According to a recently published abstract in Blood, patients undergoing bone marrow transplant (BMT) who receive Rh immunoglobulin (RHIG), commonly used to prevent hemolytic disease of the fetus and newborn (HDFN), do not appear to have different outcomes than those who don’t.
The authors aimed to determine whether the administration of RHIG or anti-D alloimmunization impacted the outcomes of patients receiving BMTs through a retrospective study using data from a single center.
The study included data from 22 patients who underwent a BMT and had a confirmed diagnosis of RhD alloimmunization. The patients were divided into three groups: the first one comprised of alloimmunized patients receiving a bone marrow transplant from an RhD-positive donor, the second group of alloimmunized patients who did not receive a transplant from an RhD-positive donor, and a control group in which alloimmunization was diagnosed only after the transplant.
Results showed that outcomes were similar between the three groups, with no appreciable differences in disease relapse, death or acute graft versus host disease (aGVHD).
“Patients who received RhIg with the 6 months prior to BMT from an RhD positive donor did not have significantly worse outcomes,” the authors wrote. “However, our study was limited in its small sample size and single institutional study,”
Understanding alloimmunization and blood transfusions
Ideally, patients with an RhD-negative blood type should only receive RhD-negative blood transfusions. However, in emergency settings, where there is no RhD-negative blood available, and the patient’s life is at risk, physicians must often transfuse RhD-positive blood.
Learn more about HDFN treatment and care
When RhD-negative patients receive RhD-positive blood, their immune system can produce antibodies targeting RhD-positive red blood cells (RBCs). In the future, immunization can cause HDFN or adverse transfusion reactions.
“Anti-D alloimmunization remains a pertinent issue as RhD negative patients may receive RhD positive blood products in emergency or resource-limited settings leading to alloimmunization against anti-D,” the authors wrote. “Platelet shortages in particular lead to transfusion of RhD positive platelets to RhD negative potential BMT candidates.”
