ABO antibody titers are not predictive of hemolytic reactions due to plasma-incompatible platelet transfusions
Article first published online: 17 FEB 2012
© 2012 American Association of Blood Banks
Volume 52, Issue 10, pages 2087–2093, October 2012
How to Cite
Karafin, M. S., Blagg, L., Tobian, A. A.R., King, K. E., Ness, P. M. and Savage, W. J. (2012), ABO antibody titers are not predictive of hemolytic reactions due to plasma-incompatible platelet transfusions. Transfusion, 52: 2087–2093. doi: 10.1111/j.1537-2995.2012.03574.x
- Issue published online: 30 OCT 2012
- Article first published online: 17 FEB 2012
- Received for publication September 6, 2011; revision received January 6, 2012, and accepted January 8, 2012.
BACKGROUND: The overall risk of hemolytic transfusion reactions (HTRs) from plasma (minor)-incompatible platelet (PLT) transfusions and the role of a critical anti-A or anti-B titer in predicting and preventing these reactions has not been clearly established.
STUDY DESIGN AND METHODS: We evaluated all apheresis PLT (AP) transfusions for 3 months. Using the gel titer method, we determined the anti-A and/or the anti-B immunoglobulin (Ig)G titer for all incompatible APs. Reported febrile transfusion reactions and HTRs were recorded; transfusions were not prospectively evaluated by the study team. A posttransfusion direct antiglobulin test (DAT) and eluate were performed after a reported febrile or hemolytic reaction for patients who received plasma-incompatible APs.
RESULTS: A total of 647 of 4288 AP transfusions (15.1%) were plasma incompatible. Group O APs (n = 278) had significantly higher anti-A and anti-B titers than group A or B APs (p < 0.0001). No group A or B APs had a titer of more than 128 (0/342). For group O APs, 73 had titers of 256 or greater (26.3%), and 27 had titers of 512 or greater (9.7%). No HTRs were reported to any plasma-incompatible AP transfusion during the study period. Two plasma-incompatible AP transfusions were associated with fever and chills and positive DATs, of which one had a positive eluate. The incidence of a DAT and eluate-positive febrile transfusion reaction in the plasma-incompatible AP population is 0.15% (95% confidence interval, 0.0%-0.86%).
CONCLUSION: A critical anti-A or -B titer is not sufficient to predict the risk of hemolysis in patients receiving plasma-incompatible APs, although underreporting of reactions to the blood bank may limit the generalizability of this study.