Abstract WP173: Major ABO Incompatible Platelet Transfusion is Associated With Ischemic Lesions on Brain MRI of Patients With Intracerebral Hemorrhage

Abstract

Background: We identified that major ABO incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes, yet the driver for this relationship is unknown and does not appear to be related to impaired hemostasis. Conversely, acute ICH patients are known to develop remote ischemic lesions on brain MRI. These ischemic lesions are associated with poor ICH outcomes, but risk factors for their formation are unknown. We explored whether major ABO incompatible platelet transfusions are associated with these ischemic lesions. Methods: Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2016 were assessed. Patients receiving an acute, single platelet transfusion within 24 h of admission and a brain MRI during their ICH admission were included. Major ABO incompatible platelet transfusion was the exposure. The presence of ischemic lesions on brain MRI, defined as diffusion restriction >10 mm away from the hematoma was the outcome. Regression models assessed relationships between major ABO-incompatible platelets and ischemic lesions, adjusting for ICH severity and time to MRI. Results: Of 40 ICH patients with an acute platelet transfusion and MRI, the mean age was 67.1 (SD 14.1), 37.5% were female, and 20% received a major ABO incompatible platelet unit. Patients receiving a major incompatible platelet unit were more likely to have ischemic lesions (62.5% vs 21.9%), and there continued to be an association of major ABO-incompatible platelets units with these lesions after adjusting for time to MRI (OR 5.45, 95%CI 1.01-29.30, p=0.04) and ICH score (OR 9.15, 95%CI 1.37-62.67, p=0.02). Sensitivity analyses adjusting for patient blood type did not alter this relationship (OR 17.08, 95%CI 1.34-217.94, p = 0.03). Conclusions: Major ABO incompatible platelet units were associated with remote ischemic DWI lesions. Further work is needed to address the generalizability of our data and to clarify relationships of platelet unit characteristics, cerebral ischemia, and clinical outcomes after ICH.