Fresh frozen plasma, can cause Rh sensitization?

[mpmiola]

Antigenic particles dispersed in the PFC, can cause sensitization and development of anti Rh-D? Anyone heard anything or know of reports described. thank you!

[Malcolm Needs ☆]

I certainly recall reading this in some of the more elderly editions of Mollison's book "Blood Transfusion in Clinical Medicine", but, as I recall it, the number of red cell membrane "bits and pieces" were thought to be too low to cause primary immunisation, but sufficient to cause secondary immunisation. If you have coma across a patient who has produced anti-D after transfusion with D+ FFP, it may be that they were already immunised (by previous methods, such as transfusion or pregnancy), but that the level of anti-D in the circulation was too low to be detected, and that this is another example of a secondary responce.

I'll try to have a look back in my old Mollison books and try to pin point the bit that I read (or think I read!!!!!!!!!!!!), but that won't be tonight, as I am on-call.

[mpmiola]

Malcolm, we detected anti-D in a child who just received transfusions of plasma D +. I appreciate your attention and await their research without worrying about the weather ...

[mpmiola]

Malcolm, we detected anti-D in a child who just received transfusions of plasma D +. I appreciate your attention and look forward to their research without worrying about the weather ...

[John C. Staley]

How soon after the transfusion was the anti-D detected? What is the possibility that the FFP was mislabled and was actually Rh neg with anti-D in it? Or the donor was one of those rare D+ individuals that manages to make some form of anti-D. Remember, when the possible is ruled out you must consider the impossible.

[David Saikin]

I have seen plasma sensitize folks . . . our interp was that is was due to residual rbc stroma in the frozen product.

[Mabel Adams]

I have read of rare cases of FFP stimulating antibody production. Be sure the patient isn't getting RhIG for ITP or some such (doubtful in an Rh neg patient).

[mpmiola]

John, did not develop anti-D immediately after transfusion. The child was transfused with four units of plasma last year. We identified an anti-D two months later, that remains almost a year.

Already excluded medications, Mabel ...

I wonder publications about ...

Thankful ...

[goodchild]

I seem to recall an Australian article that talked about plasma-borne antibody production, but I could be misremembering. I'll try and find it again.

[Mabel Adams]

I am sure there was a journal article a lot of years back that said this was possible--maybe in Transfusion in the 90s. Maybe you could find it searching Pub Med.

[Dr. Pepper]

I would hope that the FFP was labeled correctly and did not contain antibodies - a call to the blood supplier would confirm this. What about making this a moot point by keeping FFP units of all 8 ABO/Rh types in your freezer and simply handing out identical flavors? Saves on puzzled and nervous calls from the nurses as well.

[pstruik]

For the record the 11th edition of Mollison ( <3) p635 'Precautions to be taken before infusion' says...

'Fresh plasma, which is now rarely used, may contain red cells, so that appropriate measures should be taken to prevent immunization of D-negative women of childbearing age. There is no credible evidence that FFP presents such a risk'

But absence of evidence is not evidence of absence.

So you have raised a really interesting point.

Certainly it would have been very difficult to find such evidence in the hospital where I worked as :

- We very rarely gave a patient FFP without them receiving other potentially antibody stimulating products as well, especially since we started using PCC for warfarin reversal.

- Many patients who received regular FFP therapy (GI bleeds, some ITU patients) tended to die before they had a chance to make antibodies

- We didn't go out of our way to look for new antibodies in the rare patient who did receive only FFP

So, in answer to your question I think I can unreservedly reply yes .... or no ... or maybe.

Wanders off, thinking .....

[cthherbal]

John, did not develop anti-D immediately after transfusion. The child was transfused with four units of plasma last year. We identified an anti-D two months later, that remains almost a year.

Already excluded medications, Mabel ...

I wonder publications about ...

Thankful ...

Could the child have been exposed elsewhere (transfused Rh+ in an emergency perhaps at another hospital)?

[mpmiola]

According to the mother, not.

[mpmiola]

Thanks everyone ... I will continue studying this case.

If anyone remember a new data, please email me.

[Malcolm Needs ☆]

Quote from Chapter 5 (The Rh Blood Groups - written by Peter Issitt) in Immunobiology of Transfusion Medicine, edited by George Garratty, 1st edition, 1994, Marcel Dekker Inc.

"In terms of plasma transfusions, liquid stored plasma from Rh+ donors (that probably contains a few intact RBCs) has been seen to stimulate both primary (140, 141) and secondary (141) responses to D in Rh- individuals. Frozen plasma and cryoprecipitate do not seem to have been incriminated as causative of primary immunization but can effect a secondary response, presumably because of the presence of RBC stroma (142)."

140. McBride JA, O'Hoski P, Blajchman MA, et al. Rhesus immunization following intensiv plasmapheresis (abstract). Transfusion 1978; 18: 626.

141. Burnie KL, Barr RM, personal communication to Mollison PL, Engelfriet CP, Contreras M. In: Blood Transfusion in Clinical Medicine, 8th edition, Oxford, England: Blackwell Scientific, 1987.

142. Barclay GR, Greiss MA, Urbaniak SJ. Adverse effect of plasma exchange on anti-D production in rhesus immunization oeing to removal of inhibitory factors. Br Med J 1980; 2: 1569.

I KNEW that I had read it somewhere!

:bow::bow:

[rebeccarjthomas]

What about the possibility that the child was sensitized by Mom if Mom RH Pos? Jane Swanson had a person with, I believe anti-Fya, that the Mom seemed to be the only possible explanation for sensitizing event.

[John C. Staley]

What about the possibility that the child was sensitized by Mom if Mom RH Pos? Jane Swanson had a person with, I believe anti-Fya, that the Mom seemed to be the only possible explanation for sensitizing event.

I like this possibility!! We always worry about mom, this is a possibility I had not considered. I do realize that as a "general rule" a new born's immune system is not up to this kind of a respnse but then general rules were made to be broken. :eyepoppin

[Malcolm Needs ☆]

I like this possibility!! We always worry about mom, this is a possibility I had not considered. I do realize that as a "general rule" a new born's immune system is not up to this kind of a respnse but then general rules were made to be broken. :eyepoppin

Indeed so John.

As I've said somewhere on this site before, there are some babies born with their own anti-A and/or anti-B that could not possibly have come from the mother (because she, herself was group A, group B or group AB) and this was proven by studies of their (the babies') Gm and Km isotypes.

[PAWHITTECAR]

I have seen babies come in as newborns with a negative ABS (mom had a negative ABS ) and then return at 3-4 months with a positive screen. Only explination that makes since is they are the baby's antibodies...