Immunosuppressive protocols for transplantation and certain hematologic malignancies can prevent the primary immune response to the D blood group antigen

A review of the published literature on Rh alloimmunization reveals that its incidence varies with the volume of infused D+ red blood cells (RBCs), the probable Rh genotype of the RBCs, and the immune competency of the D– recipient. Among the reports of Rh alloimmunization in different clinical circumstances, we identified five studies in which a combined total of 62 D– recipients of hematopoietic stem cell or solid-organ transplants were transfused with D+ RBCs and none (0%) formed anti-D. The observation that immunosuppressive protocols developed to prevent rejection of tissue and organ transplants also prevented alloimmunization to the D blood group antigen raises the possibility of practical applications in blood transfusion practice. Immunohematology2013;29:110–14.