Rhesus (D) mismatch

Anti-D is not a naturally occurring antibody but may be induced by sensi-tisation with D +ve cells through pregnancy or previous incompatible transfusion. Important to screen both recipient and donor serum for the presence of anti-D.

• When either donor or recipient serum contains anti-D, rhesus D -ve blood products should always be given post-transplant. Note: in the situation where a rhesus D +ve recipient receives a graft from a donor whose serum contains anti-D, immune haemolysis may occur despite plasma reduction of the donor marrow due to active production of donor lymphocyte derived anti-D. Cannot be prevented but is rarely severe.

• Provided neither donor nor recipient have anti-D in the serum, specific pre-transplant manipulation of the product is only required in the situation of rhesus D +ve donor going into rhesus D -ve recipient where red cell depletion is required pre-transplant.

• It will occasionally be necessary to give rhesus D +ve platelet support when rhesus D -ve is preferable simply due to lack of abundant availability of rhesus -ve platelet products.

• If rhesus D +ve platelets have to be given, give anti-D 250iu SC immediately post-transfusion.

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