Platelet transfusions from D+ donors to D- patients: a 10-year follow-up study of 1014 patients.
BACKGROUND
Current guidelines recommend that platelets (PLTs) from D- donors should be given to D- patients. However, such evidence comes from studies with a limited number of included patients that reported an incidence of anti-D alloimmunization to be up to 19%. We thus decided to extend these findings by examining anti-D alloimmunization at our institution, where PLT transfusions from D+ donors are transfused to D- patients because of logistic constraints.


METHODS
From April 1999 to December 2009, we retrospectively reviewed the clinical and transfusion records of all D- patients who received PLT transfusions from D+ donors at our hospital. PLT concentrates (PCs) were obtained from apheresis and from whole blood donations. RhIG was not administered after the transfusion of PCs from D+ donors. The antibody screen test to detect anti-D was performed by low-ionic-strength solution indirect antiglobulin test using the gel test.


RESULTS
Our series comprises 1014 D- patients who received 5128 PLT transfusions from D+ donors (89% were pooled PCs). We had 315 (31.1%) patients who had a blood sample to analyze the presence of anti-D 4 or more weeks after the first D+ PLT transfusion with a median follow-up of 29 weeks (range, 4-718 weeks). Anti-D developed in 12 (3.8%) of these 315 patients.


CONCLUSIONS
The frequency of anti-D alloimmunization of D- patients after receiving pooled PCs from D+ donors is low. The transfusion of D-incompatible pooled PCs without immunoprophylaxis to D- men or D- women without childbearing potential seems a reasonable and safe alternative.
Hemotherapy and Hemostasis Department, Hospital Clínic, IDIBAPS, Barcelona, Spain. jcid@clinic.ub.es
Joan
J
Cid
Gloria
G
Carbassé
Arturo
A
Pereira
Cristina
C
Sanz
Roberto
R
Mazzara
Ginés
G
Escolar
Miguel
M
Lozano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012189:Retrospective Studies; D018029:Rho(D) Immune Globulin; D055815:Young Adult
D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin