The safety of ABO minor incompatible platelets transfusions using a rapid infuser

Area of Science:

• Transfusion Medicine
• Hematology
• Critical Care

Background:

• Rapid infusers are safe for platelet administration.
• The safety of infusing ABO-incompatible platelets with red blood cells (RBCs) via rapid infusers is not well-established.
• A theoretical risk of hemolysis exists due to isoagglutinins in platelet plasma interacting with RBCs.

Purpose of the Study:

• To investigate the clinical significance of infusing ABO-incompatible platelets with RBCs using a rapid infuser.
• To determine if mixing ABO-incompatible platelets and RBCs in a rapid infuser induces hemolysis in vitro.

Main Methods:

• Seven in vitro studies were conducted, including ABO-incompatible (Type A RBCs/Type O platelets) and control groups.
• Anti-A titers in platelet units were measured.
• RBC and platelet units were mixed in a rapid infuser and incubated for 30 minutes.
• Hemolysis was assessed by free hemoglobin concentration, hemolysis check, direct antiglobulin test (DAT), and direct agglutination.

Main Results:

• Post-mix DAT was positive for IgG in all samples and weakly positive for complement in most.
• Changes in free hemoglobin were minimal (-2.2 to +3.4 mg/dL).
• Hemolysis checks were negative or only slightly positive, with no significant difference from controls. Anti-A titers did not correlate with hemolysis.

Conclusions:

• Mixing ABO-incompatible platelets with RBCs in a rapid infuser does not induce significant in vitro hemolysis.
• These findings support the use of rapid infusers for hemostatic resuscitation, irrespective of ABO compatibility between platelets and RBCs.