Barts Health NHS Trust, London, United Kingdom; Bolton NHS Foundation Trust, Greater Manchester, United Kingdom.
Component Development Laboratory, NHS Blood and Transplant, Cambridge, United Kingdom; Department of Haematology, University of Cambridge, United Kingdom.
Blood Rev. 2022 Nov;56:100989. doi: 10.1016/j.blre.2022.100989. Epub 2022 Jul 14.
Background The limited supply of universal plasma has resulted in transfusion of ABO incompatible plasma to patients. As the need to implement whole blood transfusion in pre-hospitals setting rises, the lowest cut-off for anti-A/anti-B that does not cause haemolysis remains unknown. In this first scoping review, we aimed to determine the lowest ABO titre and volume reported in the literature to cause haemolysis from ABO incompatible plasma transfusions (plasma, platelets, cryoprecipitate, and whole blood). Methods We searched several databases from inception to April 2022, including all study types. Three independent reviewers extracted and reviewed the data. Primary outcome was the anti-A and anti-B titre (measured by IgM or IgG) that resulted in measurable haemolysis following ABO incompatible plasma transfusion. Results We identified 5681 citations, of which 49 studies were eligible, reporting a total of 62 cases (34 adults, 14 children and 14 did not specify age). The methods for antibody measurement and antibody type (IgG or IgM) varied significantly between studies. Component volumes were poorly reported. The most common component responsible for the haemolysis was apheresis platelets followed by pooled platelets and whole blood. Most haemolytic cases reported were due to anti-A. The lowest anti-A titre reported to cause haemolysis (children and adults) was 32 (IgG), while for anti-B it was 512 (IgG and IgM) for adults, 16,384 for paediatrics (IgG and IgM) and 128 (IgM) in cases where the age was not specified. The lowest reported volume associated with haemolysis were 100 ml (adults) and 15 ml (children). Of the 62 15 (24%) died. Conclusion The lowest titre reported to cause haemolysis was an anti-A of 32. ABO mismatch plasma transfusion may be associated with significant mortality. There is a need to agree/standardise methods for ABO titration measurement internationally for plasma components and agree the lowest anti-A/anti-B titre for transfusing ABO mismatched plasma.
背景 由于通用血浆供应有限，导致输注 ABO 不相容的血浆给患者。随着在院前环境中实施全血输血的需求增加，尚未确定不会引起溶血的抗-A/抗-B 的最低截止值。在这项首次范围界定综述中，我们旨在确定文献中报告的导致 ABO 不相容血浆输注（血浆、血小板、冷沉淀和全血）发生溶血的最低 ABO 效价和体积。
方法 我们从开始到 2022 年 4 月在多个数据库中进行了搜索，包括所有研究类型。三名独立的评审员提取和审查了数据。主要结局是抗-A 和抗-B 效价（通过 IgM 或 IgG 测量），这些效价导致 ABO 不相容血浆输注后可测量的溶血。
结果 我们确定了 5681 条引文，其中 49 项研究符合条件，共报告了 62 例（34 例成人、14 例儿童和 14 例未指定年龄）。研究之间抗体测量和抗体类型（IgG 或 IgM）的方法差异很大。成分体积报道不佳。最常见的导致溶血的成分是单采血小板，其次是混合血小板和全血。报告的大多数溶血病例是由于抗-A 引起的。导致溶血的最低抗-A 效价报告（儿童和成人）为 32（IgG），而抗-B 为成人 512（IgG 和 IgM），儿科为 16384（IgG 和 IgM），年龄不详者为 128（IgM）。与溶血相关的最低报告体积为 100 ml（成人）和 15 ml（儿童）。在 62 例 15 例（24%）死亡。
结论 报告的导致溶血的最低效价为 32 的抗-A。ABO 不匹配的血浆输注可能与显著的死亡率相关。有必要在国际上就血浆成分的 ABO 滴定测量方法达成一致/标准化，并就输注 ABO 不匹配的血浆的最低抗-A/抗-B 效价达成一致。
