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Al-Asmari B, Baothman A, Almohammadi M, Aljuaid M, Jastaniah W. Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients With Sickle Cell Disease in Saudi Arabia. J Pediatr Hematol Oncol 2024; 46:e284-e289. [PMID: 38857199 PMCID: PMC11188624 DOI: 10.1097/mph.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/13/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Sickle cell disease (SCD) is a common hereditary hemoglobin disorder worldwide. One of the main treatments for patients with SCD is the requirement for blood transfusions. Posttransfusion alloimmunization with red blood cell (RBC) antigens continues to be a major risk factor for SCD. The objective of this study was to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric patients with SCD in our center and compare our results with published reports from Saudia Arabia SA, regional countries, and some international countries. MATERIALS AND METHODS A retrospective chart review of patients with SCD at King Abdulaziz Medical City-Jeddah, between 2008 and 2019 was performed. Demographic characteristics and transfusion histories were recorded. Blood samples were analyzed for alloimmunization using immunohematologic techniques. RESULTS In total, 121 patients were analyzed. Alloantibodies were detected in 21 patients (17.4%) and were mostly single in 15 patients (71.4%), anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other 6 patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibody levels were significantly higher in patients with frequent hospital admissions (>5 times annually), those who had an exchange blood transfusion, those younger than 3 years old, and those who received a larger number of blood units ( P ≤0.05). CONCLUSION The rate of RBC alloimmunization is determined and considered relatively low compared with that in other nations. Matching for extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fy a , Fy b , Jk a , and Jk b antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion-related complications.
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Affiliation(s)
- Badriah Al-Asmari
- Department of Pediatric Hematology and Oncology, Princess Norah Oncology Center, King Abdul Aziz Medical City-Jeddah (KAMC-J)
| | - Abdullah Baothman
- Department of Pediatric Hematology and Oncology, Princess Norah Oncology Center, King Abdul Aziz Medical City-Jeddah (KAMC-J)
- Department of pediatric, College of Medicine, King Saud Bin Abdul Aziz University for Health Science
| | - Mohammed Almohammadi
- Department of Pathology and Laboratory Medicine, KAMC-J, Saudi Arabia. College of Medicine, KSAU-HS
| | - Mohammed Aljuaid
- Department of Pediatrics—Royal commission hospital, Yanbu, Saudi Arabia
| | - Wasil Jastaniah
- Department of Oncology Center, King Faisal Specialist Hospital and Research Center (Gen.Org.), Jeddah
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2
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Floch A, Viret S, Malard L, Pakdaman S, Jouard A, Habibi A, Galacteros F, François A, Pirenne F. Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion. Blood Adv 2023; 7:7608-7620. [PMID: 37699002 PMCID: PMC10790094 DOI: 10.1182/bloodadvances.2022009328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
ABSTRACT Red blood cell (RBC) transfusion is a major therapy for sickle cell disease (SCD). Patients are at risk of forming antibodies to RBC antigens, which can result in the impossibility to find compatible units and can cause hemolytic transfusion reactions. This retrospective study investigates the evolution of RBC consumption and the frequencies, specificities, and chronology of the appearance of antibodies in a population of patients consistently receiving RH (C, D, E, c, e) and K-matched RBC units (RBCus) from a predominantly European donor population. Over the 11-year period in the Paris area, 6496 patients received transfusion at least once for a total of 239 944 units. Antibodies were made by 1742 patients. The first antibodies of a patient were predictive of subsequent immunization. By the 17th RBCu transfused (by the 20th, excluding warm autoantibodies), 75% of the patients who would make antibodies had made their first. By the 16th, 90% who would make antibodies to a high frequency antigen had made their first antibody to these antigens. Females made their first antibodies slightly earlier than males. Patients who received multiple transfusions (>50 units) had a higher immunization prevalence than those who rarely received transfusion (<12 units) but fewer clinically significant antibodies. Patients with SCD and prophylactic RH-K matching not immunized by the 20th RBCu are likely to have a low alloimmunization risk (to antigens other than RH-K), that is, be low responders, especially relative to the most clinically significant antibodies. This number of 20 units is a point before which close monitoring of patients is most important but remains open to future adjustment.
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Affiliation(s)
- Aline Floch
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Sophie Viret
- Etablissement Français du Sang Ile-de-France, Créteil, France
| | | | - Sadaf Pakdaman
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Alicia Jouard
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Anoosha Habibi
- Referral Center for Sickle Cell Disease, Henri Mondor Hospital, Créteil, France
| | - Frédéric Galacteros
- Referral Center for Sickle Cell Disease, Henri Mondor Hospital, Créteil, France
| | | | - France Pirenne
- Etablissement Français du Sang Ile-de-France, Créteil, France
- INSERM U955, Equipe Transfusion et Maladies du Globule Rouge, Université Paris-Est Creteil, Institut Mondor de Recherche Biomédicale, Créteil, France
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3
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Wallace LR, Thibodeaux SR. Transfusion Support for Patients with Sickle Cell Disease. Transfus Apher Sci 2022; 61:103556. [DOI: 10.1016/j.transci.2022.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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4
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Linder GE, Chou ST. Red cell transfusion and alloimmunization in sickle cell disease. Haematologica 2021; 106:1805-1815. [PMID: 33792218 PMCID: PMC8252926 DOI: 10.3324/haematol.2020.270546] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 01/23/2023] Open
Abstract
Red cell transfusion remains a critical component of care for acute and chronic complications of sickle cell disease. Randomized clinical trials demonstrated the benefits of transfusion therapy for prevention of primary and secondary strokes and postoperative acute chest syndrome. Transfusion for splenic sequestration, acute chest syndrome, and acute stroke are guided by expert consensus recommendations. Despite overall improvements in blood inventory safety, adverse effects of transfusion are prevalent among patients with sickle cell disease and include alloimmunization, acute and delayed hemolytic transfusion reactions, and iron overload. Judicious use of red cell transfusions, optimization of red cell antigen matching, and the use of erythrocytapheresis and iron chelation can minimize adverse effects. Early recognition and management of hemolytic transfusion reactions can avert poor clinical outcomes. In this review, we discuss transfusion methods, indications, and complications in sickle cell disease with an emphasis on alloimmunization.
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Affiliation(s)
- Grace E Linder
- Department of Pathology and Lab Medicine, Children's Hospital of Philadelphia
| | - Stella T Chou
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
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5
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Abstract
Red blood cell (RBC) transfusion is critical in managing acute and chronic complications of sickle cell disease. Alloimmunization and iron overload remain significant complications of transfusion therapy and are minimized with prophylactic Rh and K antigen RBC matching and iron chelation. Matched sibling donor hematopoietic stem cell transplant (HSCT) is a curative therapeutic option. Autologous hematopoietic stem cell (HSC)-based gene therapy has recently shown great promise, for which obtaining sufficient HSCs is essential for success. This article discusses RBC transfusion indications and complications, transfusion support during HSCT, and HSC mobilization and collection for autologous HSCT with gene therapy.
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Affiliation(s)
- Yan Zheng
- Department of Pathology, St. Jude Children's Research Hospital, MS 342, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Abramson Research Center Room 316D, Philadelphia, PA 19010, USA.
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6
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Sharma D, Ogbenna AA, Kassim A, Andrews J. Transfusion support in patients with sickle cell disease. Semin Hematol 2020; 57:39-50. [PMID: 32892842 DOI: 10.1053/j.seminhematol.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 12/23/2022]
Abstract
Blood transfusions are an integral component of the management of acute and chronic complications of sickle cell disease. Red cells can be administered as a simple transfusion, part of a modified exchange procedure involving manual removal of autologous red cells and infusion of donor red cells, and part of an automated red cell exchange procedure using apheresis techniques. Individuals with sickle cell disease are at risk of multiple complications of blood transfusions, including transfusional hemosiderosis, auto- and alloimmunization to minor red cell and human leukocyte antigens, delayed hemolytic transfusion reactions, and hyper-hemolysis. In low- and middle-income countries in sub-Saharan Africa, where a directed donor system is prevalent and limited laboratory methods are in place to perform extended red cell phenotyping, leukodepletion of cellular products, and infectious disease screening, there are additional challenges to providing safe and adequate transfusion support for this patient population. We review current indications for acute and chronic transfusions in sickle cell disease that are derived primarily from randomized controlled trials and observational studies in children living in high-income countries. We will highlight populations with unique transfusion needs, such as pregnant women and children, as well as the role of the transfusion medicine consultative service for individuals with sickle cell disease planning to have curative hematopoietic stem cell transplantation or gene therapy. Finally, we will discuss risk factors for alloimmunization in individuals with sickle cell disease, emerging new strategies to prevent alloimmunization in this population, and critical gaps in the implementation of transfusion guidelines for sickle cell disease in high- and low-income countries.
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Affiliation(s)
- Deva Sharma
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Transfusion Medicine, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ann Abiola Ogbenna
- Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt-Meharry Sickle Cell Center of Excellence, Vanderilt University Medical Center, Nashville, TN, USA.
| | - Jennifer Andrews
- Division of Transfusion Medicine, Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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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: 204] [Impact Index Per Article: 51.0] [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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8
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Raba M. Selecting red blood cell units to perform RBCX in patients with sickle cell disease. Transfus Apher Sci 2019; 58:142-146. [PMID: 30910616 DOI: 10.1016/j.transci.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Red blood cell exchange (RBCX) is a standard option for treating or preventing complications in patients with sickle cell disease (SCD). According to the patient's blood volume, the amounts of red blood cells (RBC) to be exchanged and the practices of the apheresis and clinical teams, such treatment requires numerous red blood cell units (RBCUs) (3-15 RBCUs per procedure). To perform RBCXs safely and prevent the risk of alloimmunization, appropriate RBCUs must be selected and transfused to replace the sickled RBCs. Understanding of alloimmunization in patients with SCD strengthened the development of recommendations for preventing the risk of alloimmunization. This review describes the alloimmunization risk, the methods used to decrease the risk, and our own experience.
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Affiliation(s)
- M Raba
- Delivery and Immunohematology Unit, Etablissement Français du Sang, Centre Hospitalier Lyon Sud, Lyon, France.
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9
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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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10
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Tzounakas VL, Valsami SI, Kriebardis AG, Papassideri IS, Seghatchian J, Antonelou MH. Red cell transfusion in paediatric patients with thalassaemia and sickle cell disease: Current status, challenges and perspectives. Transfus Apher Sci 2018; 57:347-357. [PMID: 29880248 DOI: 10.1016/j.transci.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Notwithstanding the high safety level of the currently available blood for transfusion and the decreasing frequency of transfusion-related complications, administration of labile blood products to paediatric patients still poses unique challenges and considerations. The incidence of thalassaemia and sickle cell disease in the paediatric population may be high enough under specific racial and geographical contexts. Red cell transfusion is the cornerstone of β-thalassaemia treatment and one of the most effective ways to prevent or correct specific acute and chronic complications of sickle cell disease. However, this life-saving strategy comes with its own complications, such as additional iron overload, alloimmunization and haemolytic reactions, among others. In paediatrics, the dependency of the transfusion outcome upon disease and other recipient characteristics is more prominent compared with the adults, owing to differences in developmental maturity and physiology that render them more susceptible to common risks, exacerbate the host response to transfused cells, and modify the type or the clinical severity of the transfusion-related morbidity. The adverse branch of red cell transfusion is likely the overall effect of several factors acting synergistically to shape the clinical phenotype of this therapy, including inherent donor/blood unit variables, like antigenicity, red cell deformability and extracellular vesicles, as well as recipient variables, such as history of alloimmunization and inflammation level at time of transfusion. This review focuses on paediatric patients with β-thalassaemia and sickle cell disease as a recipient group with distinct transfusion-related characteristics, and introduces new concepts for consideration, not adequately studied and elucidated so far.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Serena I Valsami
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Technological and Educational Institute of Athens, Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
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11
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Al-Riyami AZ, Daar S. Transfusion in Haemoglobinopathies: Review and recommendations for local blood banks and transfusion services in Oman. Sultan Qaboos Univ Med J 2018; 18:e3-e12. [PMID: 29666675 DOI: 10.18295/squmj.2018.18.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/06/2017] [Accepted: 01/11/2017] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease and homozygous β-thalassaemia are common haemoglobinopathies in Oman, with many implications for local healthcare services. The transfusions of such patients take place in many hospitals throughout the country. Indications for blood transfusions require local recommendations and guidelines to ensure standardised levels of care. This article summarises existing transfusion guidelines for this group of patients and provides recommendations for blood banks and transfusion services in Oman. This information is especially pertinent to medical professionals and policy-makers developing required services for the standardised transfusion support of these patients.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Shahina Daar
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
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12
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Campbell-Lee SA, Gvozdjan K, Choi KM, Chen YF, Saraf SL, Hsu LL, Gordeuk VR, Strauss RG, Triulzi DJ. Red blood cell alloimmunization in sickle cell disease: assessment of transfusion protocols during two time periods. Transfusion 2018; 58:1588-1596. [PMID: 29570817 DOI: 10.1111/trf.14588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevention of red blood cell (RBC) alloimmunization in patients with sickle cell disease (SCD) focuses on phenotypic RBC matching. We assessed alloimmunization among transfused patients with SCD after implementing leukoreduction and prophylactic antigen matching (PAM). STUDY DESIGN AND METHODS Retrospective review of transfusion and medical records for SCD patients 18 months to 81 years of age was performed covering two 5-year periods: Period 1, no PAM, occasional leukoreduction, and Period 2, consistent leukoreduction and extended PAM (Rh, Kell, S, Fy, Jk) for patients already alloimmunized. Patients transfused in Period 1 were excluded from Period 2. RESULTS A total of 293 patients were transfused in Period 1 and 183 in Period 2. Median time between first sample and last type and screen after transfusion was 2.12 years in Period 1 and 1.03 years in Period 2. Initial alloimmunization prevalence was lower in Period 2 (26.2%) versus Period 1 (37.5%) and after subsequent transfusions in Period 2 (23.8%) versus Period 1 (45.7%), although without significant difference after adjusting for number of units transfused, percentage of leukoreduced RBCs, sex, and age. Alloimmunized patients received more nonleukoreduced RBCs in Period 1 than nonalloimmunized. Patients transfused during inflammatory conditions were not significantly more likely to become alloimmunized. CONCLUSIONS The prevalence of initial and subsequent RBC alloimmunization in Period 2 was lower than that in Period 1; however, overall prevalence remained high. We recommend leukoreduced, hemoglobin S-negative Rh and Kell PAM RBCs for transfusion of patients with SCD. Component and recipient factors affecting alloimmunization should be studied further.
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Affiliation(s)
- Sally A Campbell-Lee
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, IL.,Sickle Cell Center, University of Illinois at Chicago College of Medicine, Chicago, IL.,The Institute for Transfusion Medicine, Chicago, Illinois
| | - Kristina Gvozdjan
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - K Mia Choi
- Department of Pathology, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Santosh L Saraf
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL.,Sickle Cell Center, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago College of Medicine, Chicago, IL.,Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL.,Sickle Cell Center, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Ronald G Strauss
- The Institute for Transfusion Medicine, Chicago, Illinois.,The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Darrell J Triulzi
- The Institute for Transfusion Medicine, Chicago, Illinois.,The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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13
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Otrock ZK, Thibodeaux SR, Jackups R. Vascular access for red blood cell exchange. Transfusion 2018; 58 Suppl 1:569-579. [DOI: 10.1111/trf.14495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Zaher K. Otrock
- Department of Pathology and Laboratory Medicine; Henry Ford Hospital; Detroit Michigan
| | - Suzanne R. Thibodeaux
- Department of Pathology and Immunology; Washington University School of Medicine; St. Louis Missouri
| | - Ronald Jackups
- Department of Pathology and Immunology; Washington University School of Medicine; St. Louis Missouri
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14
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Narbey D, Habibi A, Chadebech P, Mekontso-Dessap A, Khellaf M, Lelièvre JD, Godeau B, Michel M, Galactéros F, Djoudi R, Bartolucci P, Pirenne F. Incidence and predictive score for delayed hemolytic transfusion reaction in adult patients with sickle cell disease. Am J Hematol 2017; 92:1340-1348. [PMID: 28924974 DOI: 10.1002/ajh.24908] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
Abstract
Delayed hemolytic transfusion reaction (DHTR) is a life-threatening complication of transfusion in sickle cell disease (SCD). The frequency of DHTR is underestimated because its symptoms mimic those of vaso-occlusive crisis and antibodies (Abs) are often not detectable. No predictive factors for identifying patients likely to develop DHTR have yet been defined. We conducted a prospective single-center observational study over 30 months in adult sickle cell patients. We included 694 transfusion episodes (TEs) in 311 patients, divided into occasional TEs (OTEs: 360) and chronic transfusion program (CTEs: 334). During follow-up, 15 cases of DHTR were recorded, exclusively after OTEs. DHTR incidence was 4.2% per OTE (95% CI [2.6; 6.9]) and 6.8% per patient during the 30 months of the study (95% CI [4.2; 11.3]). We studied 11 additional DHTR cases, to construct a predictive score for DHTR. The DHTR mortality is high, 3 (11.5%) of the 26 DHTR patients died. The variables retained in the multivariate model were history of DHTR, number of units previously transfused and immunization status before transfusion. The resulting DHTR-predictive score had an area under the ROC curve of 0.850 [95% CI: 0.780-0.930], a negative-predictive value of 98.4% and a positive-predictive value of 50%. We report in our study population, for the first time, the incidence of DHTR, and, its occurrence exclusively in occasionally transfused patients. We also describe a simple score for predicting DHTR in patients undergoing occasional transfusion, to facilitate the management of blood transfusion in SCD patients.
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Affiliation(s)
- David Narbey
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
| | - Anoosha Habibi
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
| | - Philippe Chadebech
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
| | - Armand Mekontso-Dessap
- Intensive Care Unit, Hôpital Henri Mondor; Créteil France
- IMRB, Groupe de recherche clinique CARMAS; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - Mehdi Khellaf
- Université Paris Est Créteil, Faculté de Médecine
- Emergency Unit, Hôpital Henri Mondor; Créteil France
| | - Jean-Daniel Lelièvre
- Université Paris Est Créteil, Faculté de Médecine
- Clinical Immunology Department; Hôpital Henri Mondor; Créteil France
| | - Bertrand Godeau
- Intensive Care Unit, Hôpital Henri Mondor; Créteil France
- Internal Medicine Department; Hôpital Henri Mondor; Créteil France
| | - Marc Michel
- Université Paris Est Créteil, Faculté de Médecine
- Internal Medicine Department; Hôpital Henri Mondor; Créteil France
| | - Frédéric Galactéros
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - Rachid Djoudi
- Etablissement Français du Sang; Créteil 94000 France
| | - Pablo Bartolucci
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - France Pirenne
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Université Paris Est Créteil, Faculté de Médecine
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15
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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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16
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Efficacy and Safety of Manual Partial Red Cell Exchange in the Management of Severe Complications of Sickle Cell Disease in a Developing Country. Adv Hematol 2017; 2017:3518402. [PMID: 28584527 PMCID: PMC5443989 DOI: 10.1155/2017/3518402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/24/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Abstract
Introduction The realization of red cell exchange (RCE) in Africa faces the lack of blood, transfusion safety, and equipment. We evaluated its efficacy and safety in severe complications of sickle cell disease. Patients and Method Manual partial RCE was performed among sickle cell patients who had severe complications. Efficacy was evaluated by clinical evolution, blood count, and electrophoresis of hemoglobin. Safety was evaluated on adverse effects, infections, and alloimmunization. Results We performed 166 partial RCE among 44 patients including 41 homozygous (SS) and 2 heterozygous composites SC and 1 S/β0-thalassemia. The mean age was 27.9 years. The sex ratio was 1.58. The regression of symptoms was complete in 100% of persistent vasoocclusive crisis and acute chest syndrome, 56.7% of intermittent priapism, and 30% of stroke. It was partial in 100% of leg ulcers and null in acute priapism. The mean variations of hemoglobin and hematocrit rate after one procedure were, respectively, +1.4 g/dL and +4.4%. That of hemoglobin S after 2 consecutive RCE was −60%. Neither alloimmunization nor viral seroconversion was observed. Conclusion This work shows the feasibility of manual partial RCE in a low-resource setting and its efficacy and safety during complications of SCD outside of acute priapism.
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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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18
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Solh Z, Athale U, Arnold DM, Cook RJ, Foley R, Heddle NM. Transfusion-related alloimmunization in children: epidemiology and effects of chemotherapy. Vox Sang 2016; 111:299-307. [DOI: 10.1111/vox.12419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Z. Solh
- Department of Pediatrics; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Department of Pathology and Molecular Medicine; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
| | - U. Athale
- Department of Pediatrics; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - D. M. Arnold
- Department of Medicine; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - R. J. Cook
- Department of Statistics and Actuarial Science; University of Waterloo; Waterloo ON Canada
| | - R. Foley
- Department of Pathology and Molecular Medicine; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
| | - N. M. Heddle
- Department of Medicine; Faculty of Health Sciences; McMaster University; Hamilton ON Canada
- Centre for Innovation; Canadian Blood Services; Hamilton ON Canada
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Gogri H, Kulkarni S, Vasantha K, Jadhav S, Ghosh K, Gorakshakar A. Partial matching of blood group antigens to reduce alloimmunization in Western India. Transfus Apher Sci 2016; 54:390-5. [PMID: 27020262 DOI: 10.1016/j.transci.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/01/2016] [Accepted: 02/21/2016] [Indexed: 12/01/2022]
Abstract
Red blood cell alloimmunization occurs due to the genetic disparity of red cell antigens between donor and recipient. In the present study, we report a spectrum of red cell alloantibodies characterized in patients with different clinical conditions in a reference center in India. Majority of the antibodies identified were against the blood group antigens c, D, E, M, N, S, s and Jka. Hence, apart from ABO and RhD, we recommend partial antigen matching between donor and patients for other Rh (C, c, E, e) and MNS blood group antigens to potentially reduce the risk of alloimmunization by 75%. Matching of Kell antigen is not recommended in Western India.
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Affiliation(s)
- Harita Gogri
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Swati Kulkarni
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India.
| | - K Vasantha
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Seema Jadhav
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Kanjaksha Ghosh
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
| | - Ajit Gorakshakar
- National Institute of Immunohaematology, 13th Floor New Multistoreyed Building, K. E. M. Hospital, Parel, Mumbai, Maharashtra 400091, India
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20
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Fasano RM, Leong T, Kaushal M, Sagiv E, Luban NLC, Meier ER. Effectiveness of red blood cell exchange, partial manual exchange, and simple transfusion concurrently with iron chelation therapy in reducing iron overload in chronically transfused sickle cell anemia patients. Transfusion 2016; 56:1707-15. [PMID: 26997031 DOI: 10.1111/trf.13558] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/27/2016] [Accepted: 02/02/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic transfusion therapy (CTT) is indicated for stroke prevention in children with sickle cell anemia (SCA) and is complicated by iron overload and alloimmunization. CTT is performed by simple transfusion (ST), partial manual exchange (PME), or erythrocytapheresis (RCE). Although small case series have demonstrated RCE in combination with iron chelation therapy stabilizes and/or decreases ferritin, there are no reports comparing the effect of ST, PME, and RCE on liver iron concentration (LIC). CTT modality effect on serum ferritin and LIC were compared in SCA patients on iron chelation, with hemoglobin (Hb)S goal of 30%. STUDY DESIGN AND METHODS Medical records of SCA patients on CTT and deferasirox (≥25 mg/kg/day) were retrospectively reviewed. Mean HbS%, change in ferritin and LIC, and alloimmunization rate were determined for each CTT group. RESULTS Twenty-eight patients were included; six crossed over (one from ST to PME, one from ST to PME then to RCE, three from ST to RCE, and one from PME to RCE) to include 36 transfusion modality intervals. Median pretransfusion HbS% levels were 32.7% (ST), 36.2% (PME), and 34.7% (RCE; p = 0.732). Median ferritin changes were +15 (-17 to +45), +38 (+24 to +105), and -91 (-141 to -48) ng/mL/month (p = 0.003), and median LIC changes (available in 22 patient transfusion modality intervals) were +1.3 (-1.6 to +4.3), +2.3 (-6.5 to +8.9), and -5.7 (-10.7 to -0.5) mg/g/year (p = 0.024) in ST, PME, and RCE, respectively. There was no significant difference in alloimmunization rate between ST/PME and RCE groups. CONCLUSION We recommend RCE plus chelation as an effective method for reducing iron overload, while maintaining HbS at 30% to 35%.
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Affiliation(s)
- Ross M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine.,Departments of Hematology and Clinical Pathology, Children's Healthcare of Atlanta
| | - Traci Leong
- Department of Biostatistics and Bioinformatics, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Megha Kaushal
- Department of Hematology/Oncology and the Department of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Eyal Sagiv
- Department of Hematology/Oncology and the Department of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi L C Luban
- Department of Hematology/Oncology and the Department of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.,Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Emily Riehm Meier
- Department of Hematology/Oncology and the Department of Laboratory Medicine, Center for Cancer and Blood Disorders, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.,Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
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21
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Poullin P, Sanderson F, Bernit E, Brun M, Berdah Y, Badens C. Comparative evaluation of the depletion-red cell exchange program with the Spectra Optia and the isovolemic hemodilution-red cell exchange method with the COBE Spectra in sickle cell disease patients. J Clin Apher 2015; 31:429-33. [DOI: 10.1002/jca.21422] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 07/27/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | - Yael Berdah
- CHU La Timone, Laboratoire d'Hématologie; CHU La Conception
| | - Catherine Badens
- Laboratoire de Génétique Moléculaire; CHU La Timone Marseille France
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22
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Karafin MS, Field JJ, Gottschall JL, Denomme GA. Barriers to using molecularly typed minority red blood cell donors in support of chronically transfused adult patients with sickle cell disease. Transfusion 2015; 55:1399-406. [DOI: 10.1111/trf.13037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Jerome L. Gottschall
- Medical Sciences Institute
- Medical College of Wisconsin
- Diagnostic Laboratories; BloodCenter of Wisconsin; Milwaukee Wisconsin
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23
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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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24
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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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25
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Kacker S, Ness PM, Savage WJ, Frick KD, Shirey RS, King KE, Tobian AAR. Economic evaluation of a hypothetical screening assay for alloimmunization risk among transfused patients with sickle cell disease. Transfusion 2014; 54:2034-44. [PMID: 24571485 DOI: 10.1111/trf.12585] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 11/12/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prophylactic antigen-matching can reduce alloimmunization rates among chronically transfused patients with sickle cell disease (SCD), but this matching increases costs and may only benefit 30% of patients. We assessed the clinical and financial value of a potential assay for alloimmunization risk that would allow for targeted antigen-matching. STUDY DESIGN AND METHODS A Markov-based model evaluated direct medical costs and alloimmunization events over 10 to 20 years among transfused (simple or exchange) patients with SCD. Four matching strategies were evaluated: prospective matching (for all patients), history-based matching (only for patients with prior alloimmunization), perfectly informed matching (assay with 100% sensitivity, 100% specificity), and imperfectly informed matching (reduced accuracy). Under all matching protocols, matching included C, E, K, and any additional alloantibodies present. A hospital perspective was adopted, with costs (2012US$) and events discounted (3%). RESULTS Perfectly informed antigen-matching using a $1000 assay is expected to save $82,334 per patient over 10 years, compared to prospective matching. Perfectly informed antigen-matching is more costly than history-based matching, but reduces alloimmunization events by 45.6% over 10 years. Averting each alloimmunization event using this strategy would cost an additional $10,934 per patient. Imperfectly informed antigen-matching using an assay with 75% specificity and 75% sensitivity is less costly than prospective matching, but increases alloimmunization events. Compared to history-based matching, imperfectly informed matching would decrease alloimmunization events by 32.61%, at an additional cost of $147,915 per patient over 10 years. Cost-effectiveness of informed antigen-matching is largely driven by assay specificity. CONCLUSIONS A sufficiently specific assay to inform antigen-matching may be cost-effective in reducing alloimmunization among transfused patients with SCD.
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Affiliation(s)
- Seema Kacker
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
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26
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27
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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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28
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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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29
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Smith-Whitley K, Thompson AA. Indications and complications of transfusions in sickle cell disease. Pediatr Blood Cancer 2012; 59:358-64. [PMID: 22566388 DOI: 10.1002/pbc.24179] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 03/27/2012] [Indexed: 11/08/2022]
Abstract
Red cell transfusion remains an important part of the management of acute and chronic complications in SCD. The ongoing and emerging uses of transfusions in SCD may have significant benefits; however, the potential complications of transfusions also deserve careful consideration. In this report we review current indications for transfusions, transfusion complications, modifications of transfusion practices to mitigate risk, and potential considerations to improve transfusion outcomes.
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Affiliation(s)
- Kim Smith-Whitley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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30
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Luban NL, McBride E, Ford JC, Gupta S. Transfusion medicine problems and solutions for the pediatric hematologist/oncologist. Pediatr Blood Cancer 2012; 58:1106-11. [PMID: 22238206 PMCID: PMC3328596 DOI: 10.1002/pbc.24077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/21/2011] [Indexed: 01/19/2023]
Abstract
Blood component transfusion is an integral part of the care of children with oncologic and hematologic conditions. The complexity of transfusion medicine may however lead to challenges for pediatric hematologists/oncologists. In this review, three commonly encountered areas of transfusion medicine are explored. The approach to the investigation and management of suspected platelet refractoriness is reviewed. The unique transfusion related challenges encountered by children undergoing stem cell transplantation are also discussed. Finally, issues arising out of the care of children with hemoglobinopathies are explored, with an emphasis on the incidence of allo- and autoimmunization.
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Affiliation(s)
- Naomi L.C. Luban
- Division of Laboratory Medicine and Hematology, Children’s National, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Eileen McBride
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Jason C. Ford
- Department of Pathology and Laboratory Medicine, B.C. Children’s Hospital and the University of British Columbia, Vancouver, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
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31
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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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