Rate of <scp>RhD</scp>‐alloimmunization after the transfusion of multiple <scp>RhD</scp>‐positive primary red blood cell‐containing products

Yazer, Mark H.; Triulzi, Darrell J.; Sperry, Jason L.; Seheult, Jansen N.

doi:10.1111/trf.16495

Cited by 14 publications

(23 citation statements)

References 21 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our model, mismatches are presumed to be binary events: a patient is either exposed to a foreign antigen within a transfusion episode or not, and the probability of antibody development is not dependent on the number of mismatched transfusions given during one transfusion episode. This assumption is in line with the recent publication of Yazer et al who found no significant dosage effect in RhD-alloimmunization rates among exposed transfusion recipients [18]. By ignoring the level of exposure, we maximize the proportion of patients for which exposure is prevented.…”

Section: Methodssupporting

confidence: 65%

Preventing alloimmunization using a new model for matching extensively typed red blood cells

et al. 2021

View full text Add to dashboard Cite

Background and Objectives: Alloimmunization is a well-known adverse event associated with red blood cell (RBC) transfusions, caused by phenotype incompatibilities between donor and patient RBCs that may lead to haemolytic transfusion reactions on subsequent transfusions. Alloimmunization can be prevented by transfusing fully matched RBC units. Advances in RBC genotyping render the extensive typing of both donors and patients affordable in the foreseeable future. However, the exponential increase in the variety of extensively typed RBCs asks for a software-driven selection to determine the 'best product for a given patient'. Materials and Methods: We propose the MINimize Relative Alloimmunization Risks (MINRAR) model for matching extensively typed RBC units to extensively typed patients to minimize the risk of alloimmunization. The key idea behind this model is to use antigen immunogenicity to represent the clinical implication of a mismatch. Using simulations of non-elective transfusions in Caucasian donor and patient populations, the effect on the alloimmunization rate of the MINRAR model is compared with that of a baseline model that matches antigens A, B and RhD only.Results: Our simulations show that with the MINRAR model, even for small inventories, the expected number of alloimmunizations can be reduced by 78.3% compared with a policy of only matching on antigens A, B and RhD. Furthermore, a reduction of 93.7% can be achieved when blood is issued from larger inventories. Conclusion: Despite an exponential increase in phenotype variety, matching of extensively typed RBCs can be effectively implemented using our MINRAR model, effectuating a substantial reduction in alloimmunization risk without introducing additional outdating or shortages. K E Y W O R D S alloimmunization, matching, mathematical model, red blood cells Highlights• Extended matching is feasible in practice.• Novel strategy for issuing extensively typed RBCs.

show abstract

Section: Methodssupporting

confidence: 65%

Preventing alloimmunization using a new model for matching extensively typed red blood cells

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, we saw an inverse correlation between anti‐D formation and the number of units of RBCs, and no increase in anti‐D rate after re‐exposure to D‐positive RBCs [16, 18]. Furthermore, in the study of Yazer et al [27], although there was no significant dosage effect in the alloimmunization rates with exposure to D‐positive units, the immunization rate was 30.6% in the 1‐unit group, 43.6% in 3–5 units group, and lowest rate of 18.4% in 11–20 units group [27]. It is consistent with the study of Gonzalez‐Porras et al [17], in which most patients who developed anti‐D did so within the first two or four RBCs transfused (64% after the first two RBCs transfused and 88% after the first four).…”

Section: Discussionmentioning

confidence: 96%

“…Thus, some patients received several sessions of D-positive RBC transfusion and also received D-negative RBCs when the D-negative blood type was confirmed or the supply of D-negative blood was replenished. In the study of Yazer et al [27] with mixed disease patients, 80.9% patients (277/335) received a total of 2727 units of D-negative RBC-containing components in the period after the index D-positive product to "wash out" the transfused D-positive RBCs, but there were still 34.9% patients (117/ 335) who became immunized. A similar situation occurred among trauma patients in the study of Tchakarov et al [32].…”

Section: D-positive Rbc Transfusion In D-negative Patients With Mixed...mentioning

confidence: 99%

See 1 more Smart Citation

Incidence of anti‐D alloimmunization in D‐negative individuals receiving D‐positive red blood cell transfusion: A systematic review and meta‐analysis

Luo

2022

Vox Sanguinis

View full text Add to dashboard Cite

Background and Objectives The transfusion of D‐negative red blood cells (RBCs) to D‐negative patients has been widely adopted to prevent anti‐D alloimmunization, especially in women of childbearing age. Still, transfusion of D‐positive RBCs to D‐negative recipients is occasionally inevitable in practice, and the resulting incidence of anti‐D in different D‐negative groups of patients has not been well summarized. Materials and Methods We searched the relevant literature using PubMed, Cochrane Library, and Embase databases from inception date to 30 September 2021. We looked for studies of anti‐D occurring in D‐negative recipients who received D‐positive RBC transfusions. The anti‐D incidence was summarized with 95% confidence intervals (CIs). Data with similar characteristics were combined using a random‐effects model. Results About 42 studies (2226 cases), which found anti‐D, the exact volume of D‐positive RBC transfused, and the follow‐up time for anti‐D detection, met the inclusion criteria. The pooled anti‐D incidence was 64% (95% CI, range 55%–74%) in volunteers receiving small volumes of D‐positive RBCs, 84% (95% CI, 74%–94%) in those receiving whole units, 26% (95% CI, 19%–32%) in mixed patients, 12% (95% CI, 8%–16%) in oncology patients, 27% (95% CI, 13%–40%) in trauma patients, 4% (95% CI, 0%–8%) in immune‐compromised transplant patients, and 6% (95% CI, 1%–39%) in those with AIDS. Conclusion Compared with the high frequency of anti‐D in healthy D‐negative volunteers given D‐positive RBCs, we found a lower rate of anti‐D immunization in various D‐negative patients and almost none in transplant and AIDS patients.

show abstract

“…Additionally, resuscitation with whole blood may be a better option for exsanguinating hemorrhage in certain parts of the world where there is a lack of well-equipped blood banks and insufficient availability of blood products [ 123 ]. However, the percentage of all donors who are eligible to donate RhD-negative LTOWB (male, group O, RhD-negative, and have low titer anti-A and -B) is only 3% RhD-alloimmunization rate is approximately 21% [ 124 ].…”

Section: Management Of the Polytrauma Victimmentioning

confidence: 99%

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

Fecher

Stimpson

Ferrigno

et al. 2021

JCM

View full text Add to dashboard Cite

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

show abstract

Rate of RhD‐alloimmunization after the transfusion of multiple RhD‐positive primary red blood cell‐containing products

Cited by 14 publications

References 21 publications

Preventing alloimmunization using a new model for matching extensively typed red blood cells

Preventing alloimmunization using a new model for matching extensively typed red blood cells

Incidence of anti‐D alloimmunization in D‐negative individuals receiving D‐positive red blood cell transfusion: A systematic review and meta‐analysis

The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

Contact Info

Product

Resources

About