Outcomes After ABO-Incompatible Platelet Transfusions in Patients With Intracerebral Hemorrhage

For patients with intracerebral hemorrhage (ICH) who received an acute platelet transfusion within 24 hours of hospital admission, the use of an incompatible platelet unit led to suboptimal platelet recovery and worse in-hospital outcomes at discharge compared with patients who received ABO-compatible transfusions, according to research reported in Blood.

This study represents the first investigation into the impact of ABO-incompatible platelet transfusions in patients with ICH, corresponding study author David Roh, MD, from Columbia University Medical Center in New York, told ASH Clinical News. However, he added, these findings require additional validation in future prospective studies before firm conclusions about clinical care implications can be drawn.

“ICH is a life-threatening indication for rapid transfusion product use, when indicated, to rapidly establish hemostasis and prevent ongoing bleeding in efforts to improve outcome,” said Dr. Roh. “The use of acute platelet transfusions to ‘reverse’ antiplatelet medication exposure has previously been used in ICH treatment paradigms.” Recently, he added, this practice has been called into question. The PATCH trial, for example, suggested that the use of platelet transfusions could potentially be associated with harm, at least in patients with ICH.

The researchers identified 125 patients with ICH who were consecutively admitted to Columbia University Irving Medical Center and who received a single platelet transfusion within 24 hours of admission. The investigators evaluated rates of mortality and poor neurologic outcome (modified Rankin Scale [mRS] score of 4-6) at discharge and three months after discharge. Researchers reviewed patient charts to obtain discharge outcomes, while a standardized phone interview was used to perform the three-month follow-up.

Forty-seven patients in this sample (38%) received an ABO-incompatible transfusion. The mean age of all patients in the study was 65 years, most patients were male (57.6%), and the median ICH score was 2. Most patients had type O blood (52.8%), followed by type A (33.6%), type B (10.4%), and type AB (3.2%).

Overall, there were no differences in demographics, ICH characteristics/severity, or age of transfused platelets between patients who received ABO-incompatible versus ABO-compatible platelet transfusion.

Patients who received ABO-incompatible platelet transfusions had a significantly lower median absolute count increment, which was indicative of poorer platelet recovery (2×103 cells/µL vs. 15×103 cells/µL; p=0.01; see TABLE). Receipt of ABO-incompatible platelets was also significantly associated with increased risk of mortality (adjusted odds ratio [OR] = 2.59; p=0.05) and poor mRS score (adjusted OR=3.61; p=0.06) at discharge. However, the investigators wrote that these estimates were imprecise, and no associations were observed at three-month follow-up.

Limitations of this study include its small sample size and single-center design. Dr. Roh noted that these results require replication in additional research to ensure that the identified associations are generalizable to patients with ICH who receive platelet units at other centers.

“Further exploration of questions delving into the mechanisms behind these findings are required to identify best transfusion approaches for this vulnerable patient population,” he concluded, “with specific attention to factors related to patient complications from ABO-incompatible platelet transfusion exposure, to platelet donor characteristics, and to platelet storage.”

Study authors report no relevant conflicts of interest.

Reference

Magid-Bernstein J, Beaman CB, Carvalho Poyraz F, et al. Impacts of ABO incompatible platelet transfusions on platelet recovery and outcomes after intracerebral hemorrhage. [published online ahead of print, 2021 Mar 1]. Blood. doi: 10.1182/blood.2020008381.