Anti-D alloimmunization after D-mismatched allogeneic hematopoietic stem cell transplantation in patients with hematologic diseases.
BACKGROUND
The de novo development of anti-D after D-mismatched allogeneic hematopoietic stem cell transplantation (AHSCT) is a possibility that must be considered. The transfusion of D- blood components after AHSCT has been recommended but anti-D alloimmunization in this setting has been studied little. Thus, the aim of this study was to analyze anti-D formation after D-mismatched AHSCT.


METHODS
Thirty patients with a hematologic disease who underwent D-mismatched AHSCT were retrospectively studied. Support therapy included red blood cells (RBCs) and platelet (PLT) concentrates (PCs) from whole-blood donations and PLTs from apheresis. After AHSCT, patients received D+ PCs without administering Rh immunoglobulin (RhIG). An antibody screening to detect anti-D was performed by low-ionic-strength saline-indirect antiglobulin test with the tube test.


RESULTS
Fifteen D+ patients received stem cells (SCs) of D- donors and 15 D- patients received SCs of D+ donors. After AHSCT, patients received a median of 11.5 (range, 0-32) D- RBC units. D+ patients received 682 (83%) of 825 PLT units from D+ donors, and D- patients received 573 (85%) of 678 PLT units from D+ donors. None of the 30 patients developed anti-D after a median follow-up of 32 weeks (range, 4-310 weeks).


CONCLUSIONS
Anti-D alloimmunization after performing a D-mismatched AHSCT is infrequent in patients with hematologic diseases although patients receive D-mismatched PLT transfusions without RhIG administration.
Cid
Joan
J
Department of Hemotherapy, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic Provincial, University of Barcelona, Barcelona, Spain.
Lozano
Miguel
M
Fernández-Avilés
Francesc
F
Carreras
Enric
E
Pereira
Arturo
A
Mazzara
Roberto
R
Ordinas
Antorio
A
D000208:Acute Disease; D000328:Adult; D001788:Blood Grouping and Crossmatching; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000276:immunology / Q000628:therapy*; D012189:Retrospective Studies; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D012204:Rh-Hr Blood-Group System; C026410:Rho(D) antigen