Prospective evaluation of a transfusion policy of D+ red blood cells into D− patients

Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of ‘high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.

Section: Part 2: Plt Transfusion and The D Antigenmentioning

confidence: 99%

Section: Part 2: Plt Transfusion and The D Antigenmentioning

confidence: 99%

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

“…Even after transfusion of normal D-positive units, only about 21-31% of patients develop an anti-D [10,11,12]. Weak D and DEL units are likely considerable to be less immunogenic.…”

Section: A General View On Anti-d Immunizationmentioning

confidence: 99%

<b><i>RHD</i></b> PCR of D-Negative Blood Donors

Wagner¹

2013

RHD PCR of blood donors may be used to reveal weak D, partial D, DEL and chimeric D+/D- donors among presumed D-negative blood donors. Units donated by such donors pose a definite yet low risk for anti-D immunization of transfusion recipients. The frequency of DEL donors among D-negative donors is 1:350 to 1:2,000 in Europe and up to 1:5 in Asian countries. Different strategies for RHD PCR of blood donors have been used. Probably, the most cost-efficient implementation is replacement of sensitive D antigen testing with the indirect antiglobulin test by RHD PCR in pools which might even reduce total testing cost.

“…ABO-mismatched transplantation may have different effects if G-CSF-primed PBSC or CB grafts or new conditioning regimens are used [11]. Besides the ABO blood group system, Rhesus (Rh) antigens, especially the D antigen, are clinically the most significant factors for alloimmunization that usually occur after exposure of RhD-negative individuals to RhD-positive blood components [12]. Studies in HSCT recipients have shown an incidence of 10% of anti-D alloimmunization in RhD-positive patients with a RhD-negative donor [13,14].…”

Section: Introductionmentioning

confidence: 99%

ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation

Worel

2015

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative option for a variety of malignant and non-malignant hematological and congenital diseases. Due to the fact that the human leukocyte antigen system is inherited independently of the blood group system, approximately 40-50% of all HSCTs are performed across the ABO blood group barrier. The expected immune-hematological consequences after transplantation of an ABO-mismatched stem cell graft are immediate and delayed hemolytic complications due to presence of isohemagglutinins or passenger lymphocyte syndrome. The risks of these complications can partially be prevented by graft manipulation and appropriate transfusion support. Dependent on the kind of ABO mismatch, different effects on engraftment have been observed, e.g. delayed red blood cell recovery and pure red cell aplasia. Data on incidence of acute graft-versus-host disease (GVHD), non-relapse mortality, relapse, and overall survival are inconsistent as most studies include limited patient numbers, various graft sources, and different conditioning and GVHD prophylaxis regimens. This makes it difficult to detect a consistent effect of ABO-mismatched transplantation in the literature. However, knowledge of expectable complications and close monitoring of patients helps to detect problems early and to treat patients efficiently, thus reducing the number of fatal or life-threatening events caused by ABO-mismatched HSCT.