Platelet ABO/D Type Substitutions/Mitigations

Principle:

Platelets have only weak ABO antigen expression but contain the naturally occurring antibodies of the original donor.

Policy:

  1. 20 kg or more:
    1. Platelets of any ABO/D type may be given to any patient
  2. Below 20 kg:
    1. First choice:  ABO identical
    2. Second choice:  Plasma compatible
    3. Third choice:  Platelet components in platelet additive solution PAS
    4. Fourth choice:  Contact transfusion medicine for use of plasma-incompatible type
  3. Do NOT volume reduce platelets:  this adversely affects platelet function and requires a prolonged recuperation period of several hours before the platelets can be transfused.  Platelets in additive solution have only minimal residual plasma (35 ml out of 200 ml volume).
  4. There is no need to chose platelet types from a D-compatible donor because we use methods that minimize RBC contamination (automated component processing to prepare buffy coats for pooling or apheresis).
    1. It is at the discretion of the ordering physician if he wants to consider Rh immunoprophylaxis if D-incompatible type is chosen.

References:

  1. Standards for Blood Banks and Transfusion Services, Current Edition, AABB, Bethesda, MD, USA
  2. Guidelines to the Preparation, Use, and Quality Assurance of Blood Components, European Committee (Partial Agreement) on Blood Transfusion (CD-P-TS), Current Edition