Prevention of immunization to D+ red blood cells with red blood cell exchange and intravenous Rh immune globulin.
BACKGROUND
Although young women who are D- occasionally receive unintentional transfusions with D+ red blood cells (RBCs), there are little data to assist with management of such an event. Two cases of D- girls transfused with D+ RBCs are reported. In an effort to prevent formation of anti-D, RBC exchange followed by administration of intravenous (IV) Rh immune globulin (RhIg) was used.


METHODS
Patient 1, a 56-kg, 16-year-old D- girl, was involved in a motor vehicle crash. She received 4 units of Group O uncrossmatched D+ RBCs. Thirty-six hours after admission, she underwent RBC exchange with 10 units of D- RBCs, followed by a total of 2718 microg of IV RhIg over 32 hours. Six months later, her antibody screen was negative. Patient 2, a 39-kg, 10-year-old D- girl with aplastic anemia, received 1 unit of D+ RBCs. She underwent RBC exchange on the same day with 5 units of D- RBCs, followed by a total of 900 microg of IV RhIg over 8 hours. Six months later her antibody screen was negative.


CONCLUSIONS
RBC exchange followed by a calculated dose of IV RhIg was successful in preventing allo-immunization to D. Several small studies suggest that both trauma and hematology patients may be less capable of becoming immunized with the transfusion of D+ blood components. Until these findings are more clearly defined, there will be times when prevention of immunization of any D- girl is desired. RBC exchange followed by RhIg appears to be one way to achieve this goal.
Nester
T A
TA
Puget Sound Blood Center, the University of Washington, the Children's Hospital and Regional Medical Center, and the Harborview Medical Center, Seattle, Washington 98104, USA. theresan@psbc.org
Rumsey
D M
DM
Howell
C C
CC
Gilligan
D M
DM
Drachman
J G
JG
Maier
R V
RV
Kyles
D M
DM
Matthews
D C
DC
Pendergrass
T W
TW
D000293:Adolescent; D002648:Child; D017707:Erythrocyte Transfusion; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007518:Isoantibodies / Q000097:blood; D012203:Rh Isoimmunization / Q000517:prevention & control*; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*
D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin