Dunbar Nancy M, Katus Matthew C, Freeman Christine M, Szczepiorkowski Zbigniew M
Department of Pathology.
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Transfusion. 2015 Aug;55(8):1882-8. doi: 10.1111/trf.13077. Epub 2015 Mar 11.
Many hospital transfusion services prioritize ABO plasma compatibility in platelet (PLT) transfusion to minimize risk for acute hemolytic transfusion reactions. In spite of the low risk of D alloimmunization associated with apheresis PLT transfusion, attempts may also be made to provide D- PLTs to D- patients. This study was undertaken to assess how often ABO compatibility and/or D matching occurs at our institution and how the ABO and D mix of our PLT supply impacts PLT selection.
We retrospectively reviewed the ABO and D type of all PLTs transfused plus the age, sex, and ABO and D type of all PLT recipients between January 2010 and March 2014 (51 months).
We provided ABO-identical PLTs for 5281 (54.6%), ABO plasma-compatible and cellular-incompatible for 3136 (32.4%), ABO low-titer plasma-incompatible and cellular-compatible for 1150 (11.9%), ABO plasma-incompatible and cellular-compatible for 30 (0.3%), and ABO plasma-incompatible and cellular-incompatible for 72 (0.7%). PLT supply did not match PLT demand based on patient ABO type, primarily due to a lower than expected supply of group O PLTs and higher than expected supply of group A and AB. D- patients were less likely to receive ABO-identical PLT transfusions (p = 0.0008), but were more likely to receive D- PLT transfusions (p < 0.0001).
At our hospital, available inventory and PLT selection practices resulted in the majority of group O patients receiving cellular-incompatible PLT transfusions. Efforts to provide D- PLTs to D- patients also resulted in fewer D- patients receiving ABO-identical PLT transfusions.
许多医院输血服务机构在血小板（PLT）输注中优先考虑ABO血浆相容性，以将急性溶血性输血反应的风险降至最低。尽管单采血小板输注导致D抗原同种免疫的风险较低，但仍可能尝试为D抗原阴性患者提供D抗原阴性的血小板。本研究旨在评估在我们机构中ABO相容性和/或D抗原匹配的发生频率，以及我们血小板供应的ABO和D抗原组合如何影响血小板的选择。
我们回顾性分析了2010年1月至2014年3月（51个月）期间所有输注血小板的ABO和D抗原类型，以及所有血小板接受者的年龄、性别、ABO和D抗原类型。
我们提供了ABO血型相同的血小板5281例（54.6%），ABO血浆相容但细胞不相容的3136例（32.4%），ABO低滴度血浆不相容但细胞相容的1150例（11.9%），ABO血浆不相容但细胞相容的30例（0.3%），以及ABO血浆和细胞均不相容的72例（0.7%）。血小板供应与基于患者ABO血型的需求不匹配，主要原因是O型血小板供应低于预期，而A型和AB型血小板供应高于预期。D抗原阴性患者接受ABO血型相同的血小板输注的可能性较小（p = 0.0008），但接受D抗原阴性血小板输注的可能性较大（p < 0.0001）。
在我们医院，可用库存和血小板选择做法导致大多数O型患者接受细胞不相容的血小板输注。为D抗原阴性患者提供D抗原阴性血小板的努力也导致接受ABO血型相同血小板输注的D抗原阴性患者减少。
