title: Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients.
abstract: BACKGROUND
  Although D- patients should receive red blood cells (RBCs) from D- donors, the scarcity of D- blood components in certain situations makes the transfusion of D+ RBCs unavoidable. Therefore it is recommended that guidelines be developed in order to standardize transfusion policy in these scenarios.
  
  
  METHODS
  We have prospectively evaluated a policy for the use of D+ RBCs in 905 D- patients. The amount of D- RBCs saved as well as the incidence of hemolytic reactions and anti-D alloimmunization were assessed.
  
  
  RESULTS
  554 patients received D- RBCs while 351 received a total of 1032 D+ RBCs, all of them within our criteria for the acceptable use of D+ RBCs. This strategy allowed us to save 25.6 percent of D- RBCs (1032 out of 4024 RBCs requested). No hemolytic reactions were reported. The incidence of alloimmunization was 21.4 percent. Most patients who developed anti-D did so within the first 2 or 4 RBCs transfused (64% after the first 2 RBCs transfused and 88% after the first 4). In multivariate analysis the age of less than 77 years was the only predictor for alloimmuization (HR = 2.48 [95% CI = 1.21-3.81]; p = 0.014).
  
  
  CONCLUSIONS
  The use of D+ RBCs in selected D- patients does not induce adverse reactions and allows the saving of a significant number of D- RBCs.
authors.affiliation: The Transfusion Service, Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain. jrgp@usal.es
authors.forename: Jose R
authors.initials: JR
authors.lastname: Gonzalez-Porras
authors.forename: Ignacio F
authors.initials: IF
authors.lastname: Graciani
authors.forename: Jose A
authors.initials: JA
authors.lastname: Perez-Simon
authors.forename: Jesus
authors.initials: J
authors.lastname: Martin-Sanchez
authors.forename: Cristina
authors.initials: C
authors.lastname: Encinas
authors.forename: Maria P
authors.initials: MP
authors.lastname: Conde
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Nieto
authors.forename: Mercedes
authors.initials: M
authors.lastname: Corral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015551:Autoimmunity / Q000276:immunology; D001787:Blood Group Incompatibility; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D011446:Prospective Studies; D018029:Rho(D) Immune Globulin
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin