TxMD Transfusion Medicine Resources

ABO specific or compatible cryoprecipitate should be selected for pediatric or neonatal transfusions due to small blood volume of these patients. Single units of group AB cryoprecipitate are available from Versiti for neonates.

For adults (or patients >45 kg) any ABO group is acceptable. (See Acceptable ABO/RhD Substitutions for Blood Products – Adults.) Facilities may decide to limit number of units to avoid adverse effects from excessive volume of incompatible plasma.

During transport, the maximum time platelet products may be without agitation is 30 hours and temperature should be as close as possible to 20-24°C.¹

During storage, platelet products require continuous gentle agitation at 20-24°C.1 This agitation ensures proper gas exchange for aerobic respiration of the platelets and maintaining pH above 6.2.

In the hospital or laboratory setting, situations may occur where a platelet product is briefly stored without agitation (e.g. operating or procedure room). Studies on the handling of platelet products post manufacturing generally show that interruption in agitation for up to 24 hours does not adversely affect the quality of the platelets. At the end of 5 days, invitro markers are within acceptable limits and pH remains above 6.2. Platelets stored in plasma appear to withstand interruption in agitation better than platelets stored in platelet additive solution unless the additive solution contains bicarbonate or phosphate to regulate the pH. In addition, fewer platelets and larger plasma volumes tolerate the interruptions better, presumably due to less acidic conditions and lower risk for irreversible change to the platelets.^2,3

Platelets fared better with shorter, multiple interruptions than a prolonged interruption (i.e., three 8-hour periods without agitation versus one 24-hour period). With shorter interruptions, the impact of the reduced gas exchange is lower and more tolerable for the platelets.3 With apheresis platelet shelf life being 7 days, it is particularly important to limit the duration of each individual interruption of agitation.

References:

1. Galel SA, et al. AABB Standards for Blood Banks and Transfusion Services, 34th Edition, effective April 1, 2024,
2. Hunter S, et al. The effect of interruption of agitation on platelet quality during storage for transfusion. Transfusion 2001;41:809-814.
3. Thomas S. Platelets: handle with care. Transfusion Medicine 2016;26:330–338.

Recommendation: Yes, it is often considered acceptable. RhD-positive platelets pose minimal risk to RhD-negative patients. When giving RhD-positive platelets to RhD-negative non-oncology females of childbearing age, Rh immune globulin (RhIG) administration may be considered per hospital policy.

Background:
Platelets do not express RhD antigens. It is the residual RBCs in the RhD-positive platelet component that may provoke alloimmunization when transfused to an RhD-negative recipient. With current manufacturing processes, apheresis platelets contain negligible quantity of RBCs, approximately 0.00 - 0.043mL. Whole blood derived platelets have slightly more RBCs, ~0.036mL, a level within the minimum threshold (0.03–0.05 mL) known to cause sensitization.^1,2

The number of RhD-negative patients developing anti-D after transfusion of RhD positive platelets is quite low. The overall incidence for primary RhD alloimmunization – regardless if the RhD-positive platelet is collected via apheresis or is WB-derived – is approximately 2.0%, with slightly lower rates observed in immunosuppressed patients.3 According to data from the Recipient and Donor Epidemiology Study-III (REDS-III), nearly half (46%) of all platelet transfusions go to patients with leukemia, lymphoma, or myelodysplastic syndrome.4 Because their diseases and treatments suppress bone marrow function, these patients require multiple transfusions over the course of their care. From an inventory management perspective, providing exclusively RhD-negative platelets to RhD-negative hematology/oncology patients may be impractical since the supply of RhD-negative platelets is extremely limited. In accordance with American Society of Oncology (ASCO) guidelines, RhD-positive platelets are an acceptable alternative.2 Due to the overall low likelihood of RhD alloimmunization when transfusing an RhD-positive platelet product to an RhD-negative recipient, ASCO guidelines do not consider it necessary to administer RhIG unless the patient might become pregnant in the future.

References:

1. Cid J, Yazer M, Lozano M. Platelet transfusion and respecting patient D type. Curr Opin Hematol. 2015 Nov;22(6):540-6.
2. Schiffer CA, Bohlke K, Delaney M, et al. Platelet Transfusion for Patients with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:283-299.
3. Cid J, Lorzano M, Ziman A, et al. Low frequency of anti-D alloimmunization following D+ platelet transfusion: the Anti-D Alloimmunization after D-incompatible Platelet Transfusions (ADAPT) study. British Journal of Haematology, 2015;168:598–603.
4. Gottschall J, Wu Y, Triulzi D, et al. NHLBI Recipient Epidemiology and Donor Evaluation (REDS-III) Study. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion. 2020 Jan;60(1):46-53.

Per CAP TRM.42100 (10-24-2022) and AABB BBTS 7.5.2.4 (33rd edition), when a hemolytic transfusion reaction occurs that is suspected to be related to an attribute of the donor or the blood component, the blood supplier must be notified.

Example: Suspected hemolysis due to passive ABO antibodies from ABO-nonspecific platelet transfusion (Group A recipient receives Group O or Group B apheresis platelet).

Yes. 

The irradiation indicator placed on the unit at the time of irradiation is an internal visual quality control check. The ISBT label is the permanent label for the product. The ISBT component code indicates the product has been irradiated and acceptable for patients who require this blood component modification.

Manufacturers assign a maximum limit for platelet concentration and volume for their apheresis platelet bags to maintain proper gas exchange and optimize platelet viability during storage. When these limits are exceeded but there is insufficient quantity of platelets to manufacture 2 separate platelet products, the single product is stored in a double bag configuration to assure adequate gas exchange to maintain pH above 6.2 and acceptable platelet quality at end of shelf-life.

If a hospital transfusion service desires to combine the two bags, this should be done just prior to issue or release of the platelet product for transfusion. While there is no guidance from the manufacturers or accrediting agencies on an acceptable expiration after combining the bags, an outdate of 24 hours from the time of pooling or the original product expiration, whichever is sooner, is customarily used. This is likely based on the manufacturer’s allowance for the platelets to remain in a single bag for up to 24 hours after collection before the required storage in a double bag.¹ Although it would be an uncommon occurrence, if a closed system could not be maintained during the pooling, the expiration of the final product would then be 4 hours from time of pooling per AABB Standards for Blood Banks and Transfusion Services (STD 5.1.9).²

References:

1. Terumo BCT Recommendations for the ELP Storage Bag. 2017 Terumo BCT, Inc. / PN 306640415E.
2. Galel SA, et al. AABB Standards for Blood Banks and Transfusion Services, 34th Edition, effective April 1, 2024.