Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients.
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.
Gonzalez-Porras
Jose R
JR
The Transfusion Service, Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain. jrgp@usal.es
Graciani
Ignacio F
IF
Perez-Simon
Jose A
JA
Martin-Sanchez
Jesus
J
Encinas
Cristina
C
Conde
Maria P
MP
Nieto
Maria J
MJ
Corral
Mercedes
M
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
D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin