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Sari

RhD incompatible PLT transfusions

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Hi everyone,

 

At our blood bank we're reviewing our policy concerning RhD incompatible platelet tranfusion. I'd like to hear about what sort of policies you guys have at your blood bank/hospital.

 

- Do you administer RhD pos platelets to RhD neg patients? In what situations (always, only when there is a shortage of RhD neg platelets)? To which patient groups do you not recommend RhD incompatible platelets (women < 50 yrs, patients who receive frequent platelet transfusions)?

 

- Do you have a different policy for apheresis and whole blood derived platelets?

 

- Do you administer prophylactic Rh immunoglobulin to these patients (everyone, or selected patient groups)?

 

And now for something completely different...

 

- Do you have a policy concerning Kell positive donors and plateletpheresis? Do you defer these donors, or do you have a policy of not actively recruiting these donors for plateletpheresis?

 

Cheers,

Sari

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I am at the mercy of the blood supplier for plts.  Usually all they have are A+ with an occasional O+.  I can get Rh= products if I know in advance and request them (usually).  All the products I get are apheresis derived - we do not consider giving RhIg to Rh= recipients (maybe if they were randoms and bloody).  We are unconcerned with the K typing of the donor.

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We do things pretty much as David has said. If I were giving platelets to a woman 'of child bearing age' who is not an oncology patient (or cleared w/ oncologist) or a child, I would try to use Rh negative platelets if at all possible. Otherwise the majority of our patients get A Pos. I have seen only one Rh negative patient produce anti-D because of Rh positive apheresis platelets and that was years ago. I think the current apheresis collections are cleaner.

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I have seen anti D developed from platelet transfusion, and recently. However, our policy is not to consider Rh unless the patient is a child (under 25) or a woman of child bearing years (under 50). We do not offer RhIg prophylaxis, unless the patient is a child or a woman under 50.

No difference between apheresis and pooled random and I don't consider Kell at all.

Liz

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Similar to Liz and Scott.  We recommend RhIg if the patient is female less than 50,  We have seen several cases of anti-D developed following Rh Pos apheresis platelets where the platelets are the only immunizing source  about which we know.

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Our volume is not high (usually less than 10 transfusions/month), we use mostly pre-pooled units, don't differentiate between apheresis and pooled, and will give RhIG to all D- recipients getting D+ platelets. Our center is pretty good at providing the D- pools, so this only comes up a couple of times a year.

We don't concern ourselves with K.

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Thank you for your replies! It seems that we are quite conservative in our ways. We strive to always deliver RhD compatible PLTs to all patients and currently administer RhIG to all D neg recipients of RhD pos PLTs. This has however led to occasional PLT shortages which is the reason we're re-evaluating our policy.

 

We also have a policy of not collecting apheresis platelets from Kell pos donors, but this is under active re-evaluation also.

 

One further question - if you have seen anti-D develop due to incompatible PLT transfusion, why do you choose to not administer RhIG to all RhD neg patients receiving RhD pos PLTs? Is it a financial issue, or have you seen adverse effects from RhIG in these patients?

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We give whatever and only issue IgG to children, and women of child bearing age.

 

^Go me with my oxford comma!!

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We give RhD compatible platelets as a primary choice, secondary is ABO compatible if available. All RhD neg patients who receive RhD pos platelets will be given RhIG prophylaxis.

 

We also don't concern ourselves with K at all.

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We only use apheresis plts, AB0 compatible for frequent recipients such as haematology pts since the cell survival is somewhat better, but do not consider Rh at all, unless we have had to buy pooled units from another supplier. We have strict limits reg the levels of rbc's in our apheresis products so it's only the plt ag we consider - i.e. no concerns regarding K either.

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On 4/21/2015 at 10:17 AM, AMcCord said:

We do things pretty much as David has said. If I were giving platelets to a woman 'of child bearing age' who is not an oncology patient (or cleared w/ oncologist) or a child, I would try to use Rh negative platelets if at all possible. Otherwise the majority of our patients get A Pos. I have seen only one Rh negative patient produce anti-D because of Rh positive apheresis platelets and that was years ago. I think the current apheresis collections are cleaner.

I should have added in original post ....if we are giving Rh pos platelets to an Rh negative woman 'of child bearing age' or a child, we would definitely offer RhoGAM.

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- Do you administer RhD pos platelets to RhD neg patients? In what situations (always, only when there is a shortage of RhD neg platelets)? To which patient groups do you not recommend RhD incompatible platelets (women < 50 yrs, patients who receive frequent platelet transfusions)?

We avoid Rh + platelets to Rh - recipients in pediatric patients and females of child bearing age. If we have to use Rh+ in younger women, our policy is to give RhIg.

- Do you have a different policy for apheresis and whole blood derived platelets?

We only transfuse apheresis

- Do you administer prophylactic Rh immunoglobulin to these patients (everyone, or selected patient groups)?

Yes - to women of child bearing age

And now for something completely different...

 

- Do you have a policy concerning Kell positive donors and plateletpheresis? Do you defer these donors, or do you have a policy of not actively recruiting these donors for plateletpheresis?

We are a transfusion services only so do not collect any donor products.

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We've given a patient an anti-D with apheresis platelets - fortunately a man, but unfortunately he then went on to be transfusion dependent, meaning full crossmatch and no electronic issue possible :( This was within the past year so it certainly still happens.

 

We would only give anti-D to patients of childbearing potential and we keep one unit in stock of APos in case of massive haemorrhage/urgent need

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On ‎4‎/‎21‎/‎2015 at 10:27 AM, David Saikin said:

I am at the mercy of the blood supplier for plts.  Usually all they have are A+ with an occasional O+.  I can get Rh= products if I know in advance and request them (usually).  All the products I get are apheresis derived - we do not consider giving RhIg to Rh= recipients (maybe if they were randoms and bloody).  We are unconcerned with the K typing of the donor.

My exact answer also.

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