr Pepper for adults.

For Peds we give compatible platelets with regards to the ABO antibody in the platelet collect.

D negative females from birth until menopause are given D Neg and if not then RhIg is advised and given... it lasts quite a bit so it covers the series of transfusions, if any, in oncolgy cases.

Yes, if there is a poor response it may be due to the antibodies hitting the ABO on the platelets, so we switch to ABO compatible. AB would be ideal but.... who has enough, we keep them for emergencies and for the ABs.

In large Facilities, you have the luxury (usually) of giving type specific. And often in those Facilities, they also have the type of patients that could, on any given day, use a lot of Platelets (i.e. Bone Marrow Transplants; Traumas; Liver Transplants potentially); so they are more inclined to watch how much incompatible plasma they are giving. In smaller Facilities, we have the problem of both stock (store very little), but also may not encounter many patients who require > 1 Platelet on any given day (which they can usually tolerate with incompatible plasma). That being said, 1 of the larger places I worked once actually had a patient die when given a group O Platelet (patient was not group O) with a very high A,B Titer! They are serviced by their own Donor Center which now titers all of the group O donors (for awhile, they were actually packing all of the group O Platelets in the Transfusion Service if given to a non-Group O individual)! They would literally have them lined up on the counter, waiting to be centrifuged. Yikes!

Brenda Hutson

We need plt additive solution to take the place of most of the plasma in the plt units. Of course then we have to reprogram our computers to look at major compatibility rather than minor--if at all.