Absence of D alloimmunization in D- pediatric oncology patients receiving D-incompatible single-donor platelets.
BACKGROUND
Guidelines are lacking for prophylaxis against D alloimmunization after D-incompatible platelet transfusion. A rational basis for the application of prophylaxis would be beneficial for institutions in which inventory constraints demand the administration of large numbers of D-incompatible platelets.


METHODS
A retrospective analysis was performed of all D-incompatible platelet transfusions administered at a pediatric research hospital over a 1.5-year period. Patients exclusively received single-donor WBC-reduced platelets and did not receive RhIg immunoprophylaxis. Numbers, source, ABO type, duration of serologic follow-up, and level of RBC contamination of D-incompatible transfusions were analyzed. All positive D serologies in the institution over a 3.5-year period were examined to determine cause and potential association with platelet transfusion.


RESULTS
Thirty-five patients not receiving bone marrow transplant and seven bone marrow transplant patients received 490 and 255 D-incompatible transfusions, respectively, over 1.5 years. Patients had various diagnoses, predominantly malignancies. Seventy-nine percent of D-incompatible transfusions were ABO compatible. An estimated 2300 incompatible transfusions were performed over 3.5 years. No case of D alloimmunization was detected.


CONCLUSIONS
D immunoprophylaxis is generally unnecessary in pediatric oncology patients receiving D-incompatible, WBC-reduced, single-donor platelets not visibly contaminated by RBCs. Further studies to validate these observations in the pediatric population and to extend them to other population groups are warranted.
Molnar
R
R
Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Johnson
R
R
Sweat
L T
LT
Geiger
T L
TL
D000293:Adolescent; D001782:Blood Donors; D001787:Blood Group Incompatibility; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000097:blood*; D009369:Neoplasms / Q000628:therapy*; D017713:Platelet Transfusion / Q000009:adverse effects*; D012189:Retrospective Studies; D012204:Rh-Hr Blood-Group System / Q000276:immunology*
D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System