ABO-identical versus incompatible platelet transfusion in patients with intracranial hemorrhage

• Published in: PloS one 2024-11, Vol.19 (11), p.e0312602
• Main Authors: Dunn, Lauren K, Venner, Emily, Nguyen, Matthew, Trejo, Jose Perdomo, Holley, Zachary, Naik, Bhiken I, Khan, Jenna, Mazzeffi, Michael
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - immunology; ABO system; Adult; Aged; Antibodies; Antigens; Biology and Life Sciences; Blood Group Incompatibility; Blood groups; Blood platelets; Body mass index; Brain; Cardiovascular disease; Cohort analysis; Drugs; Electronic health records; Electronic medical records; Female; Health aspects; Hemorrhage; Hospitals; Humans; Intracranial Hemorrhages - etiology; Intracranial Hemorrhages - therapy; Male; Medical records; Medicine and Health Sciences; Middle Aged; Mortality; Observational studies; Pathogens; Patients; Plasma; Platelet Count; Platelet Transfusion - methods; Platelets; Retrospective Studies; Thrombocytopenia; Transfusion; Treatment Outcome; Variables
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0312602

Patients with spontaneous and traumatic intracranial hemorrhage (ICH) are frequently transfused platelets to treat thrombocytopenia, platelet function defects, and reverse antiplatelet drugs. ABO-identical platelet transfusion has been suggested to lead to higher post-transfusion platelet increments compared to major-ABO incompatible transfusion. We hypothesized that patients who received ABO-identical transfusion would have higher post-transfusion platelet increments and superior neurologic outcomes. Adults with traumatic or non-traumatic ICH from January 1st 2018 to December 31st 2022 were identified using electronic medical records and international classification of disease (ICD)-10 codes. Patients were excluded if they lacked a platelet count within 24 hours before and within 24 hours after transfusion or if they received multiple platelet transfusions before their platelet count was remeasured. After stratification by ABO-identical, ABO-major incompatible, and ABO-minor incompatible transfusion, post transfusion increments were compared, as were clinical outcomes. Among 167 patients who received platelet transfusion, 76 (45.5%) received ABO-identical transfusion, 54 (32.3%) received ABO-major incompatible transfusion, and 37 (22.2%) received ABO-minor incompatible transfusion. There were no significant differences in absolute platelet increment between groups. The median increment was 7x109/L for ABO-identical platelets, 10x109/L for ABO-major incompatible platelets, and 11x109/L for ABO-minor incompatible platelets, p = .87. There was no significant difference in the percentage of patients discharged alive with modified Rankin score of 1 or 2 or cerebral performance category 1 or 2 between groups (p = .56 and .39 respectively). After adjusting for confounders in a general linear model there remained no associations between ABO compatibility and platelet increment after transfusion. Our data support similar efficacy for ABO-identical and ABO-incompatible platelet transfusion in patients with ICH.