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Multicenter Study
. 2025 May;65(5):957-967.
doi: 10.1111/trf.18202. Epub 2025 Mar 10.

Why do people still make anti-D over 50 years after the introduction of Rho(D) immune globulin? A Biomedical Excellence for Safer Transfusion (BEST) Collaborative study

Regina M DelBaugh  1 , Michael F Murphy  2 , Julie Staves  2 , Roberta Maria Fachini  3 , Silvano Wendel  3 , Katie Hands  4 , Carolina Bonet-Bub  5 , Jose Mauro Kutner  5 , Claudia S Cohn  6 , Cody A Cox  6 , Cyril Jacquot  7 , Rida A Hasan  8 , Wen Lu  9 , Justin E Juskewitch  9 , Jay S Raval  10 , Marian A Rollins-Raval  10 , Mark K Fung  11 , Alyssa Ziman  12 , Erica J Fermon  12 , Jed B Gorlin  13 , Jessica Peters  13 , Nancy M Dunbar  1 ; BEST foRmation of Anti‐D After Rhogam (RADAR) Study Investigators and the Biomedical Excellence for Safer Transfusion (BEST) Collaborative
Collaborators, Affiliations
Multicenter Study

Why do people still make anti-D over 50 years after the introduction of Rho(D) immune globulin? A Biomedical Excellence for Safer Transfusion (BEST) Collaborative study

Regina M DelBaugh et al. Transfusion. 2025 May.

Abstract

Background: Rho(D) immune globulin (RhIg) is used to reduce RhD alloimmunization in pregnancy. This study describes potential causes for RhD alloimmunization after the development and implementation of RhIg.

Study design and methods: This retrospective descriptive study investigated RhD-negative patients born in 1965-2005 with anti-D newly identified during 2018-2022. Transfusion, pregnancy, intravenous drug abuse, and transplantation were considered potential alloimmunization sources.

Results: There were 1200 study patients (852 females; 348 males) at 30 institutions in 5 countries (USA, Canada, UK, New Zealand, Brazil). Most patients had a single potential source of alloimmunization identified (857/1200, 71%), most commonly pregnancy among females (537/852, 63%) and transfusion among males (180/348, 52%). When multiple potential sources were included, males were more likely than females to have a history of transfusion (235/348 [68%] vs. 149/852 [17%], p < .0001) and confirmed or suspected intravenous drug abuse (100/348 [29%] vs. 138/852 [16%], p < .0001). Among females with a history of pregnancy, 119/718 (17%) had healthcare access issues, 120/718 (17%) had pregnancy in a country where they may not have received RhIg, and 21/718 (3%) refused RhIg. Among patients with a history of transfusion, males were more likely than females to have received RhD-positive red blood cells or whole blood (143/235 [61%] vs. 30/149 [20%], p < .0001) and/or platelets (84/235 [36%] vs. 19/149 [13%], p < .0001).

Discussion: Pregnancy was the most frequently identified potential source of RhD alloimmunization among females. Transfusion was most frequent in males. Intravenous drug abuse as a common potential source among patients with RhD alloimmunization merits further study.

Keywords: Rho(D) immune globulin (RhIg); alloimmunization; anti‐D; intravenous drug abuse; pregnancy; transfusion; transplant.

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References

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