Absence of D- alloimmunization in AIDS patients receiving D-mismatched RBCs.
BACKGROUND
More than 80 percent of D- patients who receive D+ blood become alloimmunized to the D antigen. Anemia occurs in most AIDS patients at some point in the disease. D- patients with AIDS may require blood transfusion and, during times of blood shortage, may receive D+ RBCs. They would be expected to become alloimmunized to the d antigen.


METHODS
The records of the transfusion service between January 1996 and July 2000 were reviewed for D- patients who received D+ blood. IATs were performed before the initial transfusion and subsequently when the patient required further RBC transfusion.


RESULTS
Eight D- AIDS patients who received multiple transfusions (three women and five men; age range, 31-44 years; mean, 44 years) who received between 2 and 11 units (mean, 6.25) of D+ RBCs were identified. Antibody screens were performed at 8 to 65 weeks after transfusion. It was found that none of the eight D- AIDS patients developed anti-D. ABO antibodies were found as expected. During the same period, it was found that six D- patients admitted with other diagnoses who received 1 to 9 units of D+ RBCs, all developed anti-D within 7 to 19 weeks of transfusion.


CONCLUSIONS
Patients with AIDS may not form alloantibodies to the D antigen. This may be attributable to their immunodepressed state, particularly to the decrease in CD4+ T lymphocytes. Therefore, during blood shortages, transfusion of D+ blood to D- AIDS patients may be without any subsequent consequence.
Boctor
Fouad N
FN
Department of Pathology, Blood Bank and Transfusion Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. fboctor@Montefiore.org
Ali
Nahed M
NM
Mohandas
Kala
K
Uehlinger
Joan
J
D000017:ABO Blood-Group System / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000276:immunology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000276:immunology*; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012203:Rh Isoimmunization; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D018029:Rho(D) Immune Globulin
D000017:ABO Blood-Group System; D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin