Absence of D- alloimmunization in AIDS patients receiving D-mismatched RBCs

• Published in: Transfusion (Philadelphia, Pa.) Vol. 43; no. 2; pp. 173 - 176
• Main Authors: Boctor, Fouad N., Ali, Nahed M., Mohandas, Kala, Uehlinger, Joan
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01.02.2003; Blackwell Publishing
• Subjects: ABO Blood-Group System - immunology; Acquired Immunodeficiency Syndrome - blood; Acquired Immunodeficiency Syndrome - immunology; Acquired Immunodeficiency Syndrome - therapy; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Group Incompatibility - immunology; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Case-Control Studies; Erythrocyte Transfusion; Female; Human viral diseases; Humans; Immunocompromised Host - immunology; Infectious diseases; Isoantibodies - blood; Male; Medical sciences; Middle Aged; Retrospective Studies; Rh Isoimmunization; Rh-Hr Blood-Group System - immunology; Rho(D) Immune Globulin; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Infection; Human; Isoimmunization; Immunopathology; Transfusion; Viral disease; AIDS; Rh-System; Immune deficiency; Mismatching; Blood
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1046/j.1537-2995.2003.00289.x

BACKGROUND : More than 80 percent of D– patients who receive D+ blood become alloimmunized to the D antigen. Anemia occurs in most AIDS patients at some point in the disease. D– patients with AIDS may require blood transfusion and, during times of blood shortage, may receive D+ RBCs. They would be expected to become alloimmunized to the d antigen. STUDY DESIGN AND METHODS : The records of the transfusion service between January 1996 and July 2000 were reviewed for D– patients who received D+ blood. IATs were performed before the initial transfusion and subsequently when the patient required further RBC transfusion. RESULTS : Eight D– AIDS patients who received multiple transfusions (three women and five men; age range, 31‐44 years; mean, 44 years) who received between 2 and 11 units (mean, 6.25) of D+ RBCs were identified. Antibody screens were performed at 8 to 65 weeks after transfusion. It was found that none of the eight D– AIDS patients developed anti‐D. ABO antibodies were found as expected. During the same period, it was found that six D– patients admitted with other diagnoses who received 1 to 9 units of D+ RBCs, all developed anti‐D within 7 to 19 weeks of transfusion. CONCLUSION : Patients with AIDS may not form alloantibodies to the D antigen. This may be attributable to their immunodepressed state, particularly to the decrease in CD4+ T lymphocytes. Therefore, during blood shortages, transfusion of D+ blood to D– AIDS patients may be without any subsequent consequence.