(P-TS-55) Major ABO-incompatible platelet transfusion is not associated with higher incidence of hospital complications in patients with intracerebral hemorrhage

Background/Case Studies: We have identified that major ABO-incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes; however, the underlying driver for these relationships remains unclear. Prior studies have identified that major ABO-incompatible platelet transfusions are associated with certain medical complications, thus we sought assess the relationship of major ABO-incompatible platelet transfusions with infectious and thromboembolic complications during an ICH hospitalization.

Study

Design/Methods: Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2018 were assessed. Patients who received a single platelet transfusion within 24 h of admission were included in the analysis. Donor and recipient blood type was available and the administration of a platelet unit with major ABO incompatibility was the exposure. The outcome was incidence of any infectious or thromboembolic complication during the ICH hospitalization. Multivariate logistic regression was used to assess relationships between major ABO-incompatible platelet transfusion with these complications adjusting for sex, race, and ICH severity.

Results/Findings: Amongst 114 ICH patients receiving a single acute platelet transfusion, mean age was 64.9, 40.4% were female, and 39.7% received a platelet unit with major ABO incompatibility. We did not identify an association of major ABO-incompatible platelet transfusion with composite infectious or thromboembolic complications (43.5% vs 40.0%, adjusted OR 0.95, 95%CI 0.44-2.10, p=0.91). When exploring intergroup differences in infectious and thromboembolic complications separately, there did not appear to be significant differences between patients receiving major ABO-incompatible platelet units vs compatible ones (43.5% vs 37.1%; 6.5% vs 12.9%, respectively).

Conclusions: Amongst ICH patients receiving an acute platelet transfusion, major ABO incompatibility was not associated with hospital complications. However, our sample size was small, and further work is needed to clarify relationships of platelet characteristics with clinical outcomes.

Importance of research: We previously found that major ABO-incompatible platelet transfusions deleteriously impact ICH outcomes. The drivers for these relationships are unclear. While work in non-ICH patients has shown associations of incompatible platelets with medical complications, we did not find a relationship of ABO-incompatible platelet transfusions with infection or thrombosis in ICH patients. More work is needed to identify how incompatible platelets impact clinical outcomes and improve transfusion practices.