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Microfluidics in Assessing Platelet Function
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ABO-Incompatible Platelet Transfusions and Mortality Risk in Patients With Intracranial Hemorrhage.

David Roh1, Jonathan M Davis2, Deborah B Bookwalter2

  • 1Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.

Neurosurgery
|March 27, 2026
PubMed
Summary
This summary is machine-generated.

Platelet transfusions in intracranial hemorrhage (ICH) patients are common. However, ABO-incompatible platelet units increase mortality risk, especially in spontaneous intracerebral hemorrhage (sICH).

Keywords:
ABO incompatibilityAneurysmal subarachnoid hemorrhageIntracranial hemorrhageMortalityPlatelet transfusionSpontaneous intracerebral hemorrhageTraumatic intracranial hemorrhage

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Area of Science:

  • Hematology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Platelet transfusion practices for intracranial hemorrhage (ICH) lack clarity, despite associated mortality risks.
  • ABO-incompatible platelet transfusions may elevate mortality in specific patient populations with ICH.

Purpose of the Study:

  • To evaluate current platelet transfusion practices in patients with various types of ICH.
  • To determine if ABO-incompatible platelet transfusions increase the risk of mortality in ICH patients.

Main Methods:

  • A multicenter network assessed adult patients with spontaneous intracerebral hemorrhage (sICH), traumatic ICH, and aneurysmal subarachnoid hemorrhage (2019-2024).
  • Logistic and Cox regression models analyzed the association between platelet transfusions, ABO-incompatible units, and 30-day mortality, adjusting for confounders.

Main Results:

  • Platelet transfusions were administered to 12% of 13,068 ICH patients; transfusions themselves did not significantly increase mortality.
  • ABO-incompatible platelet units were common (37%) and associated with a dose-dependent increase in mortality risk.
  • Patients with sICH showed particular vulnerability to mortality from ABO-incompatible platelet exposures.

Conclusions:

  • Platelet transfusion practices in ICH are prevalent, and ABO-incompatible units may significantly influence 30-day mortality.
  • Further clinical trials are warranted to investigate if using ABO-matched platelets can improve outcomes for ICH patients.