Neil Blumberg: Clinical Harm Associated With Infusion of ABO Incompatible Antibody and Antigen
Neil Blumberg, Transfusion Medicine Specialist and Platelet Researcher (Former Professor and Director, URMC), shared on LinkedIn:
“Some ideas become dogma without any strong data to support them. Examples include the equivalent safety of universal donor group O red cells and group AB plasma to ABO identical transfusions. Data have now accumulated to show that these assumptions are largely incorrect.
Our group reviewed the data demonstrating that infusion of modest amounts of ABO incompatible cellular and soluble antigen, and ABO incompatible plasma are associated with clinical harm, including increased mortality.
Tong N, Masel D, Nguyen PL, Asante A, Refaai M, Heal JM, Blumberg N.
The case against infusing ABO incompatible antibody and antigen from all blood components.
Transfus Apher Sci. 2026 Jan 31;65(2):104402. doi: 10.1016/j.transci.2026.104402. Epub ahead of print. PMID: 41633302.
Abstract
The transfusion of ABO compatible but not ABO identical red blood cells and plasma and the transfusion of platelets and cryoprecipitate without concern for ABO in any manner, are practices that have been accepted as safe for patients.
While these practices make managing blood component inventories easier by reducing component outdating, they do lead to the development of immune complexes, donor antibody induced hemolysis, and potentially endothelial cell and platelet injury.
A growing body of evidence has shown that these practices are associated, likely causally, with negative consequences for patients including increased mortality.
The adoption of a policy of providing only ABO identical blood components when practical, and avoiding infusion of ABO incompatible antibody, cellular and soluble antigen should thus become the optimal standard of care for patients.
For those without access to the full article, request a .pdf from [email protected].”
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