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Sun Q, Karafin MS, Garrett ME, Li Y, Ashley-Koch A, Telen MJ. A genome-wide association study of alloimmunization in the TOPMed OMG-SCD cohort identifies a locus on chromosome 12. Transfusion 2024. [PMID: 38966903 DOI: 10.1111/trf.17944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Red cell alloimmunization after exposure to donor red cells is a very common complication of transfusion for patients with sickle cell disease (SCD), resulting frequently in accelerated donor red blood cell destruction. Patients show substantial differences in their predisposition to alloimmunization, and genetic variability is one proposed component. Although several genetic association studies have been conducted for alloimmunization, the results have been inconsistent, and the genetic determinants of alloimmunization remain largely unknown. STUDY DESIGN AND METHODS We performed a genome-wide association study (GWAS) in 236 African American (AA) SCD patients from the Outcome Modifying Genes in Sickle Cell Disease (OMG-SCD) cohort, which is part of Trans-Omics for Precision Medicine (TOPMed), with whole-genome sequencing data available. We also performed sensitivity analyses adjusting for different sets of covariates and applied different sample grouping strategies based on the number of alloantibodies patients developed. RESULTS We identified one genome-wide significant locus on chr12 (p = 3.1e-9) with no evidence of genomic inflation (lambda = 1.003). Further leveraging QTL evidence from GTEx whole blood and/or Jackson Heart Study PBMC RNA-Seq data, we identified a number of potential genes, such as ARHGAP9, STAT6, and ATP23, that may be driving the association signal. We also discovered some suggestive loci using different analysis strategies. DISCUSSION We call for the community to collect additional alloantibody information within SCD cohorts to further the understanding of the genetic basis of alloimmunization in order to improve transfusion outcomes.
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Affiliation(s)
- Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew S Karafin
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, North Carolina, USA
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Kong Y, Xiao J, Tian L, Xu Y. The influence of HLA allele and haplotype on RhE alloimmunization among pregnant females in the Chinese Han population. Vox Sang 2024; 119:737-744. [PMID: 38637118 DOI: 10.1111/vox.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND OBJECTIVES Anti-E alloantibody is the most common and important red blood cell (RBC) alloantibody during pregnancy. The study aimed to determine the correlation between RhE alloimmunization and human leukocyte antigen (HLA) allele polymorphism, as well as haplotype diversity, among pregnant individuals in the Chinese Han population. STUDY DESIGN AND METHODS All individuals included in our study were RhE-negative pregnant women of Chinese Han ethnicity, confirmed through serological testing. Pregnancy could be the only potential stimulating factor in RBC alloimmunization. Given the serological testing, the participants were divided into anti-E (responders) and non-anti-E-producing group (non-responders). The class I and II classical HLA genotyping were determined using next-generation sequencing, and the HLA genotype and haplotype frequencies were compared between the responders and non-responders. RESULTS In total, 76 responders and 94 non-responders were enrolled in this study. Comparison results showed that all HLA class I alleles had no difference between the two groups. For HLA class II phenotypes, responders had higher frequencies of HLA-DRB1*09:01, HLA-DQA1*03:02 and HLA-DQB1*03:03 phenotypes than non-responders, and the differences were statistically significant (pc < 0.05). In addition, the haplotype frequency of HLA-DRB1*09:01-DQA1*03:02-DQB1*03:03 in the RhE responders was significantly higher than in the non-responders (31.58% vs. 12.77%; odds ratio, 3.154; 95% confidence interval, 1.823-5.456; pc value, 1.25 × 10-3). CONCLUSION Our findings indicated that HLA-DRB1*09:01, HLA-DQA1*03:02 and HLA-DQB1*03:03 might be susceptible alleles for RhE alloimmunization among Chinese Han pregnant females. These three susceptible alleles constituted the unique three-locus haplotype in the RhE responders and collaborated to RhE alloimmunization.
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Affiliation(s)
- Yujie Kong
- Department of Laboratory, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Jie Xiao
- Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, People's Republic of China
- The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Li Tian
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, People's Republic of China
- Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan Province, People's Republic of China
| | - Ying Xu
- Department of Laboratory, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
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Milosavić M, Lilić M, Andrić Z. Impact of human leucocyte antigen class II polymorphism on anti-red blood cell antibody development: Correlations and indications. Vox Sang 2024; 119:720-727. [PMID: 38596887 DOI: 10.1111/vox.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
BACKROUND AND OBJECTIVES Blood transfusion therapy is vital for many patient groups. They can cause many complications, and the development of anti-red blood cell (RBC) antibodies is of significant importance. Molecules of class II human leucocyte antigens (HLA) are one of the several factors that influence antibody development in patients. MATERIALS AND METHODS In this study, we investigated 108 patients who developed antibodies against different erythrocyte antigens and 115 patients on multiple transfusion therapies who did not develop anti-RBC antibodies. The HLA loci HLA-DRB1 and HLA-DQB1 were typed using commercial molecular assays routinely used in HLA laboratories. RESULTS An increased frequency of the HLA-DRB1*04 allele group was observed in patients who developed antibodies. Additionally, HLA-DRB1*09 was also significant for anti-E development and in patients with multi-specific alloimmunization. It was found that the HLA-DRB1*07 allele group is associated with antibodies to antigents of the Rh and MNS systems but also lacks an association with anti-K development. The HLA-DRB1*11 and -DRB1*01 allele groups displayed a protective mechanism for anti-E development, similar to that of HLA-DQB1*02 for anti-K. CONCLUSION There is an association between various HLA class II alleles and anti-RBC development.
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Affiliation(s)
- Milanka Milosavić
- Laboratory for Molecular Immunohematology, Institute for Transfusion Medicine of Republika Srpska, Banja Luka, Bosnia and Herzegovina
| | - Marko Lilić
- Department of Biology, University of Osijek, Osijek, Croatia
| | - Zorana Andrić
- Tissue Typing Department, Blood Transfusion Institute of Serbia, Belgrade, Serbia
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'Adani SN, Mohd Ashari NS, Johan MF, Edinur HA, Mohd Noor NH, Hassan MN. Red Blood Cell Alloimmunization in Pregnancy: A Review of the Pathophysiology, Prevalence, and Risk Factors. Cureus 2024; 16:e60158. [PMID: 38868295 PMCID: PMC11167514 DOI: 10.7759/cureus.60158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/14/2024] Open
Abstract
This review paper provides an overview of the risk factors and laboratory testing for red blood cell (RBC) alloimmunization in pregnancy. RBC alloimmunization is a significant medical issue that can cause haemolytic disease of the fetus and newborn (HDFN), leading to neonatal morbidity and mortality. Current HDFN prophylaxis targets only Rhesus D (RhD) alloimmunization, with no effective measures to prevent alloimmunization to other RBC antigen groups. Several factors can increase the risk of developing RBC alloimmunization during pregnancy, including fetomaternal haemorrhage, RBC and maternal genetic status, and previous transfusions. Identifying these risk factors is essential to execute the appropriate management strategies to minimize the risk of HDFN. The review also discusses the laboratory methods and overview of pregnancy management. The paper highlights the importance of identifying and managing the risk factors for RBC alloimmunization in pregnancy to minimize the risk of HDFN and improve neonatal outcomes.
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Affiliation(s)
- Sanusi Nurul 'Adani
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Muhammad Farid Johan
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Hisham Atan Edinur
- Forensic Programme, School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Mohd Nazri Hassan
- Hematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
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Kirkham JK, Estepp JH, Weiss MJ, Rashkin SR. Genetic Variation and Sickle Cell Disease Severity: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337484. [PMID: 37851445 PMCID: PMC10585422 DOI: 10.1001/jamanetworkopen.2023.37484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023] Open
Abstract
Importance Sickle cell disease (SCD) is a monogenic disorder, yet clinical outcomes are influenced by additional genetic factors. Despite decades of research, the genetics of SCD remain poorly understood. Objective To assess all reported genetic modifiers of SCD, evaluate the design of associated studies, and provide guidelines for future analyses according to modern genetic study recommendations. Data Sources PubMed, Web of Science, and Scopus were searched through May 16, 2023, identifying 5290 publications. Study Selection At least 2 reviewers identified 571 original, peer-reviewed English-language publications reporting genetic modifiers of human SCD phenotypes, wherein the outcome was not treatment response, and the comparison was not between SCD subtypes or including healthy controls. Data Extraction and Synthesis Data relevant to all genetic modifiers of SCD were extracted, evaluated, and presented following STREGA and PRISMA guidelines. Weighted z score meta-analyses and pathway analyses were conducted. Main Outcomes and Measures Outcomes were aggregated into 25 categories, grouped as acute complications, chronic conditions, hematologic parameters or biomarkers, and general or mixed measures of SCD severity. Results The 571 included studies reported on 29 670 unique individuals (50% ≤ 18 years of age) from 43 countries. Of the 17 757 extracted results (4890 significant) in 1552 genes, 3675 results met the study criteria for meta-analysis: reported phenotype and genotype, association size and direction, variability measure, sample size, and statistical test. Only 173 results for 62 associations could be cross-study combined. The remaining associations could not be aggregated because they were only reported once or methods (eg, study design, reporting practice) and genotype or phenotype definitions were insufficiently harmonized. Gene variants regulating fetal hemoglobin and α-thalassemia (important markers for SCD severity) were frequently identified: 19 single-nucleotide variants in BCL11A, HBS1L-MYB, and HBG2 were significantly associated with fetal hemoglobin (absolute value of Z = 4.00 to 20.66; P = 8.63 × 10-95 to 6.19 × 10-5), and α-thalassemia deletions were significantly associated with increased hemoglobin level and reduced risk of albuminuria, abnormal transcranial Doppler velocity, and stroke (absolute value of Z = 3.43 to 5.16; P = 2.42 × 10-7 to 6.00 × 10-4). However, other associations remain unconfirmed. Pathway analyses of significant genes highlighted the importance of cellular adhesion, inflammation, oxidative and toxic stress, and blood vessel regulation in SCD (23 of the top 25 Gene Ontology pathways involve these processes) and suggested future research areas. Conclusions and Relevance The findings of this comprehensive systematic review and meta-analysis of all published genetic modifiers of SCD indicated that implementation of standardized phenotypes, statistical methods, and reporting practices should accelerate discovery and validation of genetic modifiers and development of clinically actionable genetic profiles.
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Affiliation(s)
- Justin K. Kirkham
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeremie H. Estepp
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
- Now with Agios Pharmaceuticals, Cambridge, Massachusetts
| | - Mitch J. Weiss
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sara R. Rashkin
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Ohto H, Ito S, Srivastava K, Ogiyama Y, Uchikawa M, Nollet KE, Flegel WA. Asian-type DEL (RHD*DEL1) with an allo-anti-D: A paradoxical observation in a healthy multiparous woman. Transfusion 2023; 63:1601-1611. [PMID: 37465939 PMCID: PMC10528739 DOI: 10.1111/trf.17465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian-type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti-D alloimmunization reported before. We investigated the first observation of an anti-D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. METHODS We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. RESULTS The healthy multiparous Japanese woman, a regular blood donor, still had the anti-D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian-type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA-DRB1 and a variant of her HLA-DQB1 alleles had previously been associated with anti-D immunization. CONCLUSION We described an allo-anti-D, maintained for more than three decades, in an Asian-type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti-D immunization. Continued monitoring of anti-D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian-type DEL should be treated as Rh D-positive for transfusion and Rh immune prophylaxis purposes.
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Affiliation(s)
- Hitoshi Ohto
- Department of Mesenchymal Stem Cell Research, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Yoshiko Ogiyama
- Tohoku Block Blood Center, Japanese Red Cross Society, Sendai, Japan
| | - Makoto Uchikawa
- Kanto-Koshinetsu Block Blood Center, Japanese Red Cross Society, Tokyo, Japan
| | - Kenneth Eric Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Pirenne F, Floch A, Diop S. Alloimmunisation against red blood cells in sickle cell disease: transfusion challenges in high-income and low-income countries. Lancet Haematol 2023:S2352-3026(23)00066-2. [PMID: 37060916 DOI: 10.1016/s2352-3026(23)00066-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 04/17/2023]
Abstract
Sickle cell disease is the most frequent inherited disorder in sub-Saharan Africa and in many high-income countries (HICs). Transfusion is a key element of treatment, but it results in high rates of alloimmunisation against red blood cell antigens and post-transfusion haemolysis, which can be life-threatening in severe cases. The prevention of alloimmunisation is, therefore, an important issue in both HICs and in low-income countries (LICs). In HICs, the main reason for high alloimmunisation rates is blood group disparity between blood donors, who are mostly of European descent, and the patients, who are mostly of African descent. However, alloimmunisation rates also remain high in sub-Saharan Africa despite the homogeneity of blood group antigen frequencies between donors and patients; this occurrence is probably due to matching strategies limited to ABO blood group and RhD. However, other possible underlying causes of alloimmunisation have also been suggested, with each cause affecting HICs and LICs in different ways-eg, the immunogenetic and inflammatory status of the patient and the characteristics of the red blood cell products. In this Viewpoint, we discuss the available data and hypotheses that potentially account for the association of sickle cell disease with high rates of alloimmunisation in both settings, HICs and LICs (focusing particularly on sub-Saharan Africa), and the challenges faced by HICs and LICs to improve prevention of alloimmunisation.
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Affiliation(s)
- France Pirenne
- Transfusion and Red Blood Cell Diseases, INSERM U955, The Mondor Institute for Biomedical Research, University Paris-Est Créteil, Paris, France; Établissement Français du Sang Ile de France, Paris, France.
| | - Aline Floch
- Transfusion and Red Blood Cell Diseases, INSERM U955, The Mondor Institute for Biomedical Research, University Paris-Est Créteil, Paris, France; Établissement Français du Sang Ile de France, Paris, France
| | - Saliou Diop
- Department of Haematology, National Center Transfusion Sanguine, Cheikh Anta Diop University, Dakar, Senegal
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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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9
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Wong K, Lai WK, Jackson DE. HLA Class II regulation of immune response in sickle cell disease patients: Susceptibility to red blood cell alloimmunization (systematic review and meta-analysis). Vox Sang 2022; 117:1251-1261. [PMID: 36102140 PMCID: PMC9826043 DOI: 10.1111/vox.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Sickle cell disease (SCD) patients are commonly treated with red blood cell (RBC) transfusion. Pretransfusion tests commonly involve limited serological antibody testing. RBC alloimmunization to RBC antigens is a frequently encountered complication seen in chronically transfused patients. Genetic factors such as the human leukocyte antigen (HLA) are known to influence and regulate immune responses. HLAs are highly polymorphic and play an essential role in regulating immune responses, including RBC alloimmunization. The aim of this study was to conduct a systematic review and meta-analysis to evaluate the association between HLA Class II allelic polymorphisms with the possible risk of developing RBC alloantibodies. MATERIALS AND METHODS Four databases were systematically searched for relevant studies between the years 2000 and 2021 following the PRISMA guidelines. Four articles met the eligibility and quality criterion, and three alleles, HLA-DRB1*04, HLA-DRB1*15 and HLA-DQB1*03, that were found to be potentially associated with an increased risk in alloantibody formation were included. RESULTS The primary outcome measure was alloimmunization by RBC antigen exposure in multiply transfused SCD patients. The total estimate of alloimmunization of the SCD patients was 2.33 (95% CI, 1.58-3.44), demonstrating susceptibility to RBC alloantibody formation. Heterogeneity between the studies was insignificant, suggesting the differences associated with random sampling errors. The results showed that SCD patients carry an increased risk of producing RBC alloantibodies. CONCLUSION A strategy to prevent RBC alloimmunization is genotyping for genetically susceptible SCD patients receiving multiple transfusions. Early identification of genetic variants that can potentially increase the risk of RBC alloimmunization could aid in the screening process and selection of phenotypically matched RBC units.
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Affiliation(s)
- Karmen Wong
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Wing Kit Lai
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Denise E. Jackson
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
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Mezginejad F, Anani Sarab GR, Atarodi K, Oodi A, Azarkeivan A. Prognostic Value Evaluation of HLA-DRB1*07:01, *10, *12, *13:01 Alleles for Alloimmunization in Transfusion-Dependent Thalassemia. Transfus Apher Sci 2021; 60:103271. [PMID: 34535395 DOI: 10.1016/j.transci.2021.103271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/28/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transfusion is a lifesaving treatment for lots of patients. However, in chronic blood recipients such as thalassemia patients, there are high concerns about alloantibody production that affects the quality of their life. Therefore, research on risk factors of alloimmunization has been started and followed. This study aimed at the determination of correlation probability between some HLADRB1 alleles and alloimmunization in Iranian thalassemia patients. MATERIALS AND METHODS The present study was conducted on 60 alloimmunized and 60 non-alloimmunized transfusion-dependent thalassemia patients. Antibody screening and identification tests were carried out using the tube method, and HLA-DRB1 genotyping was done using a single specific primer-polymerase chain reaction (PCRSSP). RESULTS The results of antibody screening showed that the most prevalent alloantibodies were Anti-K (46.7 %), and followed by Anti-E (32.5 %), Anti-C (15.8 %), Anti-D (13.3 %), Anti-e (8 %), and Anti-c (5.8 %), respectively. DRB1*07:01 was detected more in non-responder patients (28.3 %). However, data analysis showed that there is no significant relationship between DRB1*07:01, *10, *13:01 frequency among responder and non-responder groups (p = 0·195, 0.648, 0.402, respectively). There was not any significant correlation between HLA-DRB1*10 and *13:01 allele and alloimmunization. There was a significant association between HLA-DRB1*12 and alloimmunization (p < 0·05, OR = 2.071, CI: 1.716-2.501). CONCLUSION The findings of this study represented that there is a significant relationship between HLADRB1*12 and Kell and E alloantibodies. Although more developed studies on other HLA alleles are demanded, these findings can be valuable in determining important alloimmunization risk factors to better management of transfusion complications.
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Affiliation(s)
- Fatemeh Mezginejad
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | | | - Kamran Atarodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Arezoo Oodi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran..
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11
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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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12
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Gerritsma JJ, Oomen I, Meinderts S, van der Schoot CE, Biemond BJ, van der Bom JG, Fijnvandraat K. Back to base pairs: What is the genetic risk for red bloodcell alloimmunization? Blood Rev 2021; 48:100794. [PMID: 33451870 DOI: 10.1016/j.blre.2020.100794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/17/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023]
Abstract
Red blood cell (RBC) alloimmunization is a serious complication of blood transfusions, challenging selection of compatible units for future transfusions. Genetic characteristics may be associated with the risk of RBC alloimmunization and may therefore serve to identify high-risk patients. The aim of this systematic review was to summarize the available evidence on genetic risk factors for RBC alloimmunization. Electronic databases were searched up to April 2020 for studies (Search terms included transfusion, alloimmunization and genetic). A total of 2581 alloimmunized cases and 26,558 controls were derived from 24 studies. The alleles that were most frequently studied and that demonstrated significant associations in a meta-analysis with alloimmunization to the Duffya antigen were HLA-DRB1*04 (Odds Ratio 7.80 (95%CI 4.57-13.33)), HLA-DRB1*15 (OR 3.76 (95%CI 2.14-6.59)), and HLA-DRB1*03 (OR 0.12 (95%CI 0.05-0.29)). Furthermore, significant associations with anti-K formation was found for the alleles HLA-DRB1*10 (OR 2.64 (95%CI 1.41-4.95)), HLA*DRB1*11 (OR 2.11, (95%CI 1.34-3.32)), and HLA-DRB1*13 (OR 1.71 (95%CI 1.26-2.33)). Overall, the available evidence was of moderate to low quality, hampering interpretation of reported results. There is an urgent need for high quality evidence on genetic risk factors for RBC alloimmunization.
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Affiliation(s)
- J J Gerritsma
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands; Sanquin Research and Landsteiner Laboratory, Immunopathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - I Oomen
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands.
| | - S Meinderts
- Sanquin Research and Landsteiner Laboratory, Blood Cell Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C E van der Schoot
- Sanquin Research and Landsteiner Laboratory, Experimental Immunohematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - B J Biemond
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands.
| | - J G van der Bom
- Sanquin/LUMC, Center for Clinical Transfusion Research, Leiden, the Netherlands.
| | - K Fijnvandraat
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands.
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13
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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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14
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Tozatto-Maio K, Girot R, Ly ID, Silva Pinto AC, Rocha V, Fernandes F, Diagne I, Benzerara Y, Dinardo CL, Soler JP, Kashima S, Araujo IL, Kenzey C, Fonseca GHH, Rodrigues ES, Volt F, Jarduli L, Ruggeri A, Mariaselvam C, Gualandro SFM, Rafii H, Cappelli B, Nogueira FM, Scigliuolo GM, Guerino-Cunha RL, Malmegrim KCR, Simões BP, Gluckman E, Tamouza R. Polymorphisms in Inflammatory Genes Modulate Clinical Complications in Patients With Sickle Cell Disease. Front Immunol 2020; 11:2041. [PMID: 33013863 PMCID: PMC7510050 DOI: 10.3389/fimmu.2020.02041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023] Open
Abstract
Sickle cell disease (SCD), the most common monogenic disease worldwide, is marked by a phenotypic variability that is, to date, only partially understood. Because inflammation plays a major role in SCD pathophysiology, we hypothesized that single nucleotide polymorphisms (SNP) in genes encoding functionally important inflammatory proteins might modulate the occurrence of SCD complications. We assessed the association between 20 SNPs in genes encoding Toll-like receptors (TLR), NK cell receptors (NKG), histocompatibility leukocyte antigens (HLA), major histocompatibility complex class I polypeptide-related sequence A (MICA) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and the occurrence of six SCD clinical complications (stroke, acute chest syndrome (ACS), leg ulcers, cholelithiasis, osteonecrosis, or retinopathy). This study was performed in a cohort of 500 patients. We found that the TLR2 rs4696480 TA, TLR2 rs3804099 CC, and HLA-G, rs9380142 AA genotypes were more frequent in patients who had fewer complications. Also, in logistic regression, the HLA-G rs9380142 G allele increased the risk of cholelithiasis (AG vs. AA, OR 1.57, 95%CI 1.16-2.15; GG vs. AA, OR 2.47, 95%CI 1.34-4.64; P = 0.02). For SNPs located in the NKG2D loci, in logistic regression, the A allele in three SNPs was associated with a lower frequency of retinopathy, namely, rs2246809 (AA vs. GG: OR 0.22, 95%CI 0.09-0.50; AG vs. GG: OR 0.47, 95%CI 0.31-0.71; P = 0.004, for patients of same origin), rs2617160 (AT vs. TT: OR 0.67, 95%CI 0.48-0.92; AA vs. TT: OR 0.45, 95%CI 0.23-0.84; P = 0.04), and rs2617169 (AA vs. TT: OR 0.33, 95%CI 0.13-0.82; AT vs. TT: OR 0.58, 95%CI 0.36-0.91, P = 0.049, in patients of same SCD genotype). These results, by uncovering susceptibility to, or protection against SCD complications, might contribute to a better understanding of the inflammatory pathways involved in SCD manifestations and to pave the way for the discovery of biomarkers that predict disease severity, which would improve SCD management.
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Affiliation(s)
- Karina Tozatto-Maio
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Indou Deme Ly
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Ana Cristina Silva Pinto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanderson Rocha
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Fernandes
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Ibrahima Diagne
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Yahia Benzerara
- Département de Bactériologie, Hôpital Saint-Antoine, Hôpitaux de l'Est parisien, Paris, France
| | - Carla L Dinardo
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Julia Pavan Soler
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Simone Kashima
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Chantal Kenzey
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Guilherme H H Fonseca
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Evandra S Rodrigues
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Volt
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Luciana Jarduli
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.,School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Annalisa Ruggeri
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Cellular Therapy and Immunobiology Working Party, The European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Sandra F M Gualandro
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hanadi Rafii
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Barbara Cappelli
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Felipe Melo Nogueira
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Graziana Maria Scigliuolo
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Renato Luiz Guerino-Cunha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Belinda P Simões
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eliane Gluckman
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
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15
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16
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A locus on chromosome 5 shows African ancestry-limited association with alloimmunization in sickle cell disease. Blood Adv 2019; 2:3637-3647. [PMID: 30578281 DOI: 10.1182/bloodadvances.2018020594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
Red blood cell (RBC) transfusion remains a critical therapeutic intervention in sickle cell disease (SCD); however, the apparent propensity of some patients to regularly develop RBC alloantibodies after transfusion presents a significant challenge to finding compatible blood for so-called alloimmunization responders. Predisposing genetic loci have long been thought to contribute to the responder phenomenon, but to date, no definitive loci have been identified. We undertook a genome-wide association study of alloimmunization responder status in 267 SCD multiple transfusion recipients, using genetic estimates of ancestral admixture to bolster our findings. Analyses revealed single nucleotide polymorphisms (SNPs) on chromosomes 2 and 5 approaching genome-wide significance (minimum P = 2.0 × 10-8 and 8.4 × 10-8, respectively), with local ancestry analysis demonstrating similar levels of admixture in responders and nonresponders at implicated loci. Association at chromosome 5 was nominally replicated in an independent cohort of 130 SCD transfusion recipients, with meta-analysis surpassing genome-wide significance (rs75853687, P meta = 6.6 × 10-9), and this extended to individuals forming multiple (>3) alloantibodies (P meta = 9.4 × 10-5). The associated variant is rare outside of African populations, and orthogonal genome-wide haplotype analyses, contingent on local ancestry, revealed genome-wide significant sharing of a ∼60-kb haplotype of African ancestry at the chromosome 5 locus (Bayes Factor = 4.95). This locus overlaps a putative cis-acting enhancer predicted to regulate transcription of ADRA1B and the lncRNA LINC01847, both members of larger ontologies associated with immune regulation. Our findings provide potential insights to the pathophysiology underlying the development of alloantibodies and implicate non-RBC ancestry-limited loci in the susceptibility to alloimmunization.
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17
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Meinderts SM, Gerritsma JJ, Sins JWR, de Boer M, van Leeuwen K, Biemond BJ, Rijneveld AW, Kerkhoffs JLH, Habibi A, van Bruggen R, Kuijpers TW, van der Schoot E, Pirenne F, Fijnvandraat K, Tanck MW, van den Berg TK. Identification of genetic biomarkers for alloimmunization in sickle cell disease. Br J Haematol 2019; 186:887-899. [PMID: 31168801 DOI: 10.1111/bjh.15998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
Most sickle cell disease (SCD) patients rely on blood transfusion as their main treatment strategy. However, frequent blood transfusion poses the risk of alloimmunization. On average, 30% of SCD patients will alloimmunize while other patient groups form antibodies less frequently. Identification of genetic markers may help to predict which patients are at risk to form alloantibodies. The aim of this study was to evaluate whether genetic variations in the Toll-like receptor pathway or in genes previously associated with antibody-mediated conditions are associated with red blood cell (RBC) alloimmunization in a cohort of SCD patients. In this case-control study, cases had a documented history of alloimmunization while controls had received ≥20 RBC units without alloantibody formation. We used a customized single nucleotide polymorphism (SNP) panel to genotype 690 SNPs in 275 (130 controls, 145 cases) patients. Frequencies were compared using multiple logistic regression analysis. In our primary analysis, no SNPs were found to be significantly associated with alloimmunization after correction for multiple testing. However, in a secondary analysis with a less stringent threshold for significance we found 19 moderately associated SNPs. Among others, SNPs in TLR1/TANK and MALT1 were associated with a higher alloimmunization risk, while SNPs in STAM/IFNAR1 and STAT4 conferred a lower alloimmunization risk.
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Affiliation(s)
- Sanne M Meinderts
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorn J Gerritsma
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Joep W R Sins
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Martin de Boer
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin van Leeuwen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Anita W Rijneveld
- Department of Haematology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - Anoosha Habibi
- Reference Centre for Sickle Cell Disease, Hôpital Henri Mondor, Créteil, France
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen van der Schoot
- Department of Experimental Immunohaematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - France Pirenne
- Etablissement Français Du Sang Ile de France, INSERM U955, University of Paris Est-Créteil, Hôpital Henri Mondor, Créteil, France
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Timo K van den Berg
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Molecular Cell Biology, VU Medical Centre, Amsterdam, the Netherlands
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18
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Tormey CA, Hendrickson JE. Transfusion-related red blood cell alloantibodies: induction and consequences. Blood 2019; 133:1821-1830. [PMID: 30808636 PMCID: PMC6484385 DOI: 10.1182/blood-2018-08-833962] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 01/19/2023] Open
Abstract
Blood transfusion is the most common procedure completed during a given hospitalization in the United States. Although often life-saving, transfusions are not risk-free. One sequela that occurs in a subset of red blood cell (RBC) transfusion recipients is the development of alloantibodies. It is estimated that only 30% of induced RBC alloantibodies are detected, given alloantibody induction and evanescence patterns, missed opportunities for alloantibody detection, and record fragmentation. Alloantibodies may be clinically significant in future transfusion scenarios, potentially resulting in acute or delayed hemolytic transfusion reactions or in difficulty locating compatible RBC units for future transfusion. Alloantibodies can also be clinically significant in future pregnancies, potentially resulting in hemolytic disease of the fetus and newborn. A better understanding of factors that impact RBC alloantibody formation may allow general or targeted preventative strategies to be developed. Animal and human studies suggest that blood donor, blood product, and transfusion recipient variables potentially influence which transfusion recipients will become alloimmunized, with genetic as well as innate/adaptive immune factors also playing a role. At present, judicious transfusion of RBCs is the primary strategy invoked in alloimmunization prevention. Other mitigation strategies include matching RBC antigens of blood donors to those of transfusion recipients or providing immunomodulatory therapies prior to blood product exposure in select recipients with a history of life-threatening alloimmunization. Multidisciplinary collaborations between providers with expertise in transfusion medicine, hematology, oncology, transplantation, obstetrics, and immunology, among other areas, are needed to better understand RBC alloimmunization and refine preventative strategies.
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Affiliation(s)
- Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
- Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT; and
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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19
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Tozatto-Maio K, Girot R, Ly ID, Rocha V, Silva Pinto AC, Diagne I, Benzerara Y, Dinardo CL, Kashima S, Leston-Araujo I, Kenzey C, Fonseca GHH, Rodrigues ES, Volt F, Jarduli LR, Ruggeri A, Mariaselvam CM, Gualandro SFM, Elayoubi H, Cunha R, Cappelli B, Malmegrim KCR, Simões BP, Gluckman E, Tamouza R. A Toll-like receptor 2 genetic variant modulates occurrence of bacterial infections in patients with sickle cell disease. Br J Haematol 2019; 185:918-924. [PMID: 30908604 DOI: 10.1111/bjh.15875] [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] [Received: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 12/11/2022]
Abstract
Despite adequate immunization and penicillin prophylaxis, bacterial infections remain a leading cause of morbidity and mortality in patients with sickle cell disease (SCD). Besides hyposplenism, inflammatory and genetic factors might modulate their susceptibility to bacterial infections. We performed a candidate gene association of single nucleotide polymorphisms (SNPs) located in Toll-like receptor (TLR) genes, encoding prominent molecules for innate immune responses, with the occurrence of bacterial infections in patients with SCD. A cohort followed in centres in Brazil, France and Senegal (n = 430) was divided in two groups: patients who presented at least one episode of bacterial infection (n = 235) and patients who never had bacterial infections (n = 195). There were no differences in gender or age distribution among the groups. The frequency of the TLR2 rs4696480 TA genotype was significantly lower in the infected group (50% vs. 67%, odds ratio [OR] = 0·50, 95% confidence interval [CI] 0·34-0·75, P < 0·001), and the TT genotype was significantly higher in the infected group (15% vs. 5%, OR = 3·18, 95% CI 1·53-6·61, P < 0·001). Previous reports demonstrated higher secretion of inflammatory factors in cells from AA individuals, lower occurrence and severity of immune diseases in T carriers. The rs4696480 TA genotype might stand between deleterious effects of over inflammatory response (AA genotype) and inefficient responses (TT genotype) to infectious agents in SCD settings.
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Affiliation(s)
- Karina Tozatto-Maio
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Robert Girot
- Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Indou D Ly
- Pediatrics Unit, Cheikh Anta Diop University, Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Vanderson Rocha
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.,Department of Haematology, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ana C Silva Pinto
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Yahia Benzerara
- Département de Bactériologie, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Carla L Dinardo
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Simone Kashima
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Itauá Leston-Araujo
- INSERM 1160, Alloimmunity-Autoimmunity-Transplantation, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Chantal Kenzey
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Guilherme H H Fonseca
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Evandra S Rodrigues
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Volt
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Luciana R Jarduli
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Annalisa Ruggeri
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Cellular Therapy & Immunobiology Working Party of EBMT, Rome, Italy.,Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Sandra F M Gualandro
- Department of Haematology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Hanadi Elayoubi
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Renato Cunha
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Barbara Cappelli
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Kelen C R Malmegrim
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Clinical Analysis, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Belinda P Simões
- Centre for Cell-Based Therapy, Blood Centre of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Eliane Gluckman
- Monacord, Centre Scientifique de Monaco, Monaco, Monaco.,Eurocord, Hôpital Saint Louis, Institut Universitaire d'Hématologie, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ryad Tamouza
- INSERM U955, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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20
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Burin des Roziers N, Chadebech P, Malard L, Vingert B, Gallon P, Samuel D, Djoudi R, Fillet AM, Pirenne F. Predisposing factors for anti-D immune response in D - patients with chronic liver disease transfused with D + platelet concentrates. Transfusion 2019; 59:1353-1358. [PMID: 30604873 DOI: 10.1111/trf.15129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent reports have indicated that the risk of anti-D alloimmunization following D-incompatible platelet (PLT) transfusion is low in hematology and oncology patients. We investigated the rate of anti-D alloimmunization in RhD-negative (D- ) patients with chronic liver disease transfused with D+ platelet concentrates (PCs) and the factors involved, at a liver transplant (LT) center. STUDY DESIGN AND METHODS We reviewed the blood bank database from January 2003 to October 2016. D- patients who had received D+ PLT transfusions were eligible if they had undergone antibody screening at least 28 days after the first D+ PC transfusion, had no previous or concomitant exposure to D+ blood products, and had not received anti-D immunoglobulins. RESULTS Six of the 56 eligible patients (10.7%) had anti-D antibodies. All had received whole blood-derived PCs. Four of 20 patients (20%) untransplanted or transfused before LT and only two of 36 patients (5.6%) transfused during or after LT produced anti-D antibodies. These two patients were on maintenance immunosuppression based on low-dose steroids and tacrolimus. The factors identified as significantly associated with anti-D immune response were the presence of red blood cell immune alloantibodies before D+ PLT transfusion (p = 0.003), and D+ PLT transfusion outside the operative and postoperative (5 days) periods for LT (p = 0.023). CONCLUSION D- patients with chronic liver disease transfused with D+ PLTs before LT are at high risk of developing anti-D antibodies. Preventive measures should be considered for these patients.
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Affiliation(s)
| | - Philippe Chadebech
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Lucile Malard
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | - Benoit Vingert
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Philippe Gallon
- Unité d'hémovigilance, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Didier Samuel
- Centre hépato-biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Rachid Djoudi
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | | | - France Pirenne
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
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21
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Raos M, Zunec R, Mocibob M, Gojceta K, Lukic M, Golubic Cepulic B. Susceptible and protective HLA‐DR and HLA‐DQ alleles for Fy
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alloimmunization in the Croatian population. Transfusion 2018; 59:1118-1124. [DOI: 10.1111/trf.15087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/11/2018] [Accepted: 10/30/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Mirela Raos
- Clinical Department of Transfusion Medicine and Transplantation BiologyUniversity Hospital Center Zagreb Zagreb Croatia
| | - Renata Zunec
- Clinical Department of Transfusion Medicine and Transplantation BiologyUniversity Hospital Center Zagreb Zagreb Croatia
| | - Marko Mocibob
- Department of Chemistry, Faculty of ScienceUniversity of Zagreb Zagreb Croatia
| | - Koraljka Gojceta
- Clinical Department of Transfusion Medicine and Transplantation BiologyUniversity Hospital Center Zagreb Zagreb Croatia
| | - Marija Lukic
- Clinical Department of Transfusion Medicine and Transplantation BiologyUniversity Hospital Center Zagreb Zagreb Croatia
| | - Branka Golubic Cepulic
- Clinical Department of Transfusion Medicine and Transplantation BiologyUniversity Hospital Center Zagreb Zagreb Croatia
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22
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van Sambeeck JHJ, de Wit PD, Luken J, Veldhuisen B, van den Hurk K, van Dongen A, Koopman MMW, van Kraaij MGJ, van der Schoot CE, Schonewille H, de Kort WLAM, Janssen MP. A Conceptual Framework for Optimizing Blood Matching Strategies: Balancing Patient Complications Against Total Costs Incurred. Front Med (Lausanne) 2018; 5:199. [PMID: 30090809 PMCID: PMC6069448 DOI: 10.3389/fmed.2018.00199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/18/2018] [Indexed: 01/06/2023] Open
Abstract
Alloimmunization is currently the most frequent adverse blood transfusion event. Whilst completely matched donor blood would nullify the alloimmunization risk, this is practically infeasible. Current matching strategies therefore aim at matching a limited number of blood groups only, and have evolved over time by systematically including matching strategies for those blood groups for which (serious) alloimmunization complications most frequently occurred. An optimal matching strategy for controlling the risk of alloimmunization however, would balance alloimmunization complications and costs within the entire blood supply chain, whilst fulfilling all practical requirements and limitations. In this article the outline of an integrated blood management model is described and various potential challenges and prospects foreseen with the development of such a model are discussed.
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Affiliation(s)
- Joost H J van Sambeeck
- Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands.,Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Netherlands
| | - Puck D de Wit
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands
| | - Jessie Luken
- Sanquin Diagnostic Services, Amsterdam, Netherlands
| | - Barbera Veldhuisen
- Sanquin Diagnostic Services, Amsterdam, Netherlands.,Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne van Dongen
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, Netherlands
| | - Marian G J van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, Netherlands.,Department of Donor Affairs, Sanquin Blood Bank, Amsterdam, Netherlands.,Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, Netherlands
| | - C Ellen van der Schoot
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Henk Schonewille
- Sanquin Research and Landsteiner Laboratory, Department of Experimental Immunohematology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Wim L A M de Kort
- Department of Donor Studies, Sanquin Research, Amsterdam, Netherlands.,Department of Social Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Mart P Janssen
- Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands
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23
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Immunohaematological complications in patients with sickle cell disease after haemopoietic progenitor cell transplantation: a prospective, single-centre, observational study. LANCET HAEMATOLOGY 2018; 4:e553-e561. [PMID: 29100558 DOI: 10.1016/s2352-3026(17)30196-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/09/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haemopoietic progenitor cell (HPC) transplantation can cure sickle cell disease. Non-myeloablative conditioning typically results in donor-derived erythrocytes and stable mixed chimerism of recipient-derived and donor-derived leucocytes. Exposure to donor antigens from the HPC graft and new red cell antibodies induced by transfusion can lead to immunohaematological complications. We assessed the incidence of such complications among HPC transplant recipients with sickle cell disease. METHODS The study population was all patients with sickle cell disease enrolled before March 31, 2015, in the three clinical trials of non-myeloablative HPC transplantation at the National Institutes of Health. We assessed formation of new red cell antibodies after transplantation and red cell incompatibility between donors and recipients. FINDINGS 61 patients were enrolled, 42 were HLA matched and 19 were haploidentical. Nine (15%) had immunohaematological complications. Before HPC transplantation, three patients had antibodies incompatible with their donors. After HPC transplantation, new red cell antibodies were seen in six patients (11 alloantibodies and two autoantibodies), among whom three developed antibodies incompatible with donor or recipient red cells and three developed compatible antibodies. The clinical course of complications was highly variable, from no severe effects attributable to antibodies, to sustained reticulocytopenia, to near-fatal haemolysis. We found no significant correlation between immunohaematological complications and graft failure, graft rejection, or death. INTERPRETATION Clinical effects ranged from seemingly not clinically important to potentially fatal. In patients with sickle cell disease, donor and recipient red cell phenotypes should be carefully assessed before transplantation to minimise and manage the risk of immunohaematological complications. FUNDING Intramural Research Program and National Institutes of Health.
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24
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da Cunha Gomes EG, Machado LAF, de Oliveira LC, Neto JFN. The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review. Transfus Med 2018; 29:149-161. [PMID: 29845661 DOI: 10.1111/tme.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
Transfusion therapy is a common practice in the treatment of anaemia and can cause erythrocyte alloimmunisation. To systematise data related to erythrocyte alloimmunisation in patients with sickle cell disease (SCD), a bibliographic search was carried out in September 2017 to search for studies in four electronic databases. (i) Referring to the original work, (ii) being cohort or case-control, (iii) having been developed with individuals with SCD and (iv) having evaluated the erythrocyte alloimmunisation. Two reviewers identified the articles for inclusion in the study, extracted the predetermined data and carried out the evaluation of the methodological quality of the work. 21 studies were selected; the studies included data on 20 636 individuals (children and adults), were mostly published in the last 10 years, were developed in the United States and had high methodological quality. The occurrence of erythrocyte alloimmunisation ranged from 4·4 to 76%, and there was a higher rate of alloimmunisation against antigens of the Rh system. The risk factors for alloimmunisation were age; gender (female); red blood cell (RBC) units received; presence of ≥1 autoantibodies, TNF-α, interleukin (IL1B), human leukocyte antigens (HLA)-DRB1 gene polymorphisms; first blood transfusion (BT) after 5 years of age, transfusion episodic, multiple or during inflammatory events, acute chest syndrome (ACS) and vase-occlusive crisis (VOC); increased percentage of CD41 T memory cells; and positive direct antiglobulin test. Transfusion policies should be developed to protect the patient and his or her health based on the main factors associated with its incidence.
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Affiliation(s)
- E G da Cunha Gomes
- Professional Master's in Health, Laboratory Medicine and Forensic Technology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - L A F Machado
- Professional Master's in Health, Laboratory Medicine and Forensic Technology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - L C de Oliveira
- Search Group NutriPali, Nutritionist Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - J F N Neto
- Lipids Laboratory-LabLip, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
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25
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Red blood cell alloimmunization: new findings at the bench and new recommendations for the bedside. Curr Opin Hematol 2017; 23:543-549. [PMID: 27454234 DOI: 10.1097/moh.0000000000000277] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To summarize recent discoveries from clinical studies and animal models that contribute to understanding the alloimmune response to non-ABO blood group antigens. RECENT FINDINGS Several studies have confirmed high rates of alloimmunization among patients requiring chronic red blood cell (RBC) transfusion. Moreover, 'triggers' for alloantibody development in the transfusion setting have been identified, with a number of investigations linking recipient inflammation to a higher likelihood of alloimmunization. Additional associations between human leukocyte antigen expression and CD4 T-cell markers in 'responder' or 'nonresponder' humans have been revealed. Recent animal studies have described novel mechanistic properties by which the alloimmune response is governed, including the critical role played by dendritic cells in transfusion-associated alloimmunization. New light has also been shed on the properties of alloantibodies developed as a result of pregnancy, as well as mechanisms through which such alloimmunization may be prevented. SUMMARY Many of the clinical/biological factors that contribute to the RBC alloimmune response have been further elucidated. This knowledge will be applied to identify individuals most likely to mount an immune response to RBC antigens, such that appropriate resources and strategies for preventing alloimmunization (or mitigating its harmful effects) can be implemented.
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26
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Elayeb R, Tamagne M, Pinheiro M, Ripa J, Djoudi R, Bierling P, Pirenne F, Vingert B. Anti-CD20 Antibody Prevents Red Blood Cell Alloimmunization in a Mouse Model. THE JOURNAL OF IMMUNOLOGY 2017; 199:3771-3780. [DOI: 10.4049/jimmunol.1700754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022]
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27
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Rodrigues C, Sell AM, Guelsin GAS, Higa TT, Pagliarini e Silva S, Macedo LC, Sippert EÂ, de Alencar JB, Zanette Â, Acorsi CRL, Castilho L, Visentainer JEL. HLA polymorphisms and risk of red blood cell alloimmunisation in polytransfused patients with sickle cell anaemia. Transfus Med 2017; 27:437-443. [DOI: 10.1111/tme.12459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Affiliation(s)
- C. Rodrigues
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - A. M. Sell
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - G. A. S. Guelsin
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - T. T. Higa
- Maringa Regional Blood Center; Maringa PR Brazil
| | | | - L. C. Macedo
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - E. Â. Sippert
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - J. B. de Alencar
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
| | - Â. Zanette
- Bahia Hematology and HemotherapyCenter; Salvador BA Brazil
| | - C. R. L. Acorsi
- Department of Statistics; State University of Maringa; Maringa PR Brazil
| | - L. Castilho
- Research Laboratory of Molecular Blood Group, Hematology and HemotherapyCenter; State University of Campinas; Campinas SP Brazil
| | - J. E. L. Visentainer
- Immunogenetics Laboratory, Basic Health Sciences Department; State University of Maringa; Maringa PR Brazil
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28
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Maluskova A, Mrazek F, Pauliskova M, Kovarova P, Koristka M, Jindra P, Cermakova Z. Association of HLA-DRB1 and HLA-DQB1 with red-blood-cell alloimmunization in the Czech population. Vox Sang 2017; 112:156-162. [PMID: 28052334 DOI: 10.1111/vox.12478] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Alloimmune antibodies against red-blood-cell (RBC) antigens induced in susceptible individuals (responders) by transfusion, pregnancy or transplantation may have serious clinical consequences. The aim of this study was to investigate association of alloimmunization against selected RBC antigens with HLA-Class II. MATERIALS AND METHODS A total of 230 responders (106 monoresponders and 124 multiresponders) were enrolled into the study. HLA-DRB1 and HLA-DQB1 variants were determined by PCR-SSO and their frequencies compared between the patients (patient subgroups) and 375 ethnically and regionally matched controls. RESULTS Development of multiple RBC antibodies was associated with HLA-DRB1*15 and HLA-DQB1*06 allelic groups in the patients, with the relationship being particularly apparent in those with anti-C+D antibodies. Furthermore, DRB1*13 and DQB1*06 were more frequent in multiresponders with anti-E+c antibodies and DRB1*03 and DQB1*02 in those with anti-E+Cw. CONCLUSION For the first time, we confirmed the association of HLA-DRB1*15 with RBC antibody multiresponder status and found HLA-Class II associations for three frequent RBC antibody combinations. Our data support the concept that HLA restriction plays an important role in the response to RBC alloantigens.
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Affiliation(s)
- A Maluskova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - F Mrazek
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - M Pauliskova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - P Kovarova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - M Koristka
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - P Jindra
- Department of Haematology and Oncology, University Hospital, Plzen, Czech Republic
| | - Z Cermakova
- Blood Centre, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
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29
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Sippert EÂ, Visentainer JEL, Alves HV, Rodrigues C, Gilli SCO, Addas-Carvalho M, Saad STO, Costa FF, Castilho L. Red blood cell alloimmunization in patients with sickle cell disease: correlation with HLA and cytokine gene polymorphisms. Transfusion 2016; 57:379-389. [PMID: 27873324 DOI: 10.1111/trf.13920] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The reason for the difference in susceptibility to red blood cell (RBC) alloimmunization among patients with sickle cell disease (SCD) is not clearly understood and is probably the result of multiple factors. Our hypothesis is that genetic polymorphisms are associated with RBC alloimmunization. STUDY DESIGN AND METHODS We investigated the possible association of susceptibility to RBC alloimmunization with polymorphisms of HLA and cytokines genes in 161 SCD patients prior exposed to RBC transfusion. Cytokine gene polymorphisms were analyzed by polymerase chain reaction (PCR) and TaqMan assays. HLA Class I genotyping was performed using PCR-specific sequence of oligonucleotides. Polymorphism frequencies were compared using the Fisher's exact test. RESULTS Our results revealed increased percentage of the A allele and the GA genotype of the TNFA -308G/A cytokine among alloimmunized patients when compared to nonalloimmunized patients (A allele, 16.4% vs. 6.8%, p = 0.004; GA genotype, 32.8% vs. 11.7%, p = 0.0021). In addition, the IL1B -511T allele and the IL1B -511TT and CT genotype frequencies were overrepresented among alloimmunized patients (T allele, 53.0% vs. 37.5%, p = 0.0085; CT + TT genotypes, 81.82% vs. 60.87%, p = 0.0071). In relation to HLA Class I, we found a higher frequency of HLA-DRB1*15 among patients alloimmunized to Rh antigens when compared to nonalloimmunized patients (15.63% vs. 6.98%, p = 0.044). CONCLUSION Brazilian SCD patients with the TNFA, IL1B, and HLA-DRB1 gene polymorphisms were at increased risk of becoming alloimmunized by RBC transfusions. These findings may contribute to the development of future therapeutic strategies for patients with SCD with higher susceptibility of alloimmunization.
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Affiliation(s)
- Emilia Ângela Sippert
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Hugo Vicentin Alves
- Basic Health Sciences Department, State University of Maringa, Maringá, Paraná, Brazil
| | - Camila Rodrigues
- Basic Health Sciences Department, State University of Maringa, Maringá, Paraná, Brazil
| | | | - Marcelo Addas-Carvalho
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Fernando Ferreira Costa
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Lilian Castilho
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
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