在引入Rho(D)免疫球蛋白50多年后，为什么人们仍在生产抗-D？一项更安全输血生物医学卓越（BEST）合作研究。

Why do people still make anti-D over 50 years after the introduction of Rho(D) immune globulin? A Biomedical Excellence for Safer Transfusion (BEST) Collaborative study.

作者信息

DelBaugh Regina M, Murphy Michael F, Staves Julie, Fachini Roberta Maria, Wendel Silvano, Hands Katie, Bonet-Bub Carolina, Kutner Jose Mauro, Cohn Claudia S, Cox Cody A, Jacquot Cyril, Hasan Rida A, Lu Wen, Juskewitch Justin E, Raval Jay S, Rollins-Raval Marian A, Fung Mark K, Ziman Alyssa, Fermon Erica J, Gorlin Jed B, Peters Jessica, Dunbar Nancy M

机构信息

Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Oxford University Hospitals, Oxford, UK.

出版信息

Transfusion. 2025 May;65(5):957-967. doi: 10.1111/trf.18202. Epub 2025 Mar 10.

DOI:10.1111/trf.18202

PMID:40059673

Abstract

BACKGROUND

Rho(D) immune globulin (RhIg) is used to reduce RhD alloimmunization in pregnancy. This study describes potential causes for RhD alloimmunization after the development and implementation of RhIg.

STUDY DESIGN AND METHODS

This retrospective descriptive study investigated RhD-negative patients born in 1965-2005 with anti-D newly identified during 2018-2022. Transfusion, pregnancy, intravenous drug abuse, and transplantation were considered potential alloimmunization sources.

RESULTS

There were 1200 study patients (852 females; 348 males) at 30 institutions in 5 countries (USA, Canada, UK, New Zealand, Brazil). Most patients had a single potential source of alloimmunization identified (857/1200, 71%), most commonly pregnancy among females (537/852, 63%) and transfusion among males (180/348, 52%). When multiple potential sources were included, males were more likely than females to have a history of transfusion (235/348 [68%] vs. 149/852 [17%], p < .0001) and confirmed or suspected intravenous drug abuse (100/348 [29%] vs. 138/852 [16%], p < .0001). Among females with a history of pregnancy, 119/718 (17%) had healthcare access issues, 120/718 (17%) had pregnancy in a country where they may not have received RhIg, and 21/718 (3%) refused RhIg. Among patients with a history of transfusion, males were more likely than females to have received RhD-positive red blood cells or whole blood (143/235 [61%] vs. 30/149 [20%], p < .0001) and/or platelets (84/235 [36%] vs. 19/149 [13%], p < .0001).

DISCUSSION

Pregnancy was the most frequently identified potential source of RhD alloimmunization among females. Transfusion was most frequent in males. Intravenous drug abuse as a common potential source among patients with RhD alloimmunization merits further study.

摘要

背景

Rho(D)免疫球蛋白（RhIg）用于降低孕期RhD同种免疫。本研究描述了RhIg研发和应用后RhD同种免疫的潜在原因。

研究设计与方法

这项回顾性描述性研究调查了1965年至2005年出生、在2018年至2022年期间新发现有抗-D的RhD阴性患者。输血、妊娠、静脉药物滥用和移植被视为潜在的同种免疫来源。

结果

来自5个国家（美国、加拿大、英国、新西兰、巴西）30家机构的1200名患者参与了研究（852名女性；348名男性）。大多数患者被确定有单一的同种免疫潜在来源（857/1200，71%），女性中最常见的是妊娠（537/852，63%），男性中最常见的是输血（180/348，52%）。当纳入多个潜在来源时，男性比女性更有可能有输血史（235/348 [68%] 对149/852 [17%]，p <.0001）以及确诊或疑似静脉药物滥用史（100/348 [29%] 对138/852 [16%]，p <.0001）。在有妊娠史的女性中，119/718（17%）存在医疗获取问题，120/718（17%）在可能未接受RhIg的国家怀孕，21/718（3%）拒绝接受RhIg。在有输血史的患者中，男性比女性更有可能接受过RhD阳性红细胞或全血（143/235 [61%] 对30/149 [20%]，p <.0001）和/或血小板（84/235 [36%] 对19/149 [13%]，p <.0001）。