Anti-Rh alloimmunization after trauma resuscitation

Williams, Lance A.; Sikora, James; Aldrees, Rana; Pham, Huy P.; Marques, Marisa B.

doi:10.1016/j.transci.2019.09.005

Cited by 20 publications

(21 citation statements)

References 8 publications

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“…Our findings suggest that selective allocation of group O Rh(D) negative RBC products to patients who have suffered severe traumatic injury to reduce the risk of developing anti-D would not be a resource-conscious or effective strategy. Previous descriptions of RBC alloimmunization in Rh(D) negative trauma patients receiving Rh(D) positive RBCs have reported highly variable rates ranging from 11% to 50%; [3][4][5][6] the alloimmunization rate in the current study of 7.8% was consistent with a recent REDS-III registry analysis that demonstrated overall RBC alloimmunization rates in all patients subsequent to transfusion to be 6.67%. 7 The patients in whom anti-D was detected were significantly less severely injured and received fewer Rh(D) positive RBC products than those who did not.…”

Section: Discussionsupporting

confidence: 87%

Anti‐D alloimmunization in Rh(D) negative adults with severe traumatic injury

et al. 2021

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Introduction Widely varying rates of alloimmunization associated with transfusing uncrossmatched RBC products to trauma patients as part of hemostatic resuscitation have been reported. We characterized the rates of RBC alloimmunization in our severely injured Rh(D) negative trauma population who received uncrossmatched Rh(D) positive RBC products. Methods In a 10‐year retrospective analysis to assess Rh(D) alloimmunization risks, Rh(D) negative adult trauma patients initially requiring uncrossmatched group O Rh(D) positive RBC products with either RBC units or low titer group O whole blood as part of massive transfusion protocol (MTP) activation were identified. Only those Rh(D) negative patients whose initial antibody screenings were negative were included. Duration of serologic follow‐up from date of MTP activation to either date of anti‐D detection or most recent negative antibody screening was calculated. Results There were 129 eligible Rh(D) negative trauma patients identified. Median injury severity score was 25. Anti‐D was detected in 10 (7.8%) patients after a median of 161.5 days; the median duration of serologic follow‐up in those who did not have anti‐D detected was 220 days. Patients who had anti‐D detected were less severely injured and received fewer Rh(D) positive RBC products versus those who did not. Discussion In our severely injured adult trauma patients with MTP activation requiring uncrossmatched group O Rh(D) positive RBC products, the rate of anti‐D detection was low. Additional studies are necessary to determine generalizability of these findings and fully characterize alloimmunization risks in trauma patients with varying extents of injury.

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Section: Discussionsupporting

confidence: 87%

Anti‐D alloimmunization in Rh(D) negative adults with severe traumatic injury

et al. 2021

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“…In D‐negative trauma patients, we saw a lower incidence of anti‐D formation, but no significant difference from hospitalized mixed nontrauma patients [31, 33, 38, 43]. The lower rate might be related to an immunomodulatory effect [44] and stress‐related immune suppression caused by traumatic injury [45].…”

Section: Discussionmentioning

confidence: 98%

“…When evaluating the strategy to replace O D‐negative RBC units with O D‐positive in emergency recipients, we found no adverse reactions, many D‐negative RBCs saved and a low risk of inducing anti‐D (as low as 4%, 17/437, in the study of Selleng et al [31]). However, when focusing on the D‐negative patients and excluding the high percentage of those who died (around 40% did not survive within 1 week) which prevented follow‐up, around 10% to 60% of D‐negative patients produce anti‐D with great heterogeneity [31, 33, 46]. Besides, a higher anti‐D rate was observed in the patients with longer follow‐up time [33].…”

Section: Discussionmentioning

confidence: 99%

“…No statistically significant differences occurred (χ 2 = 1.414, p = 0.234). Because trauma patients are associated with a high mortality rate (around 40% in these two studies [31,33]), part of patients did not have follow-up data. When patients had died, it would make the incidence of anti-D development seem lower, since these patients still count in the denominator in calculating the anti-D rate.…”

Section: D-positive Rbc Transfusion In D-negative Trauma Patientsmentioning

confidence: 99%

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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

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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.

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“…While RhD-alloimmunization is of minimal clinical significance for males and females who are beyond childbearing potential, the concern about alloimmunization and HDFN in FCPs depends in part on the rate of RhD-alloimmunization. This alloimmunization rate has been evaluated in several previous studies of trauma, surgery, and/or general hospitalized patients and has been found to range between approximately 11%-50% (Table 1) [5][6][7][8][9][10][11][12][13][14][15]. However, there is significant heterogeneity in the design of these retrospective studies, including the nature of the patients studied and the method by which the alloimmunization rate was calculated.…”

Section: Introductionmentioning

confidence: 99%