Rate of D-alloimmunization in trauma does not depend on the number of RhD-positive units transfused: The BEST collaborative study

Jansen N. Seheult, Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Jeannie Callum, Department of Pathology and Molecular Medicine, Kingston health Sciences Centre and Queen's University, Kingston, Ontario, Canada
Meghan Delaney, Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
Rosanna Drake, Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
Nancy M. Dunbar, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Sarah K. Harm, Department of pathology, University of Vermont Medical Center, Burlington, Vermont, USA
John R. Hess, Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
Bryon P. Jackson, Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
Ayda Javanbakht, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Sarah A. Moore, Department of Surgery, University of New Mexico, Albuquerque, New Mexico
Michael F. Murphy, National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
Jay S. Raval, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
Julie Staves, National Health Service Blood and Transplant, and Oxford Biomedical Research Centre, Oxford, UK
Erin E. Tuott, Transfusion Service, Harborview Medical Center and the Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
Silvano Wendel, Hospital Sírio-Libanês Blood Bank, São Paulo, Brazil
Alyssa Ziman, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA
Mark H. Yazer, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, UCLA Health, Los Angeles, California, USA

Document Type

Article

Publication Date

8-1-2022

Abstract

BACKGROUND: Evidence indicates the life-saving benefits of early blood product transfusion in severe trauma resuscitation. Many of these products will be RhD-positive, so understanding the D-alloimmunization rate is important.

METHODS: This was a multicenter, retrospective study whereby injured RhD-negative patients between 18-50 years of age who received at least one unit of RhD-positive red blood cells (RBC) or low titer group O whole blood (LTOWB) during their resuscitation between 1 January, 2010 through 31 December, 2019 were identified. If an antibody detection test was performed ≥14 days after the index RhD-positive transfusion then basic demographic information was collected, including whether the patient became D-alloimmunized. The overall D-alloimmunization rate, and the rate stratified by the number of units transfused, were calculated.

RESULTS: Data were collected from nine institutions. Five institutions reported fewer than 10 eligible patients each and were excluded. From the remaining four institutions, all from the USA, there were 235 eligible patients; 77 (random effects estimate: 32.7%; 95% CI: 19.1-50.1%) became D-alloimmunized. Three of the institutions reported D-alloimmunization rates ≥38.6%, while the remaining institution's rate was 12.2%. In both random and fixed-effects models, the rate of D-alloimmunization was not significantly different between those who received one RhD-positive unit and those who received multiple RhD-positive units.

CONCLUSION: In this large, multicenter study of injured patients, the overall rate of D-alloimmunization fell within the range previously reported. The rate of D-alloimmunization did not increase as the number of transfused RhD-positive units increased. These data can help to inform RhD type selection decisions.

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