1 / 21

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

creola
Download Presentation

Rh blood type: transfusion and transplantation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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!!

More Related