We have always given RhoGAM to Rh negative patients who must receive Rh positive platelet concentrates, it seemed prudent. Today platelet concentrates have fewer rbc's, and I wonder if anyone else thinks that perhaps this is an unnecessary precaution. Any comments would be appreciated.

We are 100% plateletpheresis user and most of the time we do not give RHIG.

Someone had mentioned that there is a problem with reimbursement for RhIG for this use. We reserve using it for women of child bearing years only. We have transfused a lot of Rh positive platelets to many patients this year, with none developing anti-D .

Most platelets we give go to Oncology patients who are incapable of responding to ANY antigen for a while -- and giving an injection to someone with a platelet count of 6 has always bothered me. OTOH, in a trauma situation with a young female, it may be of some benefit.

We advise that RhIg is available and let the clinician make the call ...

We give platelets without considertion of Rh type. Our patient population is all adult; we do not have pediatrics or OB patients. I only remember a handful of Rh neg patients who developed anti-D due to transfusion of Rh pos platelets. All where from back when we pooled platelet concentrates and in the early days of of pheresis platelets (remember when they were butterscotch colored instead of yellow?). Platelet inventory is difficult to manage at best; giving Rh neg platelets to Rh neg recipients would make it even more difficult, likely causing delays in transfusion and an increase in outdates.

We do have in our SOP that if a young Rh neg female should receive Rh Pos platelets that RhIg will be discussed with the clinician.

Our policy fits in with the last 2 posts. I've only seen one anti-D produced in an oncology patient.

I saw anti-D,C & E from plts in an adult male with lymphoma some years back. Recently we have an elderly female O neg patient that got about 6 apheresis units of Rh+ plts before we ever had to crossmatch her. She has a 4+ anti-D and a weak anti-C, but she may well have had them for years. Other than adding some delay and costs of IDs and antigen typing (not for D), it doesn't cause the patient much harm. It isn't like it is hard to find compatible blood for them.

We reserve RhIG for young females.

Our oncologists do not want to give the injection. Recently we did have 2 oncology patients form an Anti-D from Rh:pos random platelets we gave them.....though I hadn't seen any in years before these two recently.

We did have one young oncology patient who they just would not give Rh:pos platelets to .... fortunately we could always get Rh;negs in and they were willing to wait.

For traumas or bleeds we would suggest giving RhIg to any female under 50!

I personally still consider 50 a young female--until next year when I will consider 51 to be young.

At our hospital, we have had several patients (all on the older side, all male) who made anti-D after PLT transfusion at another facility during open heart or similar surgery. While it may not technically hurt them, there are instances of autoantibody formation after alloantibody formation (sometimes persistant... but I don't know if this has happened with anti-D formation.)

So my question is? would it be benefitial to prevent anti-D formation in these guys? I think so, since it is easy to do.

Linda Frederick

Thanks for all the good replies to our question about RhoGAM for Rh positive platelets. The information about (recent) patients making anti-Rh has convinced us that giving RhoGAM prophylactically remains a good idea for us. It is not uncommon for our supplier to have shortages of Rh negative rbc units, to the point that occasionally an Rh negative patient may have no other option but Tx with Rh positive rbc's in a big bleed. If that patient already has anti-D, he has lost the one chance to receive the Rh positive rbc's which might save his life. Again, many thanks for sharing your experiences.