Letter to the Editor
Screening of group O platelet donors for high-titer ABO antibodies- limitations, feasibility, and future

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Absence of a standard method of titration

Though erythrocytes agglutination technique is considered as the ‘gold-standard’ for ABO antibodies titration, a wide variation in the measurement of the ABO antibody titer has been observed among different blood centers due to the absence of a standard method of titration. Considering the low reproducibility and high subjective variation of conventional tube technique (CTT), most of the laboratories have started to use highly sensitive automated platforms using the micro-column agglutination

Lack of consensus to define critical titers

It is extremely difficult to reach a consensus to define the exact critical titres for ABO antibodies in group O platelet donors because pooling of tests results by performing a meta-analysis is not possible in this case as multiple methods are being followed by different centers for anti-A/-B titration. Furthermore, the complexity is increased by several folds as the tests of centers differ in almost every detail, including the use of donor plasma or serum, the medium used for dilution,

Unpredictable clinical implications

At present approximately 19 % of platelet transfusions in the United States are minor ABO incompatible [8]. Recently the International Society of blood Transfusion forum has also reported similar results by collecting the responses from 15 centers across the globe with a wider geographical location [9]. Whereas the US Food and Drug Administration data from 2007 to 2017 has reported only 6 fatalities due to the hemolysis from minor ABO incompatible platelet transfusions [10]. Clinically

Logistic problems

In most of the blood centers the choice of ABO-compatible or ABO-incompatible platelets is often driven by logistic considerations, i.e., to ensure the supply. As discussed before, if a significant percentage of group O donors become ineligible for non-O group recipients due to the presence of high-titer isoagglutinins; managing the platelet inventory becomes a great challenge. In addition, there is no consensus or standard policy in place to permanently exclude group O platelet donors with

Conclusion

Hemolytic reactions occur most commonly if the anti-A/-B antibody titer exceeds 1:64 to 1:100 in saline (IgM) or 1:256 to 1:400 with antiglobulin reagent (IgG), however hemolysis have been reported in transfusions with low-titer units also [17]. Therefore, the hemolytic activity is not restricted to titer alone rather it is much more complex than what we apparently perceive. The complement-activating property of IgM or IgG is identified as one of the major determining factors to define the

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