Allergic transfusion reactions to platelets are associated more with recipient and donor factors than with product attributes

BACKGROUND: Mechanisms of allergic transfusion reactions (ATRs) are not well understood. The aim of this study was to distinguish recipient-, donor-, and product-specific factors associated with ATRs. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study of apheresis platelet (AP) products transfused from April 2000 through March 2010. The concordance rate of ATRs when split AP products were transfused to at least two individuals was compared to the overall ATR rate among all AP products. Per-person ATR rates also were compared to the overall ATR rate. RESULTS: We observed 1616 ATRs among 93,737 transfusions, for an overall incidence of 1.72% (95% confidence interval [CI], 1.64%-1.81%). Of the 1616 ATRs, 630 occurred when split AP products were transfused to at least two recipients. Of these 630 AP products, ATRs were observed in at least two different recipients of the same AP collection only 6 of 630 times, for a concordant incidence of 0.95% (95% CI, 0.35%-2.06%), which is similar to the overall ATR rate (p = 0.17). On an individual level, 30.0% of recipients had ATR rates of more than 5%, and these 30.0% accounted for 62.1% of ATRs. Donors of AP products associated with concordant ATRs donated AP products that had an ATR rate of 5.8% (95% CI, 3.1%-9.7%), which is higher than the overall ATR rate (p < 0.001). CONCLUSIONS: An observed ATR does not predict an ATR in a different recipient of a split AP product. A minority of platelet recipients accounts for the majority of ATRs. Some donors are strongly associated with ATRs. Consequently, recipient and donor factors are implicated in the mechanism of ATRs.