Major ABO-Incompatible Platelet Transfusions Are Associated With Brain Ischemia After Intracerebral Hemorrhage

Area of Science:

• Neurology
• Hematology
• Transfusion Medicine

Background:

• Major ABO-incompatible platelet transfusions are linked to poor outcomes in intracerebral hemorrhage (ICH).
• Ischemic lesions on brain MRI are indicators of secondary brain injury and predict poor outcomes after ICH.
• ABO-incompatible transfusions may promote thrombo-inflammation and endothelial damage, potentially worsening cerebral ischemia.

Purpose of the Study:

• To investigate if major ABO-incompatible platelet transfusions are a risk factor for developing ischemic lesions on brain MRI in ICH patients.

Main Methods:

• Analysis of adult ICH patients receiving platelet transfusions within 24 hours of admission.
• Inclusion criteria: available ABO data and brain MRI during hospitalization.
• Adjusted regression models were used to assess the association between ABO-incompatible platelet units and MRI ischemic lesions.

Main Results:

• A total of 40 patients were analyzed; 20% received major ABO-incompatible platelet units.
• Major ABO-incompatible platelet transfusions were significantly associated with increased odds of MRI ischemic lesions (aOR, 9.2).
• This association remained after adjusting for ICH severity.

Conclusions:

• Exploratory findings suggest ABO-incompatible platelet transfusions may contribute to secondary brain injury post-ICH.
• Further research is warranted to determine if avoiding these transfusions can mitigate secondary brain injury and improve ICH outcomes.