Case report: immune anti-D stimulated by transfusion of fresh frozen plasma.
FFP has occasionally been reported to generate an immune response to RBC antigens (e.g., anti-D and anti-Fya). The Council of Europe requires that each unit of FFP have less than 6 x 10(9)/L RBCs. However, there is considerable variation internationally in the method of production and the level and assessment of RBC contamination of FFP. This study reports the case of a 63-year-old group B, D- man who received multiple transfusions of D- blood products over a 4-month period. Seven months later the patient's antibody screen remained negative and he was transfused with seven units of D- RBCs and six units of FFP, four of which were D+. Two months later anti-D, -E, and -K were detected in his plasma. Although the anti-E and anti-K could have resulted from transfusion of antigen-positive RBCs, the anti-D could have resulted only from transfusion of the D+ FFP. The D status of FFP is currently not considered when selecting products for transfusion even though the D antigen is highly immunogenic and the level of RBC contamination of FFP is not always known. This case highlights that transfusion of FFP is a stimulus for RBC antibodies and that when a patient has had a recent transfusion of FFP, consideration should be given to obtaining a sample for pretransfusion testing within 3 days before a scheduled RBC transfusion. In addition, the D status of FFP should be considered before administering FFP to premenopausal D- women.
Transfusion Medicine Unit, The Western Australian Centre for Pathology and Medical Research, PathCentre, QEII Medical Centre, Western Australia 6009.
M
M
Connolly
W N
WN
Erber
D E
DE
Grey
D000230:Adenocarcinoma / Q000150:complications / Q000628:therapy*; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001787:Blood Group Incompatibility / Q000097:blood* / Q000209:etiology; D001788:Blood Grouping and Crossmatching; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010949:Plasma; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin