How I do it: An institutional protocol for the management of RhD negative women who receive RhD positive blood.

IF 2.5 3区 医学 Q2 HEMATOLOGY
Transfusion Pub Date : 2025-03-27 DOI:10.1111/trf.18181
Rahaf Alkhateb, Kirea Mazzolini, Vipulkumar Pravinbhai Prajapati, Chantal Harrison, Kayla E Ireland, Donald Jenkins, John Daniels, Leslie Greebon
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Abstract

Background: RhD alloimmunization can result from blood transfusion or fetomaternal hemorrhage (FMH). Preventing alloimmunization in childbearing-age women with FMH via utilization of RhD immunoglobulin (RhIG) is well known; however, there are no established protocols for RhD-mismatched transfusions in emergent or traumatic settings. Here, we describe our hospital protocol for managing RhD negative women who receive RhD positive transfusions.

Design: Pathology or Transfusion Medicine staff are notified of RhD-mismatched blood transfusions. Women with childbearing potential are evaluated by Obstetrics and Gynecology (ObGyn) to determine patients' childbearing desires and physical capabilities, as well as their ability to tolerate RhIG administration. Pathologists determine eligibility for therapy with RhIG: criteria include RhD negative females, ≤50 years old, without current or historical Anti-D, who have been transfused <20% of their total blood volume (TBV) with RhD positive blood.

Results: Management strategy depends on red blood cell volume (RBCv) transfused. Patients who receive an RBCv ≤20% of their TBV are eligible to receive RhIG, while an RBCv >20% makes individuals ineligible for prophylaxis with RhIG. Red cell exchange (RCX) is not offered at our institution, regardless of RBCv transfused. Women who receive RhIG should be screened for the development of antibodies using direct and indirect antiglobulin tests for 6-12 months posttransfusion. Future pregnancies of alloimmunized women should be carefully monitored.

Conclusion: Our therapeutic plan involves identifying eligible patients based on set criteria. This is the first published protocol to prevent RhD alloimmunization in females of childbearing age due to RhD-mismatched transfusions.

背景:输血或胎儿-产妇出血(FMH)都可能导致 RhD 同种免疫。通过使用 RhD 免疫球蛋白(RhIG)预防 FMH 育龄妇女的同种异体免疫是众所周知的;然而,在紧急情况或创伤情况下,RhD 不匹配输血还没有既定的方案。在此,我们介绍了本医院对接受 RhD 阳性输血的 RhD 阴性妇女的处理方案:设计:病理科或输血科工作人员接到 RhD 不匹配输血的通知。妇产科(ObGyn)会对有生育能力的女性进行评估,以确定患者的生育意愿和身体状况,以及是否能够耐受 RhIG 给药。病理学家确定接受 RhIG 治疗的资格:标准包括 RhD 阴性女性,年龄不超过 50 岁,目前或过去没有抗 D 血型,曾接受过输血:治疗策略取决于输注的红细胞容量(RBCv)。红细胞体积≤20%的患者符合接受 RhIG 的条件,而红细胞体积>20%的患者则不符合接受 RhIG 预防的条件。 本院不提供红细胞置换(RCX)服务,无论输注的红细胞体积如何。接受 RhIG 的女性应在输血后 6-12 个月内使用直接和间接抗球蛋白试验进行抗体筛查。对异体免疫妇女的未来妊娠应进行仔细监测:我们的治疗计划包括根据既定标准确定符合条件的患者。这是首个已公布的预防育龄女性因 RhD 不匹配输血导致 RhD 同种免疫的方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Transfusion
Transfusion 医学-血液学
CiteScore
4.70
自引率
20.70%
发文量
426
审稿时长
1 months
期刊介绍: TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.
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