title: Anti-D alloimmunization after D-incompatible platelet transfusions: a 14-year single-institution retrospective review.
abstract: BACKGROUND
  A small, but immunogenic dose of red blood cells (RBCs) may be contained in apheresis platelets (PLTs). Attempts are made to provide D- recipients with D- PLTs to prevent anti-D alloimmunization and the potential for hemolytic disease of the fetus and newborn. Beth Israel Deaconess Medical Center has a policy that when necessary to transfuse D+ PLTs to D- patients, we recommend that RhIG be given when the patient is a woman of child-bearing age or a potential liver transplant patient. We sought to retrospectively determine the rate of anti-D formation after D-incompatible apheresis PLT transfusions in those patients not receiving RhIG and not receiving D+ RBCs over a 14-year period at our institution.
  
  
  METHODS
  All D- patients (626) who received D+ prestorage leukoreduced apheresis PLTs between January 1, 1997, and December 31, 2011, were identified. Those patients who received RhIG (45), D+ RBC transfusions (50), or stem cell transplantation from a D+ donor (16); had prior anti-D (23); or had unresolved Rh at admission (8) were not eligible for analysis. Only those patients who had an antibody screen performed at least 4 weeks after the incipient PLT transfusion were evaluated (130).
  
  
  RESULTS
  Of 130 eligible D- patients, 48% women and 57% immunocompetent, who received a total of 565 apheresis PLTs, none formed anti-D.
  
  
  CONCLUSIONS
  These findings support the use of D+ apheresis PLTs without RhIG irrespective of D status in all recipients.
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: O'Brien
authors.forename: Richard L
authors.initials: RL
authors.lastname: Haspel
authors.forename: Lynne
authors.initials: L
authors.lastname: Uhl
mesh_terms: D015551:Autoimmunity / Q000502:physiology; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D008297:Male; D017713:Platelet Transfusion / Q000379:methods*; D010983:Plateletpheresis; D012189:Retrospective Studies; D018029:Rho(D) Immune Globulin
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin