Probability of anti‐D development in D− patients receiving D+ RBCs

Abstract

The actual frequency of antibody formation in our patients is much lower than assumed. On the other hand, prolonged hemolysis probably induced by additional autoreactive antibodies might occur. This possible complication has not yet been addressed. Further studies might reveal whether a less restricted transfusion policy with respect to D matching is justified in selected patients.

Transfusion in the absence of inflammation induces antigen-specific tolerance to murine RBCs

“…1,2 Certain requirements must be met for alloimmunization to occur, including appropriate presentation of the foreign antigen by the recipient's antigen-presenting cells 3 ; however, variable alloantibody response rates (20%-80%) are observed even for antigens such as Rh(D), thought to be nearly universally capable of presentation by the recipient's immune system. [4][5][6] As an immunology paradigm, presentation of the same antigen under one set of conditions may lead to tolerance, whereas presentation under a different set of conditions (such as in the presence of a danger signal) may lead to immunity. 7 In the setting of an RBC transfusion, a danger signal may come from either the transfused product itself (eg, cytokines, white blood cells, damaged RBCs, or bacteria) or from recipient factors (eg, underlying disease, infection, or genetic status).…”

Platelet Transfusion - the Art and Science of Compromise

“…However, one prospective and three retrospective observational studies published in the last decade showed us two intriguing sets of data [104,105,106,107]. First, the frequency of anti-D alloimmunization following D+ RBC transfusion ranged from 21 to 33% in D- patients who were not iatrogenically immunosuppressed.…”

Red Blood Cell Alloimmunization after Blood Transfusion

“…Studies deliberately exposing healthy D-negative volunteers to D-positive blood, to obtain IgG anti-D for immunoprophylaxis purposis, showed that appoximately eighty percent of D-negative individuals will produce serological detectable anti-D [68][69][70][71] . Studies on D-immunization after D-positive RBC transfusions in Dnegative patients reported comparable 72 or lower immunization rates [73][74][75][76][77][78][79] . In a number of these studies the low rate of D immunization is associated with a depressed immune system [73][74][75][76] .…”