NHS Blood and Transplant, England, England, United Kingdom
Background/Case Studies: Currently, most clinical guidelines recommend transfusing ABO-identical platelets where possible. However, due to stock availability and platelets having a short (5-7 day) shelf life this is not always possible. Therefore, mismatched platelet transfusions occur which can result in either major or minor ABO incompatibility. In order to reduce this risk of haemolysis, platelets that are negative for high-titre (HT) anti-A/B antibodies are preferred for transfusion of ABO minor-mismatched platelets. A further risk-reduction measure would be to selectively remove anti-A and anti-B antibodies from platelet concentrates. Here data is presented on the efficacy of the Glycosorb® ABO immunoadsorption column to reduce anti A/B titres in group O platelets and impact on platelet quality.
Study
Design/Methods: Six standard group O double dose apheresis platelet donations were each pooled with HT positive group O plasma units (IgM >1:128). Each pool was split into three and treated as follows; control - untreated, pack 1 - passed through the Glycosorb® ABO column once; pack 2 - passed through the previously used Glycosorb® column. This was repeated to give n=6. The platelet units were assessed for IgM and IgG, anti-A and anti-B, pre and post filtration by ID-card method. A range of coagulation factors and platelet quality markers were also assessed post filtration.
Results/Findings: • The Glycosorb® ABO column decreases anti-A and anti-B titres from titres of 1:128 to ≤1:32 (IgM) and 1:512 to ≤1:32 (IgG) on the first pass through the column. • There was no significant change in platelet count, platelet concentrate volume, coagulation factors, CD62P expression or platelet microparticles post filtration. Conclusions: This data shows that the Glycosorb® ABO column has potential for use as a titre reduction method for platelet units. Further data are needed to understand the maximal antibody titre at which it is effective, and the proportion of donors at or above that level.
Importance of research: High titre (HT) negative platelets for transfusion across ABO group are in demand by hospitals due to a limited availability of ABO-compatible platelets. Reduction of anti-A and anti-B levels in platelets to produce a Universal platelet unit would help to alleviate this supply pressure. This initial data presents a potential medical device solution capable of removing anti-A and anti-B in platelet units without any detrimental effect on platelet quality.
