背景:当前的血液和生物疗法促进协会(AABB)标准要求输血服务在RhD阴性患者暴露于RhD阳性红细胞时制定Rh免疫球蛋白(RhIG)免疫预防政策。这是对美国(US)AABB认可的输血服务的调查,涉及RhD阴性患者接受RhD阳性后RhIG免疫预防的机构政策和实践(即,RhD-不相容)充血红细胞(pRBC)和血小板输注。
结果:大约一半的受访者(50.4%,116/230)有关于RhD不相容的pRBC和血小板输注后的RhIG给药的政策,而其他人只有pRBC的政策(13.5%,31/230)或仅血小板(17.8%,41/230)输血,但不是两者都有。相比之下,18.3%(42/230)报告说,他们的机构没有关于RhD不相容输血后RhIG免疫预防的书面政策。大多数机构(70.2%,99/141)没有解决安全参数的政策,以减轻与预防RhD不相容的pRBC输血后RhD同种免疫接种所需的高剂量RhIG相关的溶血风险。
结论:大约一半的美国AABB认可的机构报告说,在RhD不相容的pRBC和血小板输注后,有关于RhIG免疫预防的政策,一些机构可能不符合AABB标准。Further,大多数RhD不相容的pRBC输血后的RhIG免疫预防政策没有书面保障措施来降低与高剂量RhIG相关的溶血风险.
结论:这项调查强调了Rh阴性患者通过输血在RhD暴露后对RhIG免疫预防的不同和不充分的机构政策。这一观察发现了提高输血安全性的机会。
BACKGROUND: Current Association for the Advancement of Blood & Biotherapies (AABB) standards require transfusion services to have a policy on Rh immune globulin (RhIG) immunoprophylaxis for when RhD-negative patients are exposed to RhD-positive red cells. This is a survey of AABB-accredited transfusion services in the United States (US) regarding institutional policies and practices on RhIG immunoprophylaxis after RhD-negative patients receive RhD-positive (i.e., RhD-incompatible) packed red blood cell (pRBC) and platelet transfusions.
RESULTS: Approximately half of the respondents (50.4%, 116/230) have policies on RhIG administration after RhD-incompatible pRBC and platelet transfusions, while others had policies for only pRBC (13.5%, 31/230) or only platelet (17.8%, 41/230) transfusions, but not both. In contrast, 18.3% (42/230) report that their institution has no written policies on RhIG immunoprophylaxis after RhD-incompatible transfusions. Most institutions (70.2%, 99/141) do not have policies addressing safety parameters to mitigate the risk of hemolysis associated with the high dose of RhIG required to prevent RhD alloimmunization after RhD-incompatible pRBC transfusions.
CONCLUSIONS: With approximately half of US AABB-accredited institutions report having policies on RhIG immunoprophylaxis after both RhD-incompatible pRBC and platelet transfusions, some institutions may not be in compliance with AABB standards. Further, most with policies on RhIG immunoprophylaxis after RhD-incompatible pRBC transfusion do not have written safeguards to mitigate the risk of hemolysis associated with the high dose of RhIG required.
CONCLUSIONS: This survey underscores the diverse and inadequate institutional policies on RhIG immunoprophylaxis after RhD exposure in Rh-negative patients via transfusion. This observation identifies an opportunity to improve transfusion safety.