Introduction. Blood group systems: 23 systems included ABO(1901), MNS, P, Rh(1940)
1. Rh blood type: transfusion and transplantation Presented by Ri ???
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
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: humeral 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 pre-transfusion 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 ? pre-transfusion 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 Pre-transfusion compatibility testing only ABO grouping, antibody screening and a major cross-match, and D typing being discontinued
Rh incompatibility is not detrimental in transplantation.
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