Development of Non‐Rh Antibodies in Volunteers Stimulated for the Production of Hyperimmune Anti‐D

Abstract

At the North London Blood Transfusion Centre, red cells from accredited Rh-D-positive donors, matched for all antigens capable of inducing clinically significant antibodies, are used to stimulate immune plasma donors to achieve higher anti-D levels. Despite such careful matching, antibody to the relatively non-immunogenic M antigen developed in 3 out of 20 NN donors (15%) stimulated with M-positive cells. In general, good responders to the Rh antigen D are good responders to other red cell antigens; our report exemplifies the importance of using fully matched accredited red cells for immune stimulation and the need to perform thorough antibody screening after each stimulation.

Cancer type predicts alloimmunization following RhD‐incompatible RBC transfusions

“…In the current study, 54% of RhD‐negative patients formed both anti‐D and other alloantibodies compared with only 3% RhD‐negative patients who did not form anti‐D but formed other alloantibodies. This finding is similar to previously published studies suggesting that individuals who make anti‐D also have increased chances of making antibodies to other antigens carried by the RhD‐positive RBCs . In contrast to those earlier studies, Schonewille and Brand found that the antibody response against strong RBC antigens like E and K does not enhance antibody formation against weaker antigens.…”

Red-blood-cell alloimmunization and female sex predict the presence of HLA antibodies in patients undergoing liver transplant

“…It can be argued that RBC alloimmunization may denote a state of enhanced immuneresponsiveness that would make the patient more prone to develop HLA antibodies. Studies in Rh (D)‐ healthy volunteers injected with Rh (D)+ RBCs demonstrated that individuals who form anti‐D are more probable to develop additional RBC antibodies than those who do not form anti‐D [8,9]. However, the follow‐up of Rh (D)‐ patients exposed to Rh (D)+ RBCs via platelet transfusion has shown than many form either anti‐D or anti‐HLA, but not both [10].…”

Does an alloimmune response to strong immunogenic red blood cell antigens enhance a response to weaker antigens?

“…[13][14][15] It has been suggested that a primary immune response against a strong immunogenic RBC antigen may augment the immune response to less immunogenic RBC antigens. Studies in D-healthy volunteers who were injected with D+ RBCs and who formed anti-D more often showed antibodies to RBC antigens other than D, compared to those who did not form anti-D. 16,17 It is, however, unknown whether this observation reflects selection of high responders or that an ongoing immune response enhances immunization against weaker antigens. In case of the latter, the routine prevention of anti-D may, theoretically, also reduce the formation of antibodies against other blood group system antigens.…”