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ABO ‐immune complex formation and impact on platelet function, red cell structural integrity and haemostasis: an in vitro model of ABO non‐identical transfusion
Author(s) -
Zaffuto B. J.,
Conley G. W.,
Connolly G. C.,
Henrichs K. F.,
Francis C. W.,
Heal J. M.,
Blumberg N.,
Refaai M. A.
Publication year - 2016
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12354
Subject(s) - abo blood group system , haemolysis , platelet , red cell , immune system , immunology , in vitro , whole blood , hemolysis , medicine , biology , biochemistry
Background Transfusion of ABO non‐identical platelets has been associated with fatal haemolytic reactions, increased red cell transfusion needs and other adverse effects, but the practice of ABO matching in platelet transfusion is controversial. Immune complexes can be formed from the anti‐A and/or anti‐B antibodies and ABO soluble antigen(s) present in donor and recipient plasma after ABO non‐identical transfusions. We hypothesized that these immune complexes affect recipient red cell structural integrity, platelet function and haemostasis. Study Design and Methods Haemolysis, platelet function and haemostatic function were assessed before and after incubation of recipient red cells, platelets and whole blood with normal saline controls, ABO ‐identical plasma controls or in vitro ‐generated ABO ‐immune complexes. Results ABO ‐immune complexes caused significantly increased haemolysis ( P < 0·001), inhibition of platelet function ( P = 0·001) and disruption of clot formation kinetics ( P < 0·005) in both group A and O recipient samples. Conclusions Substantial changes in platelet function, red cell integrity and haemostasis occur after in vitro exposure to immune complexes. These in vitro findings may explain, in part, previously observed associations of ABO non‐identical platelet transfusions with adverse effects including increased red cell transfusion needs, organ failure and mortality.