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Clinical Trial
. 2012 Mar;52(3):635-40.
doi: 10.1111/j.1537-2995.2011.03329.x. Epub 2011 Sep 2.

Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

Kelly F Henrichs  1 , Nedda Howk, Debra S Masel, Mark Thayer, Majed A Refaai, Scott A Kirkley, Joanna M Heal, Neil Blumberg
Affiliations
Clinical Trial

Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

Kelly F Henrichs et al. Transfusion. 2012 Mar.

Abstract

Background: There are multiple benefits to transfusing only ABO-identical blood components. Historically our institution routinely transfused ABO-nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO-identical components whenever feasible, regardless of outdating or logistic considerations.

Study design and methods: Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO-identical PLTs, ABO-compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001-2004) and subsequent (2006-2009) to implementation.

Results: In the year after implementation, only 11 of 410 surgical patients received ABO-nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO-identical components was associated with significant reductions in febrile (-46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (-23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (-50% by 2009; p = 0.03).

Conclusions: Providing ABO-identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO-identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.

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Conflict of interest statement

Disclosure of Conflicts of Interest

NB has received lecture honoraria, consulting fees and research support from Pall Biomedical and Fenwal, manufacturers of leukoreduction filters, as well as from Caridian, manufacturers of cell washing equipment and supplies. The other authors declare they have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Incidence of newly detected red cell alloantibodies per antibody screen annually. The slope of the linear regression line for years 2001–2005 is not significantly different from zero (p=0.70). The slope of the linear regression line for years 2006–2009 is significantly different from zero (p=0.037).
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