<scp>ABO</scp>‐mismatched platelet and plasma transfusion practices and the potential for transfusion‐related alpha‐gal syndrome: The Biomedical Excellence for Safer Transfusion Collaborative Study
Nancy M. Dunbar, Richard M. Kaufman, Karina S. Bary, Gregory Bellairs, Claudia S. Cohn, Fanny Angelot‐Delettre, Stephanie Ditcham, Gustavo de Carvalho Duarte, Amanda Ellison, Roberta Fachini, Chloë George, Catherine Humbrecht, Vernon Louw, Sascha Meier, Sarah L. Morley, Meridah Mwase, Nancy Robitaille, Kylie Rushford, Tomohiko Sato, Richard Schäfer, Julie Staves, Minoko Takanashi, Pierre Tiberghien, Silvano Wendel, Erica M. Wood, Alyssa Ziman, Michael Murphy, for the Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Abstract
BACKGROUND: Alpha-gal syndrome (AGS) is caused by IgE antibodies against the alpha-gal oligosaccharide, which is structurally similar to the Group B antigen. Recent case reports of severe allergic transfusion reactions (ATRs) in Group O patients receiving Group B plasma and platelets raise the possibility of a new adverse event, herein called transfusion-related AGS (TRAGS). The primary goal of this study was to assess the frequency of Groups B and AB plasma and platelet transfusions to Group O patients. STUDY DESIGN AND METHODS: In this multi-site retrospective study, participating sites submitted the numbers of platelet and plasma transfusions administered during a 2-year period categorized by patient and product ABO group. RESULTS: Fourteen sites from 10 countries participated. Group O patients received Group AB for an average of 9.9% (range 2.8%-29.2%) of plasma transfusions and Group B for 3.2% (0%-12.8%). AB plasma transfusion to Group O patients represented 4.5% (0.9%-14.6%) of the total plasma transfused; Group B 1.4% (0%-5.1%). Group O patients received Group AB for an average of 1.5% (range 0%-5.9%) of platelet transfusions and Group B for 4.1% (0%-14.2%). AB platelet transfusion to Group O patients represented 0.6% (0%-2.7%) of the total platelets transfused; Group B platelets were 1.8% (0%-6.7%). DISCUSSION: Evidence supporting the possibility of a new adverse event, TRAGS, is accumulating. This study quantifies how often Group O patients may be exposed to Group B antigen in Group B or AB plasma and/or platelet transfusions, providing an estimate of the scope of potential risk for TRAGS.