Hello,

We have an ABneg female of child bearing age with allo Anti-D and Anti-E. She requires platelets.

Currently we only have group A Rh positive platelets in house and Canadian Blood Services can only provide Oneg platelets in about 2 hours.

What is the best option for this patient? How does having Anti-D change normal procedure of giving Rh neg platelets as first choice followed by Rh pos platelets with Rhig as second choice?

Thanks for your thoughts..

R

I would give the group A, D Positive platelets.  The amount of anti-B in the plasma will not affect the patient, and platelets do not express the D antigen.  However, the danger with this is that there may be a few group A, D Positive red cells in the plasma and, as the patient has already been sensitised to the D and the E antigen, these may boost the antibodies (as a secondary response can be stimulated with very few red cells).  It is a slight danger, unless the platelets "look red".

If the patient can wait for the group O, D Negative platelets, then this "danger" would disappear completely, and any danger from the anti-A, anti-B and anti-A,B in the plasma in which the platelets are suspended would be minimal.

Thanks Malcolm

We waited on the Oneg platelets. Delivered in 90 minutes despite minor snowstorm.

R