D+ platelet transfusions in D– patients: cause for concern?

Patients whose RBCs are D- may produce anti-D if they are exposed to D on donor RBCs. Except in emergency situations, patients whose RBCs lack D are transfused with only D- RBCs. Platelets carry no Rh antigens, but platelet units may be contaminated by RBCs that could carry D when these units are collected from D+ donors. The purpose of this study was to determine whether our policy of allowing D+ platelets to be transfused to patients whose RBCs type as D-, without the use of prophylactic Rh immunoglobulin (RhIG), results in D alloimmunization. The transfusion records of all patients who received platelet transfusions from December 2004 to March 2007 were reviewed. Transfusion recipients were evaluated with pretransfusion ABO and D typings, and an antibody screen. Recipients were reevaluated in the same manner before subsequent transfusions. Transfusion records of 114 D- patients were analyzed. Overall, 104 patients received D+ platelets; 67 had repeat antibody screening after transfusion. No patients were shown to make anti-D after platelet transfusion. There was no evidence of D alloimmunization as a result of transfusion of D+ platelets in any D- patient during this study. The data do not support the practice of restricting D- patients to receiving only D- apheresis platelets, even among patients with chronic transfusion requirements. Prophylactic use of RhIG for D+ apheresis platelet transfusions in D- patients also appears to be unnecessary.