Transfusion of platelet in bone marrow transplantation with RhD incompatibility

[mpmiola]

I would like to know the behaviors that have been adopted in your service in cases of bone marrow transplantation from RhD + patient, RhD- donor for transfusion of platelet concentrate.

Is there a concern to provide RhD- since the infusion? 

Or after the patient only presents donor phenotyping RhD-?

In the impossibility of providing RhD-, have hemotherapists indicated anti-D prophylaxis?

[Malcolm Needs ☆]

We never really worried about the D type of the platelets.

The fact is that the transplanted marrow is going to be exposed to the recipient's D Positive red cells for quite some time before the transplanted marrow takes over the production of D Negative red cells, and so the "transplanted immune system" (for want of a better way of putting it) will already have been stimulated to produce an anti-D, if it was going to, by the recipient's own red cells.  The number of red cells in a platelet pack, these days, should also be fairly negligible, and the platelets themselves do not express Rh antigens.

For the same reason, we never gave anti-D immunoglobulin prophylaxis.

[Neil Blumberg]

Agree with Malcolm.  We would tend to give Rh negative blood transfusions so we can tell when the recipient's cells are largely gone. We might do this in particular if the recipient is a female of child bearing age or younger.  But we would not be giving Rh immune globulin in the vast majority of settings for the reason that Malcom mentioned.