Possible complications of infusing an ABO-incompatible platelet product
(1) hemolysis
(2) thrombocytopenia (related to ABO antigens on the platelet surface)
Risk factors:
(1) incompatibility between antibodies in donor's plasma and recipient's cells
(2) responsible antibody is present in a high titer (typically from an O donor)
(3) larger volume of plasma
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Donor Type
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Donor Antibodies
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Recipients at Risk
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O
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anti-A, anti-B, anti-A,B
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A, B, AB
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A
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anti-B
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B, AB
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B
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anti-A
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A, AB
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AB
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none
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none
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The definition of high-titer antibody varies with the institution. Serial dilutions of donor plasma are tested against A and B cells. A high-titer antibody may refer to a plasma that reacts at a titer of >= 1:64, >= 1:128, >= 1:150, or >= 1:250.
The risk of such a transfusion reaction can be reduced by:
(1) reducing the volume of plasma on a platelet product by centrifuging the product and removing some of the plasma. Unfortunately once prepared the spun product must be infused within 4 hours.
(2) screening for high-titer antibodies in the donors
(3) minimizing the use of incompatible platelets as much as possible
