Rhesus alloimmunization following intensive plasma exchange.

Area of Science:

• Immunology
• Transfusion Medicine

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
• Intensive plasma exchange is a therapeutic apheresis technique used for severe SLE.
• Rh negative individuals are at risk for alloimmunization if exposed to Rh positive red blood cells.

Observation:

• A 17-year-old Rh negative female patient with severe SLE received intensive plasma exchange.
• Following plasma exchange, the patient developed a significant IgG anti-D antibody titer.
• The patient had no history of pregnancy or prior blood transfusions, apart from the plasma used in the procedure.

Findings:

• The patient's Rh status was B negative (Cde/cde).
• An IgG anti-D antibody was detected at a titer of 16, rising to 512.
• The antibody development is presumed to be due to exposure to Rh positive red blood cells or stroma within the transfused plasma.

Implications:

• Plasma transfusions, even without whole red blood cells, may carry a risk of Rh alloimmunization in susceptible individuals.
• This case highlights the potential for transfusion-related immunomodulation beyond direct red cell exposure.
• Careful donor selection and consideration of Rh status in plasma products may be warranted in specific clinical scenarios.