Transfusion efficacy of ABO major-mismatched platelets (PLTs) in children is inferior to that of ABO-identical PLTs

Authors

  • Friedgard Julmy,

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • Roland A. Ammann,

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • Behrouz Mansouri Taleghani,

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • Stefano Fontana,

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • Andreas Hirt,

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • Kurt Leibundgut

    1. From the Department of Pediatrics and the Department of Hematology, University of Berne, and the Blood Transfusion Service of the Swiss Red Cross, Berne, Switzerland.
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  • This work was supported by the Swiss Cancer League (Oncosuisse, Berne, Switzerland; Grants OCS 01470-02-2004 and KLS-01828-02-2006).

Kurt Leibundgut, MD, Division of Pediatric Hematology/Oncology, University Children's Hospital, CH-3010 Berne, Switzerland; e-mail: kurt.leibundgut@insel.ch.

Abstract

BACKGROUND: ABO major compatibility is essential in transfusions of red blood cells but is not requisite in PLT transfusions. In adults there is some evidence that transfusion efficacy of ABO blood group–identical platelets (PLTs) is superior to major-mismatched PLTs. However, in children this question has not been investigated for more than 30 years.

STUDY DESIGN AND METHODS: In a prospective study, the efficacy (based on the 1-hour percentage of PLT recovery [PPR1hr]) of 400 eligible ABO blood group–identical or out-of-group apheresis PLT concentrates (APCs), transfused mainly prophylactically to 50 children with hematologic malignancies, solid tumors, or aplastic anemia was investigated. The primary objective was to compare PPR1hr between ABO-identical and major-mismatched transfusions.

RESULTS: After ABO major-mismatched transfusions, PPR1hr was significantly lower than after ABO blood group–identical transfusions (median 21% vs. 32%; p = 0.034). Multivariate analysis showed major-mismatched transfusions to be significantly more often unsuccessful than identical transfusions (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.52-10.39; p = 0.005). Using flow cytometry and fluorescent microscopy, it could be demonstrated that PLTs of subgroup A1, significantly expressing A antigen on their surface, were rapidly cleared from the circulation of group O or B recipients. In contrast, major-mismatched transfusions of A2 PLTs, expressing no detectable A antigen, were as successful as identical transfusions (OR, 1.13; 95% CI, 0.16-7.88; p = 0.90).

CONCLUSION: These data clearly indicate that in children ABO major-mismatched PLT transfusions result in inferior transfusion efficacy, with the only exception of group A2 PLTs. ABO minor-mismatched PLTs showed comparable efficacy to identical transfusions.

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