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Passive anti-C acquired in the setting of Rh immune globulin administration following Rh mismatched apheresis platelet transfusion: A case series |
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| Authors: | Nataliya Sostin Rebecca Ross Raisa Balbuena-Merle Jeanne E. Hendrickson Christopher A. Tormey |
| Affiliation: | 1. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA;2. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA;3. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA |
| Abstract: | Rh immune globulin (RhIG) may be administered to Rh(D)-negative recipients of Rh(D)-positive platelet (PLT) transfusions to mitigate anti-D alloantibody formation. We report a series of seven patients in which anti-C was detected as a result of RhIG administered as immunoprophylaxis following Rh-mismatched apheresis PLT transfusion, persisting for a range of 27 to 167 days post-RhIG. The passively transferred anti-C antibodies created complexities for subsequent transfusion support. Based on these challenges, in combination with emerging evidence supporting an extremely low anti-D alloimmunization risk following Rh-mismatched apheresis PLTs, we have changed our practice and now limit RhIG immunoprophylaxis in this setting to women of reproductive age. In summary, the blood bank and apheresis communities should be aware that passive transfer of non-D antibodies is possible following RhIG administration. This phenomenon represents a compelling reason to consider the risk/benefit ratio of RhIG and to limit its use to situations in which it is clinically necessary. |
| Keywords: | apheresis platelets immunohematology immunoprophylaxis |