Transfusion of Platelets across blood groups

Platelet demand is increasing year on year with constant pressure to maximise use and
minimise wastage. For this reason first choice ABO and RhD identical platelets may not
always be readily available and alternatives are required.
ABO non-identical platelets may be used when identical units are not available in the time
required, to prevent time expiry of existing stock, or when specific requirements would not
otherwise be met e.g. where HLA matched platelets are required.
Caution - use of group O platelets for non-group O recipients should be avoided in
vulnerable groups such as children where haemolysis has been more commonly reported.
RhD negative platelets should be given to RhD negative women of child bearing potential;
provision to children would also seem appropriate. RhD negative women of child bearing
potential who receive RhD positive platelets should be given an appropriate dose of
prophylactic anti-D immunoglobulin.
AB and B platelets may be subject to reduced availability from the blood service; however
when ordering standard platelets for patients of any group, ABO and RhD identical should
always be requested. NHSBT will advise if a component is not available and discuss
alternative groups.
Table 1. Platelet selection by recipient ABO group:

Recipient s ABO group ABO group of Platelets

First choice O
O
Second choice A or B

First choice A
A Second choice AB (if readily available)
Third choice B* or O*

First choice B
B Second choice AB (if readily available)
Third choice A* or O*

First choice AB
AB Second choice A* or B*

Third choice O*

* components tested negative for high-titre anti-A and/or anti-B should be used here.
Note however that high-titre negative screening does not provide absolute assurance that a
haemolytic reaction will not occur and caution should always be taken when selecting /
transfusing ABO non-identical components.
References:
Kosmirak, L., Oct.2012. NHSBT Portfolio of blood components and guidance for their clinical use.
http://hospital.blood.co.uk/library/pdf/components/SPN223-5-3.pdf
British Committee for Standards in Haematology Transfusion Task Force, 2004. Transfusion guidelines for neonates and older children. British
Journal of Haematology, 124 (433-453) http://www.bcshguidelines.com/documents/trasnfusion_Neonates_bjh_124_4_2004.pdf

Version 1 March 2013