D+ platelet transfusions in D- patients: cause for concern?
Patients whose RBCs are D- may produce anti-D if they are exposed to D on donor RBCs. Except in emergency situations, patients whose RBCs lack D are transfused with only D- RBCs. Platelets carry no Rh antigens, but platelet units may be contaminated by RBCs that could carry D when these units are collected from D+ donors. The purpose of this study was to determine whether our policy of allowing D+ platelets to be transfused to patients whose RBCs type as D-, without the use of prophylactic Rh immunoglobulin (RhIG), results in D alloimmunization. The transfusion records of all patients who received platelet transfusions from December 2004 to March 2007 were reviewed. Transfusion recipients were evaluated with pretransfusion ABO and D typings, and an antibody screen. Recipients were reevaluated in the same manner before subsequent transfusions. Transfusion records of 114 D- patients were analyzed. Overall, 104 patients received D+ platelets; 67 had repeat antibody screening after transfusion. No patients were shown to make anti-D after platelet transfusion. There was no evidence of D alloimmunization as a result of transfusion of D+ platelets in any D- patient during this study. The data do not support the practice of restricting D- patients to receiving only D- apheresis platelets, even among patients with chronic transfusion requirements. Prophylactic use of RhIG for D+ apheresis platelet transfusions in D- patients also appears to be unnecessary.
Department of Pathology, Tucson, AZ 85724-508, USA.
A N
AN
Bartley
J B
JB
Carpenter
M P
MP
Berg
D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000150:complications / Q000276:immunology*; D001792:Blood Platelets / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012189:Retrospective Studies; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D018029:Rho(D) Immune Globulin; D055815:Young Adult
D000017:ABO Blood-Group System; D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen