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Cancer type predicts alloimmunization following RhD‐incompatible RBC transfusions
Author(s) -
Arora Komal,
Kelley James,
Sui Dawen,
Ning Jing,
Martinez Fernando,
Lichtiger Benjamin,
Tholpady Ashok
Publication year - 2017
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/trf.13999
Subject(s) - medicine , abo blood group system , rh blood group system , blood transfusion , antigen , isoantibodies , incidence (geometry) , antibody , cancer , immunology , population , logistic regression , blood type (non human) , retrospective cohort study , oncology , gastroenterology , physics , environmental health , optics
BACKGROUND Immunosuppressed, RhD‐negative oncology patients tend to have lower rates of sensitization to the D antigen when they receive transfusion with RhD‐positive blood components. Clinical factors associated with alloimmunization to the D antigen in RhD‐negative oncology patients when they receive transfusion with RhD‐positive red blood cells (RBCs) have not been well defined. STUDY DESIGN AND METHODS This was a 4‐year, retrospective analysis identifying RhD‐negative oncology patients who received RhD‐positive RBCs and were not previously alloimmunized to the D antigen. Age, sex, race, ABO group, primary oncology diagnosis, and numbers of RhD‐incompatible RBC transfusions were recorded. The association between antibody formation and clinical factors was studied. The incidence of alloanti‐D was calculated from a subsequent antibody‐detection test performed at least 28 days after receipt of the first transfusion of RhD‐positive RBCs. RESULTS In total, 545 RhD‐negative oncology patients received 4295 RhD‐positive RBC transfusions. Of these, 76 (14%) became alloimmunized to the D antigen. Diagnosis type was the only factor significantly associated with responder status. The logistic regression model indicated that patients who had myelodysplastic syndrome or solid malignancies were more likely to be responders than those who had acute leukemia. CONCLUSION We measured a 14% sensitization rate to the D antigen in our RhD‐negative oncology population. The rate of alloimmunization was higher in patients who had solid cancers (22.6%) or myelodysplastic syndrome (23%) compared with those who had other hematologic malignancies (7%). Knowledge of diagnoses that predispose to RhD alloimmunization enables better utilization of RhD‐negative RBCs during times of shortage.