(60) Evaluating the necessity of ABO compatibility for platelet transfusions in blood type A/AB pediatric hematology patients

Background: Every year, 2 million platelet components are transfused in the US. Since platelets do not express ABO antigens, ABO compatibility between donor and recipient is generally not considered in platelet transfusions. Type O blood donors, who do not express A and B antigens, produce anti-A and anti-B antibodies, which remain in platelet units after undergoing apheresis. These antibodies can lead to transfusion reactions, particularly in immunocompromised patients. Recent studies have shown high rates of transfusion reactions in blood type A/AB patients receiving type O platelets.

Objectives: This study aims to examine whether transfusion reactions involving the administration of O donor platelets into A or AB recipient patients will constitute a significant percentage of transfusion reactions in the Pediatric Hematology-Oncology Division (PHO) of our hospital, OSF St. Francis Medical Center (OSFMC). We also hypothesize that transfusion reactions in this specific patient population at PHO will constitute a significant percentage of transfusion reactions at OSFMC.

Design/Methods: This study is a retrospective chart review looking at two groups of patients: patients of PHO and patients of OSF SFMC who have received platelet transfusions over the past 5 years. OSF Healthcare analytics pulled data on patients with a documented transfusion reaction workup and examined associations between patient and donor ABO blood type through chi-square tests and logistic regression analysis. Data analysis was performed using IBM SPSS Statistics software.

Results: We identified 36 patients from PHO and 76 patients from OSFMC who had undergone platelet transfusion reactions in the past five years. PHO had a transfusion reaction rate of 3.2%. 33% (12 of 36) of PHO patients with platelet transfusion reactions had blood type A or AB. Of these patients, 25% (3 of 12) had been transfused with type O blood. Therefore, 8.3% (3 of 36) of PHO platelet transfusion reactions can be attributed to type A or AB patients receiving type O blood.

Conclusion: PHO constitutes 1.6% of patient beds at OSFMC (10 of 642), yet almost half of the transfusion reactions at OSFMC can be attributed to patients of PHO. Given the results of our study, it may be beneficial to implement ABO matching protocols for immunocompromised and highly specialized patient populations such as pediatric hematology-oncology. The limitations of this study include a small sample size and difficulty in identifying patients who had undergone transfusion reactions.