Anti-D Alloimmunization Following Rhesus-Incompatible Platelet Transfusion in a Myelodysplastic Syndrome Patient

TL;DR

A patient with myelodysplastic syndrome developed anti-D alloimmunization after receiving Rh-incompatible platelet transfusions, highlighting the need for Rh compatibility or anti-D immunoglobulin.

Contribution

This case highlights anti-D alloimmunization from Rh-incompatible platelet transfusions in MDS patients without prior red cell transfusions or anti-D immunoglobulin.

Findings

A 56-year-old MDS patient developed anti-D alloimmunization after multiple RhD-positive platelet transfusions.

The patient had no prior packed cell transfusions or anti-D immunoglobulin administration.

The case emphasizes the importance of Rh compatibility or anti-D immunoglobulin in frequent platelet transfusion scenarios.

Abstract

Patients with myelodysplastic syndrome (MDS) often need platelet transfusions to address thrombocytopenia. The risk of alloimmunization, particularly in Rhesus (Rh) incompatibility between donors and recipients during platelet transfusions, is heightened, especially with whole blood-derived pooled platelets as opposed to apheresis platelets. Although the occurrence of alloimmunization from platelet transfusions is minimal, there is an ongoing debate about whether Rh immune globulin (RhIg) should be administered to Rhesus D (RhD)-negative recipients of RhD-positive platelet units. We present a unique case of anti-D alloimmunization in a 56-year-old patient with underlying MDS following multiple platelet transfusions but never received packed cell transfusion or anti-D immunoglobulin. Some studies advocate for RhIg administration in specific scenarios and for certain patient populations. This case underscores the importance of considering Rhesus compatibility or administering anti-D immunoglobulin in cases where frequent platelet transfusions are required.