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Platelet transfusion in an infant leading to formation of anti‐D: implications for immunoprophylaxis
Author(s) -
Haspel Richard L.,
Walsh Lorna,
Sloan Steven R.
Publication year - 2004
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.0041-1132.2004.03370.x
Subject(s) - medicine , antibody , isoantibodies , platelet , immunology , pediatrics , exchange transfusion , immune system , antigen , platelet transfusion
BACKGROUND: The immature infant immune system rarely makes RBC alloantibodies; however, most studies confirming the absence of alloantibodies in infants have involved transfusions that were matched for one of the most immunogenic antigens, rhesus D. The potential for D– infants to develop anti‐D is unknown. Specifically, this issue has not been analyzed for infants receiving whole‐blood‐derived PLTs from D+ donors. The importance of understanding such risk is underscored by the fact that anti‐D formation can be prevented by the administration of Rh immunoglobulin. CASE REPORT: A D– infant with congenital heart disease received two D‐mismatched whole‐blood‐derived PLT units at 17 weeks of age. He did not receive Rh immunoglobulin prophylaxis. Upon a subsequent admission 13 months later, anti‐D was identified in his plasma sample. CONCLUSION: The case presented here demonstrates that a young infant can respond to less than 0.6 mL of D+ RBCs and documents the youngest patient to have developed a RBC alloantibody from a PLT transfusion. To prevent anti‐D formation, we recommend administering Rh immunoglobulin to all pediatric patients that receive PLT transfusions from D+ donors.