Jain Puneet, Tendulkar Anita, Gupta Abhaykumar
Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Asian J Transfus Sci. 2018 Jan-Jun;12(1):10-16. doi: 10.4103/ajts.AJTS_2_17.
Guidelines recommend ABO-identical platelet (PLT) transfusions. Hemolytic reactions after a minor ABO-incompatible PLT transfusion have escalated due to single-donor platelets (SDP) containing ABO-incompatible plasma. Avoiding such events by examining titers or performing plasma reduction is cumbersome. The introduction of platelet additive solutions (PAS) has enabled to reduce these reactions by avoiding passive transfer of isoagglutinin. Our aim was to study antibody titers (anti-A, anti-B) in "O" SDP by adding PAS at source and the quality parameters with reference to viability, morphology, and metabolism.
Group "O" SDP ( = 50) were prepared on a standard cell separator. PAS in a ratio of 70:30 (PAS: plasma) was added at source under sterile conditions (study arm). The units were studied on day of collection (day 0) and day 4 and compared with SDP containing 100% plasma (control arm). A titer study was performed after PAS addition.
In the study group, the median antibody titers (anti-A, anti-B) reduced from 128 to16, post-PAS addition ( < 0.001). Morphology scores were superior in PAS platelet concentrates ( < 0.001). Metabolic parameters pO and pCO were similar in the two arms signifying good unit storage and stable oxygen consumption ( > 0.05). Lactate levels, glucose consumption rate, and lactate production rates were significantly low in study arm showing the advantage of PAS.
O group SDPs can be prepared with PAS and the beneficial effects were significant with respect to antibody titers. Quality parameters were well maintained. Availability of PAS units has benefitted patients.
指南推荐输注ABO血型相同的血小板(PLT)。由于单采血小板(SDP)中含有ABO血型不相容的血浆,轻微ABO血型不相容的PLT输血后的溶血反应有所增加。通过检测滴度或进行血浆置换来避免此类事件很麻烦。血小板添加剂溶液(PAS)的引入能够通过避免同种凝集素的被动转移来减少这些反应。我们的目的是通过在源头添加PAS来研究“O”型SDP中的抗体滴度(抗A、抗B)以及与活力、形态和代谢相关的质量参数。
在标准血细胞分离机上制备“O”型SDP( = 50)。在无菌条件下于源头添加比例为70:30(PAS:血浆)的PAS(研究组)。在采集日(第0天)和第4天对这些单位进行研究,并与含有100%血浆的SDP(对照组)进行比较。添加PAS后进行滴度研究。
在研究组中,添加PAS后抗体滴度中位数(抗A、抗B)从128降至16( < 0.001)。PAS血小板浓缩物的形态学评分更高( < 0.001)。两组的代谢参数pO和pCO相似,表明单位储存良好且氧消耗稳定( > 0.05)。研究组的乳酸水平、葡萄糖消耗率和乳酸产生率显著较低,显示出PAS的优势。
“O”型SDP可用PAS制备,在抗体滴度方面有益效果显著。质量参数得到良好维持。PAS单位的可用性使患者受益。