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The page below is a sample from the LabCE course Overview Of Major Antigens of the Rh Blood Group System. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Special Considerations for Chronically or Multiply Transfused Patients

Given the immunogenicity and complexity of the Rh system antigens, individuals who are chronically or multiply transfused present significant issues in providing compatible blood. The prevalence of Rh alleles that encode altered or variant D, C, and e antigens in African ethnic groups often underlies the complex Rh alloantibody specificities seen in sickle cell disease (SCD) patients, for example. Owing to the need for chronic transfusion, 25-30% of these patients develop red cell alloantibodies. To proactively address this concern, many treatment centers determine the Rh and Kell phenotype of such patients during initial diagnosis and pre-transfusion testing. Red cell products that are antigen-matched for D, C, E, and K are provided as a means of preventing the most frequently encountered alloantibodies. Some programs also attempt to provide red cells from donors of African ancestry whenever possible in order to provide phenotypes that are more likely to be similar to that of the sickle cell patient. Although there is no consensus, programs that have implemented such protocols have been successful in reducing the incidence of alloantibody production.