Rh blood type:  transfusion and transplantation

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Introduction. Blood group systems: 23 systems included ABO(1901), MNS, P, Rh(1940)

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Rh blood type: transfusion and transplantation

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1. Rh blood type: transfusion and transplantation Presented by Ri ??? Reference: Transfusion Volume 46, January 2006 Transplantation 2004;78: 16931696

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: 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.

21. Thanks for your Attention!!

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