The case against infusing ABO incompatible antibody and antigen from all blood components

Area of Science:

• Transfusion Medicine
• Immunology
• Patient Safety

Background:

• Current practices transfuse ABO compatible, but not necessarily identical, blood components.
• This approach simplifies inventory management by reducing blood product expiration.
• However, these transfusions can lead to immune complex formation, hemolysis, and cellular injury.

Purpose of the Study:

• To evaluate the safety and consequences of transfusing ABO compatible versus ABO identical blood components.
• To assess the association between current transfusion practices and adverse patient outcomes.
• To advocate for a revised standard of care in blood component transfusion.

Main Methods:

• Review of existing evidence on ABO compatible and incompatible transfusions.
• Analysis of patient outcomes associated with different transfusion strategies.
• Evaluation of the immunological and cellular effects of non-identical blood component transfusions.

Main Results:

• Transfusion of ABO compatible but not identical components is linked to immune complexes, hemolysis, and cellular injury.
• Evidence suggests a causal association between these practices and increased patient mortality.
• Current practices, while easing inventory, pose significant risks.

Conclusions:

• The practice of transfusing ABO compatible, non-identical blood components is associated with adverse patient outcomes, including increased mortality.
• Avoiding ABO incompatible antibodies, cells, and soluble antigens is crucial.
• Adopting a policy of providing ABO identical blood components when feasible should become the optimal standard of care to enhance patient safety.