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Rh blood type: transfusion and transplantation

Rh blood type: transfusion and transplantation. Presented by Ri 宋柏憲 Reference: Transfusion Volume 46, January 2006 Transplantation 2004;78: 1693–1696. Introduction. Blood group systems: 23 systems included ABO(1901), MNS, P, Rh(1940) …etc

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Rh blood type: transfusion and transplantation

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  1. Rh blood type: transfusion and transplantation Presented by Ri 宋柏憲 Reference: Transfusion Volume 46, January 2006 Transplantation 2004;78: 1693–1696

  2. Introduction • Blood group systems: 23 systems included ABO(1901), MNS, P, Rh(1940) …etc • Rh system: second most important system in transfusion medicine • Weiner: Rhesus monkey injected with human RBCs would produce antibody that agglutinated 85% of white New Yorkers

  3. Introduction • Rh blood system had 48 antigens , most important and immunogenic antigen is D. • Rh-positive people have both RhD and RhCE, whereas Rh-negative RBCs have only RHCE • Caucasian population : 85 % Rh-positive, 15% Rh-negative • Anti-D: hemolysis in adults following an Rh-mismatched transfusion and in the newborn (HDN) if antibodies were raised in the mother from a prior transfusion or pregnancy

  4. Introduction

  5. Introduction • Host versus graft reaction (HVGR) • Hyperacute rejection: complement-mediated response with pre-existing antibody (ABO incompatable), mintues to hours • Acute rejection: T-cell mediated, 5-7 days • Chronic rejection: humoral antibody, cause fibrosis of internal blood vessel, months to years • Graft versus host reaction (GVHR)

  6. Transfusion-background • Since World War II • In the mid-20th century, most Asian countries, adopted Western pretransfusion testing procedures • Caucasian populations: 85% had D antigen, 15% D- phenotype • Taiwanese: 0.33% had D- phenotype • Anti-D: 1/733, and 1/235000

  7. Transfusion-background • D– mothers who give birth to jaundiced infants: 15% with glycuronosyl transferase mutation • 1988 the MMH discontinued routine D typing for all Taiwanese patients requiring blood transfusion

  8. Transfusion-Method and Result

  9. Transfusion-Method and Result

  10. Transfusion-Result • Anti-“Mia” (1%) and anti-E (1%) were the most commonly detected alloantibodies. • Potency: Mia and D antigen , Mia cause hydrops fetalis, HDN, and intravascular hemolytic transfusion reaction. • Anti-D was induced by transfusion every 2 years • Anti-Mia and Anti-E were induced by transfusion about 1.2 cases/month

  11. Conclusion • D antigen : Taiwanese (99.67%); Japanese (99.42%); Lao (100%) ;Vietnamese (100 %), Han (99.5%) • Presence of the Del phenotype (a weak D phenotype, about 32.6% among Taiwanese population, very rare in D- Caucasian persons) • Low incidence of the D– phenotype and relatively high incidence of “Mia”+ phenotypes throughout southeast Asia: genetically related

  12. Conclusion • Low D antigen and Anti-D  pretransfusion compatibility testing procedure should consist of only ABO grouping, antibody screening (an “Mia”+ cell should be included) and a major cross-match, and D typing being discontinued

  13. Transplantation-background • Worse outcome for Rh-mismatched recipients— Rh(D)-positive donor into a Rh(D)-negative recipient— 12 months posttransplant Clinical transplants 1988. Los Angeles, UCLA Tissue Typing Laboratory1988, p 409. • Rh(D) mismatch had a negative impact on long-term graft survival in cadaveric renal transplantation Transplantation 1998; 65: 588. • Solid organ transplantation ABO blood group compatibility, but the Rh(D) compatibility is an relevant obstacle .

  14. Transplantation: Method • 1500 live-donor kidney transplantation: • Group I: 1372 patients with Rh(D) identical Rh(+/+):1350 and Rh(-/-):22 • Group II: 128 patients with Rh(D) non-identical Group A: Rh(+/-):70 Group B: Rh(-/+):58

  15. Transplantation: Result • Between Group I and Group II • Acute rejection episode: 677 (49.3%) and 61 (47.7%)(P 0.33). • Biopsy-proven chronic rejection 359 (26.2%) and 29 (22.7%) (P 0.66). • The 1-, 5-, and 10-year graft survival rates were 94%, 78%, 54%, and 95%, 82%, and 57% • The patient survival rates were 99%, 89%, 77% and 98%, 90%, 79% at 1, 5, and 10 years. • No statistically significant difference

  16. Transplantation: Result

  17. Transplantation: Result

  18. Transplantation: Result • Between Group A and Group B • No statistically significant difference incidence of acute rejection, chronic rejection, graft survival or patient survival

  19. Transplantation: Conclusion • Rh incompatibility is not detrimental in live-donor renal transplantation.

  20. Transfusion and Transplantation Conclusion • Pretransfusion compatibility testing only ABO grouping, antibody screening and a major cross-match, and D typing being discontinued • Rh incompatibility is not detrimental in transplantation.

  21. Thanks for your Attention!!

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