Journal of Blood Disorders & Transfusion

Abstract

Rate of Alloimmunisation to D, E, C Antigens in Rh-Negative Individuals Transfused with O RhD Positive Red Blood Cells in Emergency Situations: A Systematic Review and Meta-Analysis

Rayanna C. Nunes, Sue Quiring and Denise E. Jackson*

The limited supply of the universal blood, O RhD negative, has led to the implementation of transfusion policies regarding the standard use of O RhD positive blood in adult male and women of non-childbearing age in emergency situations. However, there are concerns over associated Rh alloimmunization risks, as Rh antigens have the potential to cause Hemolytic Transfusion Reaction (HTR) and Hemolytic Disease of the Fetus and Newborn (HDFN). Therefore, we thought to determine the rate of anti-D, anti-E and anti-C antibodies formation when this policy is applied. PubMed, Embase and SCOPUS were searched from inception date to August 2023 for eligible alloimmunisation studies with anti-D, anti-C and/or anti-E specific data. Meta-analyses were performed using Open Meta-Analyst software.

Twelve studies were included in the RhD alloimmunisation meta-analysis. The relative risk of RhD alloimmunisation of Rh-negative patients receiving O RhD positive RBCS in emergency situations was determined to be 24.2% (95% CI, 16.5%-32.9%, p<0.001). Four of these studies also reported anti-E and anti-C antibodies formation. The meta-analyses performed did not yield statistically significant results but suggests the risk of anti-E and anti-C seroconversion to be around 8% and 5% respectively.

Given the relatively low rate of RhD alloimmunisation observed and the low prevalence of RhD negative individuals in the general population the use of group O RhD positive RBCs in the emergency situations may be justified. However, further prospective studies are needed to confidently establish the rate of alloimmunisation to Rh antigens in this scenario.

Published Date: 2024-02-21; Received Date: 2024-01-15