Rh five-antigen-matched transfusions associated with lower alloimmunization in patients needing repeated RBC transfusions

BackgroundRed blood cell (RBC) alloimmunization remains a significant challenge in patients requiring repeated transfusions, complicating transfusion procedures and increasing healthcare resource utilization. While extended Rh antigen matching has been proposed to mitigate alloimmunization, prospective data on its impact on transfusion-related outcomes and clinical management remain limited.MethodsIn this prospective, randomized controlled study, patients requiring multiple RBC transfusions were randomly assigned to receive either conventional antigen matching or Rh five-antigen (D, C, c, E, e)–matched transfusions. The primary endpoint was the incidence of RBC alloantibody formation. Secondary endpoints included transfusion-related adverse reactions, as well as transfusion management outcomes such as RBC utilization, transfusion intervals, and length of hospital stay. Multivariable analyses were performed to adjust for potential confounders.ResultsPatients in the Rh five-antigen–matched group demonstrated a significantly lower incidence of alloantibody formation and fewer transfusion-related adverse reactions compared to the conventional matching group. Additionally, Rh five-antigen matching was associated with reduced RBC utilization, longer transfusion intervals, and shorter hospital stays. After adjusting for relevant clinical variables, Rh five-antigen–matched transfusion remained independently associated with lower RBC utilization.ConclusionIn patients requiring repeated RBC transfusions, Rh five-antigen–matched transfusion was associated with a reduced risk of alloantibody formation and more favorable transfusion management outcomes. This strategy represents a viable transfusion management approach for patients at high immunological risk, and its long-term clinical value and cost-effectiveness should be further explored in multicenter studies.