Prevention of immunization to D+ red blood cells with red blood cell exchange and intravenous Rh immune globulin

BACKGROUND: Although young women who are D-occasionally receive unintentional transfusions with D+ red blood cells (RBCs), there are little data to assist with management of such an event. Two cases of D- girls transfused with D+ RBCs are reported. In an effort to prevent formation of anti-D, RBC exchange followed by administration of intravenous (IV) Rh immune globulin (Rhlg) was used. CASE REPORTS: Patient 1, a 56-kg, 16-year-old D-girl, was involved in a motor vehicle crash. She received 4 units of Group O uncrossmatched D+ RBCs. Thirty-six hours after admission, she underwent RBC exchange with 10 units of D- RBCs, followed by a total of 2718 μg of IV Rhlg over 32 hours. Six months later, her antibody screen was negative. Patient 2, a 39-kg, 10-year-old D-girl with aplastic anemia, received 1 unit of D+ RBCs. She underwent RBC exchange on the same day with 5 units of D- RBCs, followed by a total of 900 μg of IV Rhlg over 8 hours. Six months later her antibody screen was negative. CONCLUSION: RBC exchange followed by a calculated dose of IV Rhlg was successful in preventing alloimmunization to D. Several small studies suggest that both trauma and hematology patients may be less capable of becoming immunized with the transfusion of D+ blood components. Until these findings are more clearly defined, there will be times when prevention of immunization of any D- girl is desired. RBC exchange followed by Rhlg appears to be one way to achieve this goal.