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Kelly S. Logistics, risks, and benefits of automated red blood cell exchange for patients with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:646-652. [PMID: 38066846 PMCID: PMC10905321 DOI: 10.1182/hematology.2023000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Red blood cell (RBC) transfusions treat and prevent severe complications of sickle cell disease (SCD) and can be delivered as a simple or exchange transfusion. During an exchange, some of the patient's abnormal hemoglobin (Hb) S (HbS) RBCs are removed. An apheresis device can accomplish an automated RBC exchange, simultaneously removing patient's RBCs while returning other blood components along with normal RBCs. Automated RBC exchange is therefore an isovolemic transfusion that can efficiently decrease HbS RBCs while limiting iron loading and hyperviscosity. However, specialized equipment, trained personnel, appropriate vascular access, and increased RBC exposure are required compared to simple or manual RBC exchange. Therefore, risks and benefits must be balanced to make individualized decisions for patients with SCD who require transfusion.
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Affiliation(s)
- Shannon Kelly
- UCSF Benioff Children's Hospital Oakland, Oakland, CA
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2
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Genotyping and the Future of Transfusion in Sickle Cell Disease. Hematol Oncol Clin North Am 2022; 36:1271-1284. [DOI: 10.1016/j.hoc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Covington ML, Cone-Sullivan JK, Andrzejewski C, Lu W, Thomasson RR, O'Brien K, Brunker PAR, Stowell SR. Unmasking delayed hemolytic transfusion reactions in patients with sickle-cell disease: Challenges and opportunities for improvement. Transfusion 2022; 62:1662-1670. [PMID: 35778994 DOI: 10.1111/trf.16967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/30/2022] [Accepted: 05/17/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Mischa L Covington
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jensyn K Cone-Sullivan
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Chester Andrzejewski
- Transfusion Medicine Service, Baystate Medical Center, Baystate Health, Springfield, Massachusetts, USA
| | - Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Reggie R Thomasson
- Department of Pathology and Laboratory Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kerry O'Brien
- Department of Pathology, Beth Israel Deaconess, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia A R Brunker
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean R Stowell
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hendrickson JE. Red blood cell alloimmunization and sickle cell disease: a narrative review on antibody induction. ANNALS OF BLOOD 2020; 5:33. [PMID: 33554044 PMCID: PMC7861514 DOI: 10.21037/aob-2020-scd-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The high prevalence of red blood cell (RBC) alloantibodies in people with sickle cell disease (SCD) cannot be debated. Why people with SCD are so likely to form RBC alloantibodies, however, remains poorly understood. Over the past decade, a better understanding of non-ABO blood group antigen variants has emerged; RH genetic diversity and the role this diversity plays in RBC alloimmunization is discussed elsewhere. Outside of antigen variants, the immune systems of people with SCD are known to be different than those of people without SCD. Some of these differences are due to effects of free heme, whereas others are impacted by hyposplenism. Descriptive studies of differences in white blood cell (WBC) subsets, platelet counts and function, and complement activation between people with SCD and race-matched controls exist. Studies comparing the immune systems of alloimmunized people with SCD to non-alloimmunized people with SCD to race-matched controls without SCD have uncovered differences in T-cell subsets, monocytes, Fcγ receptor polymorphisms, and responses to free heme. Studies in murine models have documented the role that recipient inflammation plays in RBC alloantibody formation, with human studies reporting a similar association. Murine studies have also reported the importance of type 1 interferon (IFNα/β), known to play a pivotal role in autoimmunity, in RBC alloantibody formation. The goal of this manuscript is to review existing data on factors influencing RBC alloantibody induction in people with SCD with a focus on inflammation and other immune system considerations, from the bench to the bedside.
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Affiliation(s)
- Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Chou ST, Alsawas M, Fasano RM, Field JJ, Hendrickson JE, Howard J, Kameka M, Kwiatkowski JL, Pirenne F, Shi PA, Stowell SR, Thein SL, Westhoff CM, Wong TE, Akl EA. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv 2020; 4:327-355. [PMID: 31985807 PMCID: PMC6988392 DOI: 10.1182/bloodadvances.2019001143] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. OBJECTIVE Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. METHODS The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. RESULTS The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. CONCLUSIONS The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.
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Affiliation(s)
- Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Joshua J Field
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine and
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - France Pirenne
- INSERM-U955, Laboratory of Excellence, French Blood Establishment, Créteil, France
| | | | - Sean R Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, New York, NY
| | - Trisha E Wong
- Division of Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, OR; and
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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El Kababi S, Benajiba M, El Khalfi B, Hachim J, Soukri A. Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors. Transfus Clin Biol 2019; 26:240-248. [PMID: 31279519 DOI: 10.1016/j.tracli.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/09/2019] [Indexed: 01/26/2023]
Abstract
Red blood cell alloimmunization is one of the major challenges to regular transfusions in β-thalassemic patients. In Morocco, rare studies have focused on this hemoglobinopathy. OBJECTIVE We aimed to study the prevalence and risk factors of red cell alloimmunization in β-thalassemic patients. PATIENTS AND METHODS Retrospective study during 9 years (2009-2018) was conducted on 160 β-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. RESULTS The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. CONCLUSION This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.
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Affiliation(s)
- S El Kababi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - M Benajiba
- National Blood Transfusion Center, Immuno-hematology, Bab-El-Irfane, rue m'fadel-Cherka, 10000 Rabat, Morocco
| | - B El Khalfi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - J Hachim
- Hematology-Oncology pediatric department, Children's Hospital Abderrahim Harouchi, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Tarik bnou ziad street, 20360 Casablanca, Morocco
| | - A Soukri
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco.
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Fasano RM, Meyer EK, Branscomb J, White MS, Gibson RW, Eckman JR. Impact of Red Blood Cell Antigen Matching on Alloimmunization and Transfusion Complications in Patients with Sickle Cell Disease: A Systematic Review. Transfus Med Rev 2019; 33:12-23. [DOI: 10.1016/j.tmrv.2018.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/25/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023]
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How I safely transfuse patients with sickle-cell disease and manage delayed hemolytic transfusion reactions. Blood 2018; 131:2773-2781. [PMID: 29724898 DOI: 10.1182/blood-2018-02-785964] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Transfusions can be a life-saving treatment of patients with sickle-cell disease (SCD). However, availability of matched units can be limiting because of distinctive blood group polymorphisms in patients of African descent. Development of antibodies against the transfused red blood cells (RBCs), resulting in delayed hemolytic transfusion reactions (DHTRs), can be life-threatening and pose unique challenges for this population with regard to treatment strategies and transfusion management protocols. In cases where the transfused cells and the patient's own RBCs are destroyed, diagnosis of DHTR can be difficult because symptoms may mimic vaso-occlusive crisis, and frequently, antibodies are undetectable. Guidelines are needed for early diagnosis of DHTR because treatment may need to include temporarily withholding any new transfusions to avoid further hemolysis. Also needed are case-control studies to optimally tailor treatments based on the severity of DHTR and develop preventive transfusion strategies for patients at DHTR risk. Here, we will review gaps in knowledge and describe through case studies our recommended approach to prevent alloimmunization and to diagnose and treat symptomatic DHTRs for which complementary mechanistic studies to understand their pathogenesis are sorely needed.
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Dedeken L, Lê PQ, Rozen L, El Kenz H, Huybrechts S, Devalck C, Diallo S, Heijmans C, Ferster A. Automated RBC exchange compared to manual exchange transfusion for children with sickle cell disease is cost-effective and reduces iron overload. Transfusion 2018; 58:1356-1362. [PMID: 29574950 DOI: 10.1111/trf.14575] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic transfusion in sickle cell disease (SCD) remains the gold standard therapy for stroke prevention and for patients with severe disease despite adequate hydroxyurea treatment. The aim of our study was to assess the safety and efficacy of automated red blood cell exchange (aRBX) in patients with SCD previously treated with manual exchange transfusion (MET). Costs related to transfusion and chelation overtime were evaluated. STUDY DESIGN AND METHODS Beginning in January 2012, children with SCD who weighed 30 kg or more on MET could switch to aRBX. Clinical, biological, and procedures' data, including costs, were recorded for the last 6 months on MET and compared to those after the first and the second year on aRBX. RESULTS Ten patients switched from MET to aRBX at a median age of 11.8 years. After the switch, median hemoglobin S (HbS) increased significantly (33.5% on MET compared to 45% on aRBX; p < 0.001) but remained in the target values for all patients. Median ferritin decreased significantly (663.3 µg/L on MET compared to 126.8 µg/L on aRBX; p < 0.001) and intervals between procedures were significantly longer. The requirements of red blood cells (RBCs)/kg/year were not different on MET (0.88 unit/kg/year) than during the second year on aRBX (1.07 unit/kg/year; p = NS). MET costs were similar compared to aRBX since chelation was stopped in previously treated patients. CONCLUSION Erythrocytapheresis reduces iron overload and allows a longer interval between procedures without a higher RBC requirement from the second year on aRBX. The cost did not increase as estimated in our Belgian Health Care System.
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Affiliation(s)
- Laurence Dedeken
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Phu Quoc Lê
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Rozen
- Laboratory of Hematology, CHU-Brugmann and Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Hanane El Kenz
- Department of Transfusion, Blood Bank, CHU-Brugmann and Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Huybrechts
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Devalck
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Safiatou Diallo
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Heijmans
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Alina Ferster
- Department of Hematology Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
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Gehrie EA, Ness PM, Bloch EM, Kacker S, Tobian AAR. Medical and economic implications of strategies to prevent alloimmunization in sickle cell disease. Transfusion 2017; 57:2267-2276. [PMID: 28653325 PMCID: PMC5695925 DOI: 10.1111/trf.14212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/13/2017] [Accepted: 05/15/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pathogenesis of alloimmunization is not well understood, and initiatives that aim to reduce the incidence of alloimmunization are generally expensive and either ineffective or unproven. In this review, we summarize the current medical literature regarding alloimmunization in the sickle cell disease (SCD) population, with a special focus on the financial implications of different approaches to prevent alloimmunization. STUDY DESIGN AND METHODS A review of EMBASE and MEDLINE data from January 2006 through January 2016 was conducted to identify articles relating to complications of SCD. The search was specifically designed to capture articles that evaluated the costs of various strategies to prevent alloimmunization and its sequelae. RESULTS Currently, there is no proven, inexpensive way to prevent alloimmunization among individuals with SCD. Serologic matching programs are not uniformly successful in preventing alloimmunization, particularly to Rh antigens, because of the high frequency of variant Rh alleles in the SCD population. A genotypic matching program could offer some cost savings compared to a serologic matching program, but the efficacy of gene matching for the prevention of alloimmunization is largely unproven, and large-scale implementation could be expensive. CONCLUSIONS Future reductions in the costs associated with genotype matching could make a large-scale program economically feasible. Novel techniques to identify patients at highest risk for alloimmunization could improve the cost effectiveness of antigen matching programs. A clinical trial comparing the efficacy of serologic matching to genotype matching would be informative.
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Affiliation(s)
- Eric A Gehrie
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Seema Kacker
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
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The role of molecular typing and perfect match transfusion in sickle cell disease and thalassaemia: An innovative transfusion strategy. Transfus Apher Sci 2017; 56:234-237. [PMID: 28185828 DOI: 10.1016/j.transci.2017.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 11/23/2022]
Abstract
Chronic red blood cell transfusions remain an essential part of supportive treatment in patients with thalassaemia and sickle cell disease (SCD). Red blood cell (RBC) transfusions expose patients to the risk of developing antibodies: RBC alloimmunization occurs when the immune system meets foreign antigens. We created a register of extensively genotyped donors to achieve a better matched transfusion in order to reduce transfusion alloimmunization. Extended RBC antigen typing was determined and confirmed by molecular biology techniques using Human Erythrocyte Antigen (HEA) BeadChip (BioArray Solutions Ltd., Warren, NJ) in periodic blood donors and in patients with thalassaemia and SCD. During 3 years, we typed extensively 1220 periodic blood donors, 898 male and 322 female. We also studied 10 hematologic patients affected by thalassaemia and sickle cell disease referred to our institution as candidate to periodic transfusions. Our patients (8 females and 2 males with a median age of 48 years, range 24-76 years), extensively typed using molecular techniques and screened for RBC alloantibodies, were transfused with a median of 33.5 RBC units. After three years of molecular typing, the "perfect match" transfusion strategy avoided new alloantibodies development in all studied patients.
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12
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Kelly S, Quirolo K, Marsh A, Neumayr L, Garcia A, Custer B. Erythrocytapheresis for chronic transfusion therapy in sickle cell disease: survey of current practices and review of the literature. Transfusion 2016; 56:2877-2888. [DOI: 10.1111/trf.13800] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Shannon Kelly
- Blood Systems Research Institute; San Francisco California
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Keith Quirolo
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Anne Marsh
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Lynne Neumayr
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Alicia Garcia
- University of California San Francisco Benioff Children's Hospital Oakland; Oakland California
| | - Brian Custer
- Blood Systems Research Institute; San Francisco California
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Abstract
Both adult and pediatric patients with sickle cell disease face a higher risk of stroke than the general population. Given the different underlying pathophysiology predisposing these patients to stroke, providers should be aware of differences in guidelines for stroke management. This paper reviews diagnostic considerations and recommendations during the evaluation and acute management of patients with sickle cell disease presenting with stroke, focusing on recent updates in the literature. Given the high recurrence rate of stroke in these patients, secondary prevention and curative measures will also be reviewed.
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14
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Zheng Y, Maitta RW. Alloimmunisation rates of sickle cell disease patients in the United States differ from those in other geographical regions. Transfus Med 2016; 26:225-30. [DOI: 10.1111/tme.12314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/16/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Y. Zheng
- Department of Pathology/ Division of Transfusion Medicine; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine; Cleveland Ohio USA
| | - R. W. Maitta
- Department of Pathology/ Division of Transfusion Medicine; University Hospitals Case Medical Center, Case Western Reserve University School of Medicine; Cleveland Ohio USA
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15
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Nickel RS, Horan JT, Fasano RM, Meyer E, Josephson CD, Winkler AM, Yee ME, Kean LS, Hendrickson JE. Immunophenotypic parameters and RBC alloimmunization in children with sickle cell disease on chronic transfusion. Am J Hematol 2015; 90:1135-41. [PMID: 26361243 DOI: 10.1002/ajh.24188] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 12/16/2022]
Abstract
Alloimmunization against red blood cell (RBC) antigens is a cause of morbidity and mortality in transfused patients with sickle cell disease (SCD). To investigate distinguishing characteristics of patients who develop RBC alloantibodies after transfusion (responders) versus those who do not (non-responders), a cross-sectional study of 90 children with SCD on chronic RBC transfusion therapy at a single institution was conducted in which 18 immune parameters (including T and B cell subsets) were tested via flow cytometry, and medical records were reviewed. RBC alloimmunization was present in 26/90 (29%) patients, with anti-E, K, and C among the most commonly detected alloantibodies despite prophylactic matching for these antigens at the study institution. In addition, RBC autoantibodies had been detected in 18/26 (69%) of alloimmunized versus 7/64 (11%) of non-alloimmunized patients (P < 0.0001). Alloimmunized patients were significantly older (median 13.0 years vs. 10.7 years, P = 0.010) and had more RBC unit exposures (median 148 U vs. 82 U, P = 0.020) than non-alloimmunized patients. Sex, age at initiation of chronic transfusion, splenectomy, stroke, and transfusion outside of the study institution were not significantly associated with RBC alloimmunization. Alloimmunized patients had a significantly increased percentage of CD4+ T memory cells compared to non-alloimmunized patients (57% vs. 49%, P = 0.0047), with no other significant differences in immune cell subsets or laboratory values detected between these groups. Additional research of RBC alloimmunization is needed to optimize transfusion therapy and to develop strategies to prevent alloimmunization.
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Affiliation(s)
- Robert S. Nickel
- Division of Hematology; Children's National Health System; Washington District of Columbia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - John T. Horan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
| | - Ross M. Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Erin Meyer
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Cassandra D. Josephson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Anne M. Winkler
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine; Emory University; Atlanta Georgia
| | - Marianne E.M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
| | - Leslie S. Kean
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Department of Pediatrics, University of Washington, and the Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Jeanne E. Hendrickson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University; Atlanta Georgia
- Department of Laboratory Medicine; Yale University; New Haven Connecticut
- Department of Pediatrics; Yale University; New Haven Connecticut
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Svensson AM, Delaney M. Considerations of red blood cell molecular testing in transfusion medicine. Expert Rev Mol Diagn 2015; 15:1455-64. [PMID: 26367503 DOI: 10.1586/14737159.2015.1086646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The field of transfusion medicine is on the threshold of a paradigm shift, as the technology for genotyping of red blood cell antigens, including US FDA-approved arrays, is now moving into standard practice. Access to cost-efficient, high-resolution genotyping has the potential to increase the quality of care by decreasing the risk for alloimmunization and incompatible transfusions in individuals on long-term blood transfusion protocols, including patient groups with hemoglobinopathies and other chronic diseases. Current and future applications of molecular methods in transfusion medicine and blood banking are discussed, with emphasis on indications for genotyping in various clinical scenarios. Furthermore, limitations of the current gold standard methodology and serology, as well as of contemporary molecular methodology, are examined.
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Affiliation(s)
- Annika M Svensson
- a 1 Department of Pathology, School of Medicine, University of Colorado , Denver, USA.,b 2 Department of Pathology and Laboratory Medicine, Children's Hospital Colorado , Colorado, USA
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Delaney M, Harris S, Haile A, Johnsen J, Teramura G, Nelson K. Red blood cell antigen genotype analysis for 9087 Asian, Asian American, and Native American blood donors. Transfusion 2015; 55:2369-75. [DOI: 10.1111/trf.13163] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Meghan Delaney
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
- Department of Laboratory Medicine; University of Washington
| | - Samantha Harris
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
| | - Askale Haile
- Red Cell Reference Laboratory; Puget Sound Blood Center
| | - Jill Johnsen
- Department of Medicine; Division of Hematology; University of Washington
- Puget Sound Blood Center Research Institute; Seattle Washington
| | - Gayle Teramura
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
| | - Karen Nelson
- Specialty Diagnostics; Red Cell Genomics Laboratory; Puget Sound Blood Center
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19
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Michot JM, Driss F, Guitton C, Moh Klaren J, Lefebvre F, Chamillard X, Gallon P, Fourn E, Pela AM, Tertian G, Le Bras P, Chantalat-Auger C, Delfraissy JF, Goujard C, Lambotte O. Immunohematologic tolerance of chronic transfusion exchanges with erythrocytapheresis in sickle cell disease. Transfusion 2014; 55:357-63. [DOI: 10.1111/trf.12875] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/07/2014] [Accepted: 07/09/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Jean-Marie Michot
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
- Université Paris Sud 11; Le Kremlin-Bicêtre France
| | - Françoise Driss
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Corinne Guitton
- Service de Pédiatrie Générale; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Julia Moh Klaren
- Etablissement Français du Sang; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - François Lefebvre
- Service de Biostatistique et de Mathématiques Appliquées à la Médecine; Université de Strasbourg; Strasbourg France
| | - Xavier Chamillard
- Etablissement Français du Sang; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Philippe Gallon
- Etablissement Français du Sang; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Erwan Fourn
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Alain M. Pela
- Etablissement Français du Sang; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Gérard Tertian
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
- Université Paris Sud 11; Le Kremlin-Bicêtre France
| | - Philippe Le Bras
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Christelle Chantalat-Auger
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
| | - Jean-François Delfraissy
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
- Université Paris Sud 11; Le Kremlin-Bicêtre France
| | - Cécile Goujard
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
- Université Paris Sud 11; Le Kremlin-Bicêtre France
| | - Olivier Lambotte
- Service de Médecine Interne et Immunologie Clinique; Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Bicêtre; Le Kremlin-Bicêtre France
- Université Paris Sud 11; Le Kremlin-Bicêtre France
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Sipurzynski-Budrass S, Sovinz P, Lanzer G, Schallmoser K. Therapeutic red blood cell exchange in a child with sickle cell anaemia using the Spectra Optia®apheresis system. Transfus Med 2014; 24:184-6. [DOI: 10.1111/tme.12114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 01/31/2014] [Accepted: 02/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - P. Sovinz
- Division of Paediatric Haematology/Oncology, Department of Paediatrics and Adolescent Medicine; Medical University of Graz; Graz Austria
| | - G. Lanzer
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Graz
| | - K. Schallmoser
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Graz
- Department of Blood Group Serology and Transfusion Medicine; Paracelsus Medical University Hospital; Salzburg Austria
- Spinal Cord Injury & Tissue Regeneration Center Salzburg (SCI-TReCS); Paracelsus Medical University; Salzburg Austria
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21
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O'Suoji C, Liem RI, Mack AK, Kingsberry P, Ramsey G, Thompson AA. Alloimmunization in sickle cell anemia in the era of extended red cell typing. Pediatr Blood Cancer 2013; 60:1487-91. [PMID: 23508932 DOI: 10.1002/pbc.24530] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/31/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion remains an essential part of the management of patients with sickle cell disease (SCD). Alloimmunization is a major complication of transfusions. Extended RBC typing is advocated as a means to reduce alloimmunization in SCD. Our goal was to assess alloimmunization among individuals with SCD at our center since implementing extended RBC typing. MATERIALS AND METHODS We reviewed electronic medical records of all patients with SCD (N = 641) in our comprehensive SCD Program to determine transfusion histories. Cross-referencing with our blood bank database, we extracted data such as antibodies identified, detection date and genotyping in specific cases. Transfusion sources were determined for those with C, E, and Kell antibodies. RESULTS Of 180 patients transfused from 2002 to 2011, 26 developed at least one new antibody. The majority of alloimmunized patients (14/26) received episodic transfusions only. The most common antibodies formed were against C and E antigens. Of the 16 patients who developed C, E, Kell antibodies, nine had one or more documented transfusions at an outside hospital. Five patients had Rh variants undetectable on routine phenotyping including two novel e alleles related to ceAR and ce(S)(733G). CONCLUSION Despite extended RBC typing, alloimmunization may still occur due to RBC variants that are not detected on routine screening and transfusions at institutions where extended RBC typing is not done. Extended RBC typing should be the standard of care for patients with SCD. Prospective genotyping may reduce allosensitization to rare variants not detected on routine screening.
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Affiliation(s)
- Chibuzo O'Suoji
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood 2013; 122:1062-71. [DOI: 10.1182/blood-2013-03-490623] [Citation(s) in RCA: 331] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Key Points
Rh serologic phenotype–matched transfusions from minority donors do not prevent all Rh alloimmunization in patients with SCD. Variant RH genes are common in patients with SCD and contribute to Rh alloimmunization and transfusion reactions.
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Red blood cell microparticles and blood group antigens: an analysis by flow cytometry. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10 Suppl 2:s39-45. [PMID: 22890266 DOI: 10.2450/2012.007s] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The storage of blood induces the formation of erythrocytes-derived microparticles. Their pathogenic role in blood transfusion is not known so far, especially the risk to trigger alloantibody production in the recipient. This work aims to study the expression of clinically significant blood group antigens on the surface of red blood cells microparticles. MATERIAL AND METHODS Red blood cells contained in erythrocyte concentrates were stained with specific antibodies directed against blood group antigens and routinely used in immunohematology practice. After inducing erythrocytes vesiculation with calcium ionophore, the presence of blood group antigens was analysed by flow cytometry. RESULTS The expression of several blood group antigens from the RH, KEL, JK, FY, MNS, LE and LU systems was detected on erythrocyte microparticles. The presence of M (MNS1), N (MNS2) and s (MNS4) antigens could not be demonstrated by flow cytometry, despite that glycophorin A and B were identified on microparticles using anti-CD235a and anti-MNS3. DISCUSSION We conclude that blood group antigens are localized on erythrocytes-derived microparticles and probably keep their immunogenicity because of their capacity to bind specific antibody. Selective segregation process during vesiculation or their ability to elicit an immune response in vivo has to be tested by further studies.
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Ben Amor I, Louati N, Khemekhem H, Dhieb A, Rekik H, Mdhaffar M, Gargouri J. [Red blood cell immunization in haemoglobinopathie: about 84 cases]. Transfus Clin Biol 2012; 19:345-52. [PMID: 23103424 DOI: 10.1016/j.tracli.2012.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/16/2012] [Indexed: 11/26/2022]
Abstract
AIMS To estimate the rate of red cell immunization in hemoglobinopathies. PATIENTS AND METHODS Prospective study (1990-2009) about 84 patients: 44 homozygous sickle cell anemia, one heterozygous sickle cell anemia S/C, 30 thalassemia and nine sickle cell anemia-thalassemia. The mean age was 10.13 years (extremes: 1-45). The red cell units transfused were ABORH1 compatible, then RH-KELL phenotyped after 2006 and phenocompatible after alloimmunisation. The cross-match was realized using indirect antiglobuline test. Irregular red cell antibody screening was realized before every transfusional episode and the direct antiglobuline test was done when there was a poor transfusional efficiency. RESULTS The number of red blood cells units transfused was 3545 (42.2/patient). The number of red cell antibody screening and the number of direct antiglobulin test were respectively 1474 (17.5/patient) and 272 (3.2/patient). Twenty-seven antibodies were identified (32.1%): 14 alloantibodies (16.6%, 16.6% in sickle cell disease, 16.6% in thalassemia, P=1), 16 antoantibodies (19.04%, 11.1% in sickle cell disease, 33.3% in thalassemia, P=0.018). There were three cases of association of allo- and autoantibodies. The most frequent alloantibodies were anti-RH3 and anti-KEL1 and were developed after transfusion of standard red cell units. There was no significant relation, neither between sex and risk of immunization, nor between the number of red cell units transfused and alloimmunization. On the other hand, there was a significant relation between autoimmunization and the number of red cell units transfused in thalassemia (P<0.001). CONCLUSION This study proves the interest of using RH-KELL red cell units compatible in patients with hemoglobinopathies in order to reduce alloimmunisation rates.
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Affiliation(s)
- I Ben Amor
- Centre régional de transfusion sanguine de Sfax, angle Magida-Boulila, Sfax, Tunisie.
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25
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Chou ST, Liem RI, Thompson AA. Challenges of alloimmunization in patients with haemoglobinopathies. Br J Haematol 2012; 159:394-404. [PMID: 23034087 DOI: 10.1111/bjh.12061] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Red blood cell (RBC) transfusions can be life-sustaining in chronic inherited anaemias, such as thalassaemia, and the indications for blood transfusions in patients with sickle cell disease continue to expand. Complications of transfusions, such as allosensitization, can create significant medical challenges in the management of patients with haemoglobinopathies. This review summarizes key findings from the medical literature related to alloimmunization in haemoglobinopathies and examines potential measures to mitigate these risks. Areas where future studies are needed are also addressed.
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Affiliation(s)
- Stella T Chou
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Wahl SK, Garcia A, Hagar W, Gildengorin G, Quirolo K, Vichinsky E. Lower alloimmunization rates in pediatric sickle cell patients on chronic erythrocytapheresis compared to chronic simple transfusions. Transfusion 2012; 52:2671-6. [DOI: 10.1111/j.1537-2995.2012.03659.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Pinto PCA, Braga JAP, Santos AMND. Risk factors for alloimmunization in patients with sickle cell anemia. Rev Assoc Med Bras (1992) 2012; 57:668-73. [PMID: 22249547 DOI: 10.1590/s0104-42302011000600014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 09/06/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine erythrocyte phenotyping in blood donors and patients with sickle cell anemia (SS) treated at Hemocentro of Alagoas and describe the frequency and factors associated with erythrocyte alloimmunization. METHODS Cross-sectional study with 102 SS patients and 100 blood donors. The following tests were performed: erythrocyte phenotyping, Direct and Indirect antiglobulin test, and detection of irregular antibodies by panel of phenotyped red blood cells. Data were compared by Mann-Whitney, chi-square or Fisher's exact tests. Factors associated with alloimmunization were studied by univariate and multiple logistic regression analysis. RESULTS The most frequent antigens found in patients and blood donors were: c, e, M, s, JK(a). Significant differences were observed between the frequency of the phenotype of patients and donors in regard to antigens s, FY(a) and JK(b). Of 79 transfused patients, 10 presented positive Indirect Coombs. Thirteen alloantibodies were found, 7 of the Rh system, 2 of Kell and 4 were not identified. Factors associated with alloimmunization were the period of time between the last transfusion and the date of the test and more than 10 red blood cell transfusions. Patients who received more than 10 transfusions were 16.39 (95% CI: 2.23-120.59) times more likely to be alloimmunized than patients with fewer transfusions. CONCLUSION The prevalence of alloimmunization in SS patients was 12.7%, with 70% of antibodies belonging to the Rh and Kell systems. This study shows the importance of performing erythrocyte phenotyping in blood donors and receptors to decrease the risk of alloimmunization.
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Wilkinson K, Harris S, Gaur P, Haile A, Armour R, Teramura G, Delaney M. Molecular blood typing augments serologic testing and allows for enhanced matching of red blood cells for transfusion in patients with sickle cell disease. Transfusion 2011; 52:381-8. [PMID: 21827505 DOI: 10.1111/j.1537-2995.2011.03288.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katie Wilkinson
- Puget Sound Institute of Pathology and Puget Sound Blood Center, Seattle, Washington 98104, USA
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Allogeneic hematopoietic stem cell transplantation for sickle cell disease: the time is now. Blood 2011; 118:1197-207. [PMID: 21628400 DOI: 10.1182/blood-2011-01-332510] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although sickle cell disease (SCD) has a variable clinical course, many patients develop end-organ complications that are associated with significant morbidity and early mortality. Myeloablative allogeneic HSCT (allo-HSCT) is curative but has been historically performed only in children younger than 16 years of age. Modest modifications in the conditioning regimen and supportive care have improved outcome such that the majority of children with a suitable HLA-matched sibling donor can expect a cure from this approach. However, adult patients have been excluded from myeloablative allo-HSCT because of anticipated excess toxicity resulting from accumulated disease burden. Efforts to use nonmyeloablative transplantation strategies in adults logically followed but were initially met with largely disappointing results. Recent results, however, indicate that nonmyeloablative allo-HSCT in adult patients with SCD allows for stable mixed hematopoietic chimerism with associated full-donor erythroid engraftment and normalization of blood counts, and persistence in some without continued immunosuppression suggests immunologic tolerance. The attainment of tolerance should allow extension of these potentially curative approaches to alternative donor sources. Efforts to build on these experiences should increase the use of allo-HSCT in patients with SCD while minimizing morbidity and mortality.
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