RhD-Alloimmunization in Adult and Pediatric Trauma Patients.

Autor: Gammon RR; OneBlood, Orlando, FL, USA. Electronic address: richard.gammon@oneblood.org., Almozain N; Department of Pathology and Transfusion Medicine, King Faisal Specialist Hospital and Research Centre-Riyadh, Riyadh, Saudi Arabia; Department of Pathology and Transfusion Medicine, King Saud University- Riyadh, Riyadh, Saudi Arabia., Hermelin D; Impact life, St. Louis, Missouri, USA; Department of Pathology, Saint Louis University School of Medicine, Missouri, USA., Klein N; Department of Pathology, University of California Davis, Sacramento, CA, USA., Mangwana S; Sri Balaji Action Medical Institute, New Delhi, India., Nair AR; Department of Transfusion Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvantanthapuram, India., O'Brien JJ; Ochsner Medical Center, New Orleans, LA, USA., Shmookler AD; Department of Pathology, University of Kentucky, Lexington, KY, USA., Stephens L; University of California, La Jolla, CA, USA., Bocquet C; Standards Development and Quality Initiatives, Association for the Advancement of Blood and Biotherapies, Bethesda, MD, USA.
Jazyk: angličtina
Zdroj: Transfusion medicine reviews [Transfus Med Rev] 2024 Oct; Vol. 38 (4), pp. 150842. Date of Electronic Publication: 2024 Jul 10.
DOI: 10.1016/j.tmrv.2024.150842
Abstrakt: The actual risk of providing RhD-positive units to RhD-negative recipients remains debatable. There is no standard of care in the United States (US) to guide transfusion decisions regarding RhD type for patients with an unknown blood type, except for women of childbearing age and neonates. The risk of alloantibody formation by an RhD-negative patient exposed to RhD-positive blood is reported to be from 3% to 70%. Due to such wide variations, this review was undertaken to determine the prevalence of anti-D alloimmunization in trauma patients who are RhD-negative and were transfused RhD-positive blood products. This study used the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) approach to answer the question, "In trauma patients who were transfused blood, what is the prevalence of alloimmunization to the D-antigen?" The review included all published articles through April 3, 2022 in databases. Articles published after the search period found by the authors were added to the manuscript if they addressed the primary question and there was unanimous consensus. There were 1683 full-text articles that met the search criteria, with 19 studies meeting eligibility criteria. In addition, 57 references were added after the search period had closed. The incidence of anti-D alloimmunization in adult trauma patients receiving whole blood varied from 7.8% to 42.7%. In contrast, incidence varied in patients receiving red blood cells (RBCs), from 0 to 94%, depending on number of categories analyzed. Anti-D alloimmunization with platelet transfusions varied from 0% to 19%. The alloimmunization rate increased with age and was detected only in children older than 5 years. Recent guidelines recommend the administration of Rh immune globulin (RhIG) to all traumatically injured patients who are both RhD-negative and pregnant. However, there is no specific guidance focused on the RhD-negative patient, pregnant or nonpregnant, and who have received RhD-positive red blood cells (RBC) and platelets. While numerous studies have attempted to evaluate the frequency of RhD alloimmunization rate in trauma settings, emerging data suggests that many factors affect this phenomenon. Additionally, the role of RhIG administration in cases of RhD-incompatible transfusions within the trauma setting adds complexity. As our trajectory propels us towards precision medicine and tailored transfusion practices, gaining a big data approach becomes indispensable.
Competing Interests: Declaration of competing interest Richard R. Gammon, MD- CLS Behring Patient Blood Management Advisory Board. All other authors- No conflicts of interest to disclose.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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