AB0- und Rhesus-Kompatibilität bei der Thrombozytentransfusion

Die Transfusion von Thrombozytenkonzentraten (TK) ist bei schweren Thrombozytopenien und lebensbedrohlichen Blutungen unverzichtbar. Die kurze Haltbarkeit der Präparate und die begrenzte Verfügbarkeit erschweren die AB0-idente und RhD-kompatible Versorgung. Der Artikel erläutert die immunhämatologischen Grundlagen der AB0- und RhD-Inkompatibilität bei der TK-Transfusion und zeigt praktische Strategien zur Risikominimierung bei ABD-inkompatibler Transfusion.

Abstract

The transfusion of platelet concentrates (PC) is essential for patients with severe thrombocytopenia and life-threatening haemorrhages. The short shelf life of PC and their limited availability make it difficult to provide patients with AB0-identical and RhD-compatible PC, as recommended by the German haemotherapy guidelines. In daily practice, PC are often issued on a “first in first out” basis, but it is sometimes difficult to find compatible PCs for patients with rarer blood groups such as B or AB RhD-negative, which raises the question of which incompatibilities are acceptable and which risk minimization strategies should be applied. The PCs used in Germany are leucocyte-depleted and are prepared by the pool or apheresis method using either plasma or a mixture of plasma and a platelet additive solution (PAS). Each product has individual advantages. This article explains the immunohaematological basis of AB0 and RhD incompatibility in platelet transfusion and outlines practical strategies to minimise the risk of ABD incompatible transfusion.

Schlüsselwörter

Thrombozytentransfusion - AB0-Inkompatibilität - RhD-Inkompatibilität - Isoagglutinine - Hämolyse

Key word

platelet transfusion - AB0 incompatibility - RhD incompatibility - isohemagglutinins - Hemolysis

Publication History

Article published online:
14 May 2025

• Literatur

• 1 Lozano M, Heddle N, Williamson LM. et al. Practices associated with ABO-incompatible platelet transfusions: a BEST Collaborative international survey. Transfusion 2010; 50: 1743-1748
• 2 Curtis BR, Edwards JT, Hessner MJ. et al. Blood group A and B antigens are strongly expressed on platelets of some individuals. Blood 2000; 96: 1574-1581
• 3 Julmy F, Achermann F, Schulzki T. et al. PLTs of blood group A1 donors express increased surface A antigen owing to apheresis and prolonged storage. Transfusion 2003; 43: 1378-1385
• 4 Gottschall J, Wu Y, Triulzi D. et al. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion 2020; 60: 46-53
• 5 Cheng Z, Kong Y, Lin Y. et al. Transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion: A systematic review and meta-analysis. Transfus Apher Sci 2024; 63: 103943
• 6 Triulzi DJ, Assmann SF, Strauss RG. et al. The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia. Blood 2012; 119: 5553-5562
• 7 Heal JM, Rowe JM, Blumberg N. ABO and platelet transfusion revisited. Ann Hematol 1993; 66: 309-314
• 8 Carr R, Hutton JL, Jenkins JA. et al. Transfusion of ABO-mismatched platelets leads to early platelet refractoriness. Br J Haematol 1990; 75: 408-413
• 9 Fontaine MJ, Kuo J, Chen G. et al. Complement (C1q) fixing solid-phase screening for HLA antibodies increases the availability of compatible platelet components for refractory patients. Transfusion 2011; 51: 2611-2618
• 10 Dunbar NM. Does ABO and RhD matching matter for platelet transfusion?. Hematology Am Soc Hematol Educ Program 2020; 2020: 512-517
• 11 Cardigan R, New HV, Estcourt L. et al. International Forum on Policies and Practice for Transfusion of ABO and RhD Non-Identical Platelets: Summary. Vox Sang 2022; 117: 136-144
• 12 Menis M, Izurieta HS, Anderson SA. et al. Outpatient transfusions and occurrence of serious noninfectious transfusion-related complications among US elderly, 2007-2008: utility of large administrative databases in blood safety research. Transfusion 2012; 52: 1968-1976
• 13 Funk M, Müller S, Meyer B. Hämovigilanz-Bericht des Paul-Ehrlich-Instituts 2021: Auswertung der Meldungen von Reaktionen und Zwischenfällen nach § 63i AMG. Langen: Paul-Ehrlich-Institut; 2021
• 14 Berséus O, Boman K, Nessen SC. et al. Risks of hemolysis due to anti-A and anti-B caused by the transfusion of blood or blood components containing ABO-incompatible plasma. Transfusion 2013; 53: 114S-123S
• 15 Yazer MH, Seheult J, Kleinman S. et al. Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO-incompatible plasma. Transfusion 2018; 58: 532-538
• 16 McCullagh J, Cardigan R, Brunskill SJ. et al. Assessing the risks of haemolysis as an adverse reaction following the transfusion of ABO incompatible plasma-containing components – A scoping review. Blood Rev 2022; 56: 100989
• 17 Bundesärztekammer. Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten (Richtlinie Hämotherapie): Gesamtnovelle 2023. Köln: Deutscher Ärzteverlag; 2023
• 18 Karafin MS, Blagg L, Tobian AAR. et al. ABO antibody titers are not predictive of hemolytic reactions due to plasma-incompatible platelet transfusions. Transfusion 2012; 52: 2087-2093
• 19 Quillen K, Sheldon SL, Daniel-Johnson JA. et al. A practical strategy to reduce the risk of passive hemolysis by screening plateletpheresis donors for high-titer ABO antibodies. Transfusion 2011; 51: 92-96
• 20 Sprogøe U, Yazer MH, Rasmussen MH. et al. Minimal variation in anti-A and -B titers among healthy volunteers over time: Implications for the use of out-of-group blood components. J Trauma Acute Care Surg 2017; 82: S87-S90
• 21 Estcourt LJ, Birchall J, Allard S. et al. Guidelines for the use of platelet transfusions. Br J Haematol 2017; 176: 365-394
• 22 Liumbruno G, Bennardello F, Lattanzio A. et al. Recommendations for the transfusion of plasma and platelets. Blood Transfus 2009; 7: 132-150
• 23 Bodnar M, Bienz M, Clarke G. FAQ: Donor high titre isohemagglutinin (anti-A/anti-B) testing at Canadian Blood Services. https://profedu.blood.ca/en/transfusion/publications/faq-donor-high-titre-isohemagglutinin-anti-aanti-b-testing-canadian-blood Stand: 18.03.2025
• 24 Tynuv M, Flegel WA. Quality improvement with platelet additive solution for safer out-of-group platelet transfusions. Immunohematology 2019; 35: 108-115
• 25 Balbuena-Merle R, West FB, Tormey CA. et al. Fatal acute hemolytic transfusion reaction due to anti-B from a platelet apheresis unit stored in platelet additive solution. Transfusion 2019; 59: 1911-1915
• 26 Atoyebi W, Mundy N, Croxton T. et al. Is it necessary to administer anti-D to prevent RhD immunization after the transfusion of RhD-positive platelet concentrates?. Br J Haematol 2000; 111: 980-983
• 27 Gunson HH, Stratton F, Phillips PK. The primary Rho(D) immune response in male volunteers. Br J Haematol 1976; 32: 317-329
• 28 Jakobowicz R, Williams L, Silberman F. Immunization of Rh-negative volunteers by repeated injections of very small amounts of Rh-positive blood. Vox Sang 1972; 23: 376-381
• 29 Hubert T, Kerkhoffs JL, Brand A. et al. Anti-D immunization after D positive platelet transfusions in D negative recipients: A systematic review and meta-analysis. Transfusion 2024; 64: 933-945
• 30 Cid J, Carbassé G, Pereira A. et al. Platelet transfusions from D+donors to D- patients: a 10-year follow-up study of 1014 patients. Transfusion 2011; 51: 1163-1169
• 31 Cid J, Lozano 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. Br J Haematol 2015; 168: 598-603
• 32 Schonewille H, Honohan Á, van der Watering LM. et al. Incidence of alloantibody formation after ABO-D or extended matched red blood cell transfusions: a randomized trial (MATCH study). Transfusion 2016; 56: 311-320
• 33 Reckhaus J, Jutzi M, Fontana S. et al. Platelet Transfusion Induces Alloimmunization to D and Non-D Rhesus Antigens. Transfus Med Hemother 2018; 45: 167-172
• 34 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. Gesamtnovelle. 5. Aufl. Köln: Deutscher Ärzteverlag; 2020