Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Vitalant, Pittsburgh, Pennsylvania, USA.
Transfusion. 2023 May;63 Suppl 3:S54-S59. doi: 10.1111/trf.17330. Epub 2023 Apr 17.
The D-alloimmunization rate in trauma patients does not appear to depend on the number of RhD-positive units transfused. The effect of the timing and pattern of RhD-positive transfusions has not been evaluated.
RhD-negative trauma patients who were transfused with RhD-positive red blood cells (RBC) or low titer group O whole blood (collectively called RBCs) on at least two separate calendar days and who had antibody detection tests performed at least 14 days after the second RhD-positive RBC transfusion without receiving RhIg were included in the analysis. Patients whose anti-D was detected within 14 days of the index RhD-positive RBC transfusion were excluded. Patient demographics and the dates of RhD-positive RBC transfusions and results of antibody detection tests performed after the index transfusion were collected on eligible patients.
There were 44/61 (72.1%) patients in whom anti-D was not detected (non-alloimmunized) and 17/61 (27.9%) in whom anti-D was detected (alloimmunized). The patients had similar demographics with trends towards higher median admission heart rates and lower median admission Glasgow Coma Scale values in the alloimmunized group. Both groups received statistically identical median quantities of RhD-positive RBCs (non-alloimmunized 5 vs. alloimmunized 4 units, p = .53), however, the alloimmunized group received all their RhD-positive RBCs over a significantly shorter period of time compared to the non-alloimmunized (median 4 vs. 15 days, respectively, p = .01).
Receipt of all RhD-positive RBCs over a shorter period of time was associated with higher D-alloimmunization rates. These results need to be confirmed in larger studies.
创伤患者的 D 同种免疫率似乎与输注的 RhD 阳性单位数量无关。尚未评估 RhD 阳性输血的时间和模式的影响。
至少在两个不同的日历日输注 RhD 阳性红细胞（RBC）或低滴度 O 型全血（统称为 RBC）的 RhD 阴性创伤患者，如果在第二次 RhD 阳性 RBC 输血后至少 14 天且未接受 RhIg 检测到抗体检测试验，则纳入分析。将在指数 RhD 阳性 RBC 输血后 14 天内检测到抗-D 的患者排除在外。收集合格患者的患者人口统计学资料以及 RhD 阳性 RBC 输血日期和输血后抗体检测结果。
有 44/61（72.1%）名患者未检测到抗-D（未同种免疫），17/61（27.9%）名患者检测到抗-D（同种免疫）。两组患者的人口统计学特征相似，同种免疫组的中位入院心率较高，中位入院格拉斯哥昏迷评分较低。两组患者接受的 RhD 阳性 RBC 中位数数量相似（未同种免疫 5 单位与同种免疫 4 单位，p=0.53），但同种免疫组在明显较短的时间内接受了所有 RhD 阳性 RBC（中位数分别为 4 天和 15 天，p=0.01）。
在较短的时间内接受所有 RhD 阳性 RBC 与更高的 D 同种免疫率相关。这些结果需要在更大的研究中得到证实。
