How are delayed hemolytic transfusion reactions (DHTR) prevented?

Updated: Sep 08, 2017
  • Author: Douglas Blackall, MD, MPH; Chief Editor: Michael A Kaliner, MD  more...
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Properly identify blood group alloantibodies prior to transfusion, and select antigen-negative RBCs for transfusion.

Patients with previously identified alloantibodies must be documented in a database, with information shared between institutions, as appropriate. Antigen-negative RBC units should be provided whenever possible, even if corresponding alloantibodies have decreased below detectable levels (to prevent immune restimulation).

Patients with alloantibodies require fully crossmatched (ie, antihuman globulin phase) donor units.

In patients of ethnic minorities who have received multiple transfusions (eg, African-Americans with sickle cell disease), testing for commonly involved antigens (eg, Rh, Kell, Kidd, Duffy) and transfusing antigen-negative units can significantly reduce the frequency of alloimmunization. However, the cost effectiveness of this approach must be considered because most patients who receive multiple transfusions do not form clinically significant alloantibodies. A more cost-effective approach may be to match the ethnic origin of donors and recipients, reserving extensive antigen typing for recipients who have been alloimmunized previously. These patients may also benefit from leukocyte reduced RBCs because leukoreduction appears to decrease the frequency of alloimmunization to RBC antigens, possibly due to decreased stimulation of TH 2 lymphocytes associated with transfusions. [6]

If Rh-positive units (RBCs, platelets, or granulocytes) must be transfused into an Rh-negative recipient, alloimmunization to the D antigen can be prevented by administering intravenous Rh-immunoglobulin (eg, WinRho SD, 10-12 mcg/mL of transfused Rh-positive RBCs). If transfusing a large number of Rh-positive units, the dose of Rh-immunoglobulin may be reduced after removing the antigen load by RBC exchange. [16, 17]

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