Transfusion of D positive red cells to selected D-negative patients

To transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D positive red blood cells.

Over the last 18 years, we have experienced situations of D negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D positive red blood cells in D negative patients, focussing on alloinmunization and mortality.

Applying the protocol, 3% of D negative patients were transfused with D positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower.

The use of D positive red blood cells in selected D negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited.