PB0888 - Anaphylactic Shock To A Hematological Disorder Patient During Transfusion Of Platelet Aphaeresis Unit Stored In Platelet Additive Solution: A Rare Case Report

Background: Adverse transfusion reactions from apheresis platelets (AP) stored in Platelet additive solution (PAS) are uncommon, as PAS is a balanced electrolyte solution developed to replace plasma from platelet concentrates as the storage medium.

Aims: To evaluate the cause of anaphylactic reaction that occurred in a patient after transfusion of AP stored in PAS.

Methods: An AP product was donated by a blood group A male, processed using PAS. The patient developed severe Hypotension with Tachycardia immediately after 10 minutes of transfusion. Pre-transfusion and Post transfusion vitals showed a marked decrease in Blood Pressure from 110/70 mmHg to 70/50 mm Hg with Pulse increased from 88 bpm to 118 bpm. Oxygen saturations were normal. Serological testing included an antibody screen (gel technology), a direct antiglobulin test (DAT), and Sterility testing of the transfused product.

Results: A 61-year-old blood group O patient with Aplastic anemia developed severe hypotension within the first 10 minutes of the start of AP in PAS transfusion despite premedication with Inj.Avil and Inj.Hydrocort. The post-transfusion reaction evaluation was non-significant showing negative antibody screen and also negative DAT, both for immunoglobulin G and C3d; No bacterial growth was seen in the transfused product and patient blood culture was sterile. Ruling out hemolytic and septic transfusion reactions. The patient was resuscitated with Inj. Adrenaline and got shifted to ICU for further follow-up. The patient vitals got stabilized after 4 hours and got discharged in hemodynamically stable condition. Notably, a group O patient at a different hospital received a split of the same apheresis unit, with no reaction.

Conclusion(s): To our knowledge, this is the first case with anaphylactic shock reported from AP transfusion stored in PAS. The fact that one transfusion recipient had anaphylactic shock whereas another did not have any reported reaction highlights the potential importance of recipient variables in adverse transfusion reactions.