title: [Platelet transfusion and immunization anti-Rh1: implication for immunoprophylaxis].
abstract: Rhesus (Rh) antigens are not expressed on platelets but residual red cells carry the risk of anti-D iso-immunization in transfusion recipients of platelet concentrates (PC). The main theoretical risk associated with this reaction relates to female subjects due to potential obstetrical situations of maternal-foetal Rh incompatibility. Isogroup PC transfusion in this system is therefore advised. However, logistical constraints impose frequent Rh-incompatible transfusions that require the recommendation of anti-Rh immunoglobulin in a girl of childbearing age in this situation. This recommendation, already restricted to a group of patients deserves to be questioned over a decade after being issued. Data from published reports are difficult to interpret because of the heterogeneity of the few series (CP type, immune status, timing of biological tests) but the current techniques for preparing products and most common use of CP apheresis limited the risk of immunization. Moreover, platelet transfusions are particularly relevant to immunocompromised populations which, to what extent (heavy chemotherapy and/or hematopoietic stem cells recipients) seems to be protected from this risk. It is noteworthy that the clinical consequences that may be expected from such immunization are not reported. Although some authors emphasize significant isoimmunization rates (maximum 19%), the heterogeneous conditions and the lack of evidence of clinical consequence suggest evaluating the recommendations or revising them towards more targeted indications of seroprophylaxis.
authors.affiliation: Service d'hématologie oncologie pédiatrique, hôpital d'Enfants La Timone, assistance publique des hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Inserm, UMR_S 1062, faculté de médecine Timone, Aix-Marseille université, 13005 Marseille, France. Electronic address: herve.chambost@ap-hm.fr.
authors.forename: H
authors.initials: H
authors.lastname: Chambost
mesh_terms: D001792:Blood Platelets / Q000276:immunology; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016867:Immunocompromised Host; D007518:Isoantibodies / Q000096:biosynthesis* / Q000276:immunology; D017713:Platelet Transfusion / Q000009:adverse effects*; D010983:Plateletpheresis; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy; D012203:Rh Isoimmunization / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage / Q000627:therapeutic use*; D012306:Risk; D065227:Transfusion Reaction
chemical_list: D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin
keywords: Antibody; Anticorps; Immunization; Immunoglobulin; Immunoglobulines; Incompatibilité transfusionnelle; Plaquettes; Platelets; Rhesus; Rhésus