Platelet transfusions from D+ donors to D− patients: a 10‐year follow‐up study of 1014 patients

Background: Platelet concentrates (PC) contain residual contaminating red blood cells (RBC), being higher in pooled buffy coat PC (BC-PC) than in apheresis units (AP-PC). Data about PC-induced alloimmunization against non-D Rhesus (Rh) antigens are limited. Methods: For all newly detected RhD and non-D alloantibodies between August 2015 and September /2017 we prospectively evaluated if they were triggered through PC by analyzing for incompatible RBC and/or PC transfusions. Results: We found 5,799 positive results in 89,190 antibody screening tests. We identified 13 newly detectable Rh antibodies through incompatible PCs in 11 patients: 6× anti-D, 4× anti-E, 2× anti-c, 1× anti-f. They received a total of 156 PC (83 BC-PC; 73 AP-PC): 5 patients received incompatible BC-PC only, 1 patient received incompatible AP-PC only, 5 patients received incompatible BC-PC and AP-PC. Quality control showed a mean (range) of 0.304 (0.152-1.662) and 0.014 (0.003-0.080) × 10⁹ RBC/l for BC-PC and AP-PC, respectively. Ten of the 11 patients received RBC transfusions, all of them being antigen-negative for the alloantibodies identified. Conclusions: PC transfusions may not only induce RhD alloimmunization, but also immunization against further Rh antigens such as c, E, and f. The risk seems higher for BC-PC than for AP-PC. The results may have impact on future recommendations of PC transfusion with respect to Rh compatibility and upper limits of RBC contamination.

Section: Introductionmentioning

confidence: 99%

Platelet Transfusion Induces Alloimmunization to D and Non-D Rhesus Antigens

Reckhaus

Jutzi

Fontana

et al. 2018

“…Some authors reported no incidence of anti-D alloimmunization in this group of patients [84,86,87,90,91,92,93,94,95]; other authors, however, reported an incidence of anti-D alloimmunization that ranged from 2.7 to 18.7% [83,88,89,108]. …”

Section: Part 2: Plt Transfusion and The D Antigenmentioning

confidence: 98%

“…In some of the reports on D alloimmunization after D incompatible PLT transfusion, the percentage of ABO incompatible transfusions is provided; it ranges between 43 and 90% (table 3) [84,87,88,91,93,95]. Thus, the protective effect associated with the transfusion of ABO and D mismatched RBCs is unlikely to be seen in current clinical practice given the high incidence of ABO matched transfusions in the studies reported [99].…”

Section: Part 2: Plt Transfusion and The D Antigenmentioning

confidence: 99%

“…If we exclude those patients, the percentage of D alloimmunization varies as shown in table 3. Overall, the incidence of D alloimmunization in immunosuppressed patients after D incompatible platelet transfusions is reported to be between 0 and 19% [83,84,85,86,87,88,89,90,91,92,93,94], but keeping some recently published data in mind [95], we can conclude that the frequency of anti-D alloimmunization actually ranges between 0 and 6.8% [96]. …”

Section: Part 2: Plt Transfusion and The D Antigenmentioning

confidence: 99%

See 1 more Smart Citation

Platelet Transfusion - the Art and Science of Compromise

Cid

Harm

Yazer

2013

Self Cite

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.

“…Anti-D alloimmunization can therefore occur when platelets from RhD-positive donors are transfused to RhD-negative patients. Various studies of RhD-negative recipients receiving RhD-positive platelet transfusions reported an incidence of 0-19% RhD alloimmunization in cancer patients [5,6,7,8]. Prevention of anti-D alloimmunization by administering Rh immunoglobulin is a well-established practice for RhD-negative pregnant women to prevent hemolytic disease of the newborn (HDN).…”

Section: Introductionmentioning

confidence: 99%

Anti-D Alloimmunization after RhD-Positive Platelet Transfusion in RhD-Negative Women under 55 Years Diagnosed with Acute Leukemia: Results of a Retrospective Study

Villalba

Santiago

Freiria

et al. 2018

Background: Anti-D alloimmunization can occur when platelets from RhD-positive donors are transfused to RhD-negative patients, due to red blood cell residues in the platelet concentrates. Methods: Our objective was to analyze the anti-D alloimmunization rate in a selected group of women under 55 years of age diagnosed with acute leukemia over an 18-year period. We focused the analysis on RhD-negative patients who received RhD-positive platelet transfusions. Results: From January 1998 to October 2016, 382 women under 55 years were diagnosed with acute leukemia. A total of 56 patients were RhD-negative, and 48 (85.7%) received RhD-positive platelets. The median number of platelet concentrates transfused per patient was 23, and 48% of all platelet transfusions were RhD-positive. The 48 RhD-negative patients received a total of 949 RhD-positive platelet concentrates. Two patients developed anti-D: a 36-year-old woman with M3 acute myeloblastic leukemia and a 52-year-old patient with a secondary acute myeloblastic leukemia. Conclusion: We conclude that there is a need for agreement in the transfusion guidelines on the recommendation of anti-D alloimmunization prophylaxis. We suggest a possible benefit in favor of anti-D prophylaxis in childbearing women with acute leukemia.