Updated Evaluation of RhD Status Among Women of Child-Bearing Age in Detroit, Michigan

OBJECTIVES: The Rh blood group system is one of the most important and immunogenic blood group systems after the ABO blood group system and, like other blood group antigens, it follows ethnic and racial trends. However, when it comes to D variants-partial D and weak D-most of the cohorts studied in the literature have been of European descent. This study aimed to discover the variant D trends in Detroit, Michigan, with an emphasis on Black communities. METHODS: From 2016 to 2018, there were 102 patients (women of childbearing potential: \u3c 50 years) at Henry Ford Hospital that had serologic D discrepant testing. These patients were sent out for molecular RHD determination. RESULTS: In total, 12.7% of patients were characterized as RhD positive and 87.3% of patients were characterized as RhD variants (nominated as RhD negative at our institution). CONCLUSIONS: Our predominantly Black cohort sheds light on the diversity of the RhD antigen. The majority of Blacks were classified as RhD variants (RhD negative nomination at our institution). Therefore, molecular testing for this patient population with serologic RhD discrepancies is paramount to properly manage their obstetric care

Lack of Alloimmunization to the D Antigen in D- Liver Transplant Recipients Receiving D+ RBCs Perioperatively

Background: D negative (D-) patients are routinely transfused with D- red blood cells (RBCs) due to the increased immunogenicity of the D antigen. The rate of alloimmunization to the D antigen following transfusion can be as high as 80%; however, immunosuppressed patients may be less likely to become alloimmunized. Some D- patients undergoing liver transplant may require a large number of RBC units which can risk the inventory of D- RBCs which are considered relatively rare (10-15% of donor units) as compared to D positive (D+) RBCs. So the blood bank may be forced to supply such patients with D+ RBCs due to inventory constraints. Though the process of providing D+ RBCs to D- transplant recipients is accepted in blood bank practice, the incidence of alloimmunization to the D-antigen in D- liver transplant patients has not been well defined. With a very active liver transplant program at our institution, studying the prevalence of anti-D formation in D- orthotopic liver transplant patients receiving D+ RBCs perioperatively will assist in successful patient blood management. Methods: This was a retrospective study performed at a single large academic medical center. The study was approved by our Institutional Review Board. Electronic medical records and blood bank files for all 1045 consecutive patients who underwent orthotopic liver transplantation at Henry Ford Hospital in Detroit, Michigan, from January 2007 through December 2017 were reviewed. Results: Twenty-three D- patients of a total of 154 D- patients (15%) received D+ blood perioperatively. The median age was 56 years (range 36-67 years); 17 (74%) were male. Two patients did not survive surgery. Four patients did not have serological follow up. Antibody screens were available on 17 patients: There was no evidence of D alloimmunization in any patient after a median follow up of 8.2 months (range 6 days - 79.4 months). Median number of D+ RBC units transfused was 8 units (range 1-66 units). We had 14 D- patients (14/154=9.1% of all D- liver transplant recipients) who presented with D alloimmunization before transplant; none of these patients was transfused with D+ blood at our institution. Conclusion: Our study showed that there was no risk of alloimmunization to the D antigen in D- orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion of D+ RBCs in D- liver transplant recipients is an acceptable practice perioperatively in the setting of immunosuppression. This practice allows the conservation of D- RBC units for other patients in greater need.https://scholarlycommons.henryford.com/merf2019clinres/1048/thumbnail.jp

Lack of alloimmunization to the D antigen in D-negative orthotopic liver transplant recipients receiving D-positive red blood cells perioperatively

BACKGROUND AND OBJECTIVES: D-negative patients undergoing orthotopic liver transplantation (OLT) might require a large number of red blood cell (RBC) units, which can impact the inventory of D-negative blood. The blood bank might need to supply these patients with D-positive RBCs because of inventory constraints. This study evaluates the prevalence of anti-D formation in D-negative OLT patients who received D-positive RBCs perioperatively, as this will assist in successful patient blood management. MATERIALS AND METHODS: This was a retrospective study performed at a single academic medical centre. Electronic medical records for all 1052 consecutive patients who underwent OLT from January 2007 through December 2017 were reviewed. D-negative patients who were transfused perioperatively with D-positive RBCs and had antibody screening at least 30 days after transfusion were included. RESULTS: Of a total of 155 D-negative patients, 23 (14.8%) received D-positive RBCs perioperatively. Seventeen patients were included in the study. The median age was 54 years (range 36-67 years); 13 (76.5%) were male. The median number of D-positive RBC units transfused perioperatively was 7 (range 1-66 units). There was no evidence of D alloimmunization in any patient after a median serologic follow-up of 49.5 months (range 31 days to 127.7 months). The average number of antibody screening post OLT was 7.29. CONCLUSION: Our study showed that transfusion of D-positive RBCs in D-negative OLT recipients is a safe and acceptable practice in the setting of immunosuppression. This practice allows the conservation of D-negative RBC inventory