The impact of pathogen reduction on ABO isoagglutinin titers in apheresis platelets

Yeghiazaryan, Mikayel; Ahmad, Yembur; Singer, Jessie; Nazaryan, Vaanush; Fletcher, Craig; Akgun, Yamac

doi:10.1016/j.htct.2025.103840

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Original article • Hematol., Transfus. Cell Ther. 47 (3) • 2025 • https://doi.org/10.1016/j.htct.2025.103840 linkcopy

The impact of pathogen reduction on ABO isoagglutinin titers in apheresis platelets

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Platelet transfusions are a cornerstone of modern medical care, used across various clinical contexts. Ensuring the compatibility of blood products, especially regarding ABO isoagglutinins, is critical to minimize adverse reactions. Pathogen reduction technologies have been widely adopted to enhance the safety of blood products, however, the impact of such treatments on ABO isoagglutinin titers in platelet products remains unclear.

Methods This study analyzed 60 apheresis platelet donations, including type O, A, and B donors, using the INTERCEPT® Blood System for pathogen reduction. Samples were collected both from donor whole blood at the time of apheresis (Retention) and from the final pathogen-reduced platelet product after it had passed through the compound adsorption device (Post-CAD). ABO isoagglutinin titers, including both IgM and IgG classes, were measured using solid-phase technology on the NEO Iris platform.

Results This study found a significant reduction in IgM isoagglutinin titers in Post-CAD samples, with 99 % of Retention titers being greater than or equal to their Post-CAD counterparts. IgG titers exhibited more variability, with 9 % of Post-CAD samples displaying higher titers than Retention samples. Statistical analysis confirmed differences between Retention and Post-CAD samples for both IgM and IgG titers, with p-values <0.05 in most comparisons.

Conclusion Pathogen reduction using the INTERCEPT® Blood System effectively reduces ABO isoagglutinin titers in apheresis platelets, potentially lowering the risk of hemolytic transfusion reactions. This reduction is beneficial for safer out-of-group platelet transfusions, especially in vulnerable populations such as pediatric patients. These findings support the continued use of pathogen-reduced platelets in transfusion medicine to enhance both safety and availability of blood products.

Keywords
Pathogen reduction; Apheresis platelets; Isoagglutinin titers; Solid phase

Blood type	Sample n	Antibody specificity, class	Specimen source	Median	Mode	Min	Max	CVa	p valueb	Concordance (%)c +/−1	Concordance (%)c +/−2
O	30	Anti-A, IgM	Retention	32	64	2	128	0.37	<0.05	93 %	100 %
			Post-CAD	16	64	2	64	0.41
O	30	Anti-B, IgM	Retention	16	16	1	64	0.45	<0.05	100 %	100 %
			Post-CAD	8	8	0	64	0.49
O	30	Anti-A, IgG	Retention	64	128	1	256	0.28	0.066	100 %	100 %
			Post-CAD	64	128	1	256	0.31
O	30	Anti-B, IgG	Retention	32	128	2	128	0.36	<0.05	100 %	100 %
			Post-CAD	32	32	2	128	0.40
A	15	Anti-B, IgM	Retention	8	8	2	128	0.50	<0.05	87 %	93 %
			Post-CAD	4	2	1	128	0.73
A	15	Anti-B, IgG	Retention	1	0	0	8	3.32	0.484	100 %	100 %
			Post-CAD	1	0	0	8	2.50
B	15d	Anti-A, IgM	Retention	16	32	2	128	0.38	0.095d	93 %	100 %
			Post-CAD	8	8	2	128	0.43
B	15	Anti-A, IgG	Retention	8	32	0	64	0.60	<0.05	80 %	100 %
			Post-CAD	4	2	0	32	0.82
All	60	Anti-A & Anti-B, IgM	Retention	16	16	1	128	0.42	<0.05	94 %	99 %
			Post-CAD	8	8	0	128	0.50
All	60	Anti-A & Anti-B, IgG	Retention	32	128	0	256	0.65	<0.05	97 %	100 %
			Post-CAD	16	128	0	256	0.61

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Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[TFN1] ^a
Coefficient of variation was calculated using titer steps.

[TFN2] ^b
The results were compared using non-parametric Wilcoxon signed ranked test (using Z distribution) with a significance level at 0.05.

[TFN3] ^c
Concordance is calculated using absolute difference in titers steps between retention and post-CAD samples.

[TFN4] ^d
One of 15 Type B, IgM samples was an outlier with a post-CAD result two titer steps above its corresponding retention sample. This was the only pair of samples out of 60 pairs that had a higher IgM titer on the post-CAD sample than the retention sample. When the outlier is excluded (n = 14, for type B) from the analysis the p value is below 0.05 (p value of 0.006).