Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

BACKGROUND: There are multiple benefits to transfusing only ABO‐identical blood components. Historically our institution routinely transfused ABO‐nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO‐identical component...

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Bibliographic Details
Published in:	Transfusion (Philadelphia, Pa.) Vol. 52; no. 3; pp. 635 - 640
Main Authors:	Henrichs, Kelly F., Howk, Nedda, Masel, Debra S., Thayer, Mark, Refaai, Majed A., Kirkley, Scott A., Heal, Joanna M., Blumberg, Neil
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01-03-2012 Wiley
Subjects:	ABO Blood-Group System ABO system Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Banking - methods Blood Banks - organization & administration Blood Banks - statistics & numerical data Blood coagulation. Blood cells Blood Component Transfusion - adverse effects Blood Component Transfusion - methods Blood Component Transfusion - statistics & numerical data Blood Group Incompatibility - epidemiology Blood Group Incompatibility - prevention & control Blood Loss, Surgical - statistics & numerical data Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Cryoprecipitates Data processing Erythrocytes Factor VIII - administration & dosage Factor VIII - adverse effects Feasibility Studies Fibrinogen - administration & dosage Fibrinogen - adverse effects Fundamental and applied biological sciences. Psychology Guideline Adherence - statistics & numerical data Humans Hypersensitivity Incidence Isoantibodies - blood Isoimmunization Medical sciences Molecular and cellular biology Organizational Policy Outcome and Process Assessment, Health Care Platelet Platelet Transfusion - adverse effects Platelet Transfusion - methods Platelet Transfusion - statistics & numerical data Platelets Program Evaluation Transfusion Transfusions. Complications. Transfusion reactions. Cell and gene therapy Human Isoimmunization Blood cell Platelet Transfusion Red blood cell Incidence Logistics
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Summary:	BACKGROUND: There are multiple benefits to transfusing only ABO‐identical blood components. Historically our institution routinely transfused ABO‐nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO‐identical components whenever feasible, regardless of outdating or logistic considerations. STUDY DESIGN AND METHODS: Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO‐identical PLTs, ABO‐compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001‐2004) and subsequent (2006‐2009) to implementation. RESULTS: In the year after implementation, only 11 of 410 surgical patients received ABO‐nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO‐identical components was associated with significant reductions in febrile (−46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (−23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (−50% by 2009; p = 0.03). CONCLUSIONS: Providing ABO‐identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO‐identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.
Bibliography:	istex:504FB95AC3B3523349A85E0E5BFAB0EB1266B331 ArticleID:TRF3329 ark:/67375/WNG-NCFMZXZV-K Supported in part by NIH Grants HL078603, HL095467, and HL100051. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0041-1132 1537-2995
DOI:	10.1111/j.1537-2995.2011.03329.x