Anti-D alloimmunization after D-incompatible platelet transfusions: a 14-year single-institution retrospective review

• Published in: Transfusion (Philadelphia, Pa.) Vol. 54; no. 3; pp. 650 - 654
• Main Authors: O'Brien, Kerry L., Haspel, Richard L., Uhl, Lynne
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01.03.2014; Wiley; Wiley Subscription Services, Inc
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autoimmunity - physiology; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Erythrocytes - immunology; Female; Hospitals; Humans; Isoantibodies - immunology; Male; Medical sciences; Patients; Platelet Transfusion - methods; Plateletpheresis; Retrospective Studies; Rho(D) Immune Globulin; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplants & implants; Isoimmunization; Platelet; Transfusion; Institution; Follow up study
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.12341

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. Study Design and 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. Conclusion These findings support the use of D+ apheresis PLTs without RhIG irrespective of D status in all recipients.