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Published on: September 6, 2017
Platelet transfusions from D+ donors to D- patients: a 10-year follow-up study of 1014 patients
Joan Cid1, Gloria Carbassé, Arturo Pereira
1Hemotherapy and Hemostasis Department, Hospital Clínic, IDIBAPS, Barcelona, Spain. jcid@clinic.ub.es
Insights
Transfusing RhD-positive platelets to RhD-negative patients resulted in a low rate of anti-D alloimmunization (3.8%). This suggests D-incompatible platelet transfusions may be safe for RhD-negative men and women not of childbearing potential.
Area of Science:
- Transfusion Medicine
- Immunology
- Hematology
Background:
- Current guidelines recommend RhD-compatible platelet transfusions.
- Previous studies showed up to 19% anti-D alloimmunization in RhD-negative patients receiving RhD-positive platelets.
- Logistic constraints necessitate evaluating RhD-incompatible transfusions.
Purpose of the Study:
- To determine the incidence of anti-D alloimmunization in RhD-negative patients receiving RhD-positive platelet transfusions.
- To assess the safety and feasibility of transfusing RhD-positive platelets to RhD-negative recipients.
Main Methods:
- Retrospective review of clinical and transfusion records of 1014 RhD-negative patients receiving RhD-positive platelet concentrates (PCs) from 1999-2009.
- Analysis of anti-D antibody development in 315 patients with follow-up of at least 4 weeks post-transfusion.
- Rh immunoglobulin (RhIG) was not administered post-transfusion.
Main Results:
- A total of 5128 RhD-positive platelet transfusions were administered to 1014 RhD-negative patients.
- Anti-D antibodies developed in 12 out of 315 (3.8%) evaluable patients.
- The median follow-up period was 29 weeks.
Conclusions:
- The frequency of anti-D alloimmunization following RhD-incompatible pooled platelet transfusions is low (3.8%).
- Transfusing RhD-negative patients with RhD-incompatible pooled platelets without immunoprophylaxis is a reasonable and safe alternative for RhD-negative men and women without childbearing potential.
Background:
Current guidelines recommend that platelets (PLTs) from D- donors should be given to D- patients. However, such evidence comes from studies with a limited number of included patients that reported an incidence of anti-D alloimmunization to be up to 19%. We thus decided to extend these findings by examining anti-D alloimmunization at our institution, where PLT transfusions from D+ donors are transfused to D- patients because of logistic constraints.
Study Design And Methods:
From April 1999 to December 2009, we retrospectively reviewed the clinical and transfusion records of all D- patients who received PLT transfusions from D+ donors at our hospital. PLT concentrates (PCs) were obtained from apheresis and from whole blood donations. RhIG was not administered after the transfusion of PCs from D+ donors. The antibody screen test to detect anti-D was performed by low-ionic-strength solution indirect antiglobulin test using the gel test.
Results:
Our series comprises 1014 D- patients who received 5128 PLT transfusions from D+ donors (89% were pooled PCs). We had 315 (31.1%) patients who had a blood sample to analyze the presence of anti-D 4 or more weeks after the first D+ PLT transfusion with a median follow-up of 29 weeks (range, 4-718 weeks). Anti-D developed in 12 (3.8%) of these 315 patients.
Conclusions:
The frequency of anti-D alloimmunization of D- patients after receiving pooled PCs from D+ donors is low. The transfusion of D-incompatible pooled PCs without immunoprophylaxis to D- men or D- women without childbearing potential seems a reasonable and safe alternative.
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