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Oud JA, de Haas M, de Vooght KMK, van de Kerkhof D, Som N, Péquériaux NCV, Hudig F, van der Bom JG, Evers D, Zwaginga JJ. Challenging the dogma: Red blood cell-directed autoimmunity as risk factor for red blood cell alloimmunisation after blood transfusion. Br J Haematol 2024; 204:2103-2111. [PMID: 38494337 DOI: 10.1111/bjh.19354] [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: 11/30/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Abstract
Red blood cell autoimmunity and alloimmunity are potentially linked. Quantification of this association can tailor extensively matched red blood cell transfusions in patients with autoimmunity. Using an incident new-user cohort comprising 47 285 previously non-transfused, non-alloimmunised patients, we compared transfusion-induced red blood cell alloimmunisation incidences in direct antiglobulin test (DAT)-positive and control patients. Additionally, we performed case-control analyses to handle potential confounding by clinical immunomodulators. Among (IgG and/or C3d) DAT-positive patients (N = 380), cumulative red blood cell alloimmunisation incidences after 10 units transfused reached 4.5% (95% confidence interval [CI] 2.5-8.2) versus 4.2% (CI 3.9-4.5, p = 0.88) in controls. In case-control analyses, alloimmunisation relative risks among DAT-positive patients increased to 1.7 (CI 1.1-2.8). Additional adjustments for pre-DAT transfusion exposure or the extent of Rh/K mismatching did not impact results. In conclusion, while patients with DAT positivity show an intrinsically increased alloimmune red blood cell response, their absolute risk is comparable to control patients due to counteracting co-existing immunosuppressive conditions. Consequently, isolated DAT positivity in patients lacking overt haemolysis or complicated alloantibody testing does not seem to warrant extended matching strategies.
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Affiliation(s)
- Josine A Oud
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Immunohaematology Diagnostics, Sanquin, Amsterdam, The Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven, The Netherlands
| | - Nel Som
- Department of Clinical Chemistry, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
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Zarrabian D, Hanna M. Characterization of pediatric transfusion-dependent thalassemia patients in a large academic center. J Clin Lab Anal 2023; 37:e24962. [PMID: 37665129 PMCID: PMC10623514 DOI: 10.1002/jcla.24962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Transfusion-dependent thalassemia patients are at high risk of transfusion-related complications. Yet, there is scanty data on the frequency of transfusion reactions, particularity alloimmunization among pediatric transfusion-dependent thalassemia patients. In addition, there is no consensus on the prophylactic antigen matching for prevention of alloimmunization or the extent of antigen matching for alloimmunized thalassemia patients. METHODS We conducted a retrospective study to assess the frequency and specificity of alloimmunization among pediatric transfusion-dependent thalassemia patients receiving ABO, RhD, and K-matched red blood cell units. In addition, we studied the association between patients' characteristics and alloimmunization. The clinical and transfusion records of transfusion-dependent thalassemia patients followed up at our institution between July 2018 and June 2022 were reviewed. RESULTS Ninety-two transfusion-dependent thalassemia patients having mean age of 13.37 years (SD, 5.56) were included in our study. Eight patients (9%) had developed clinically significant alloantibodies; six patients (6%) developed alloantibody against E antigen while two patients (2%) developed more than one alloantibody. Of alloimmunized patients, five patients had received transfusion outside Canada. Patients' sex, age, having a genotype variant, total number, and duration of transfusion received were not associated with the risk of alloimmunization. The transfusion-recipient's diagnosis of β-thalassemia, having developed autoantibody, and history of receiving transfusion outside Canada were associated with alloimmunization. CONCLUSION Blood matching for ABO, RhD, and K antigens resulted in, although not eliminated, lower frequency of alloimmunization than that previously reported among pediatric thalassemia patients. Extending matching to include Rh antigens could further reduce the rate of alloimmunization.
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Affiliation(s)
- Dorsa Zarrabian
- Research Institute, The Hospital for Sick ChildrenTorontoOntarioCanada
| | - Mirette Hanna
- Research Institute, The Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Pediatric Laboratory Medicine, Division of HematopathologyThe Hospital for Sick ChildrenTorontoOntarioCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoOntarioCanada
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Yadav BK, Chaudhary RK, Elhence P, Phadke SR, Mandal K, Saxena D, Moirangthem A. Red cell alloimmunization and associated risk factors in multiply transfused thalassemia patients: A prospective cohort study conducted at a tertiary care center in Northern India. Asian J Transfus Sci 2023; 17:145-150. [PMID: 38274964 PMCID: PMC10807536 DOI: 10.4103/ajts.ajts_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND One of the complications of chronic transfusions in thalassemia is the development of red cell alloimmunization. AIMS The aim of the study was to determine the frequency, specificity of red cell alloantibodies, and factors influencing alloimmunization in multiply transfused thalassemia patients. MATERIALS AND METHODS The study was carried out prospectively on beta-thalassemia patients over 10 months. Plasma samples were used for antibody screening and identification using the column agglutination technique. Patients' clinical, laboratory, and transfusion details were obtained from hospital information system and patient files. STATISTICAL ANALYSIS Continuous variables were reported as median and quartile, whereas categorical variables were provided as numbers and proportions. P < 0.05 was considered statistically significant. RESULTS Out of 255 patients, 17 (6.6%) patients developed alloantibodies. Alloimmunized patients had significantly higher median ages at their first transfusions (1 year vs. 0.5 years; P = 0.042) than nonalloimmunized patients. Alloimmunized patients had significantly higher conjugated bilirubin (P = 0.016) and serum ferritin (P = 0.007). The majority of alloantibodies had specificity toward K antigen, followed by E, C, D, JKa, and JKb antigens. Alloimmunized patients received more units per year than nonalloimmunized patients (median, 30 vs. 24 units; P < 0.001). The average transfusion interval time between two successive transfusions showed a significant difference (P < 0.001). CONCLUSIONS The prevalence of alloimmunization in thalassemia patients in North India is relatively low. Since most of the alloantibodies belong to Rh and Kell blood group system, extended phenotype-matched blood for Rh and Kell will be helpful in further preventing or decreasing the development of alloantibodies in multiply transfused thalassemia patients.
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Affiliation(s)
- Brijesh Kumar Yadav
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajendra K. Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priti Elhence
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shubha Rao Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepti Saxena
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amita Moirangthem
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute Medical Sciences, Lucknow, Uttar Pradesh, India
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Minhas K, Ejaz MS, Tukruna A, Haider M, Arif A, Saleem Tebha S. Red Blood Cell Alloimmunization in Pediatric group with Beta Thalassemia: A Five-Year Experience. Glob Pediatr Health 2022; 9:2333794X221132679. [PMID: 36310636 PMCID: PMC9608007 DOI: 10.1177/2333794x221132679] [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: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Beta-thalassemia is one of the most frequently occurring hematological disorders in [Removed for blinded peer-review]. Regular blood transfusion is required in almost all cases for management. However, this is associated with significant major complications like red blood cell (RBC) alloimmunization. This retrospective cross-sectional is conducted to evaluate the RBC alloimmunization frequency in children with beta-thalassemia aged between 6 months and 16 years in [Removed for blinded peer-review]. Antibody screening was performed using the Dia clon3 cell antigen panel. If the screening came back positive, a detailed panel was created for the identification of specific antibody. In our sample, the frequency of RBC alloimmunization was found in 22 (26.19%) patients. Of these 22 patients, the Rhesus system was found in most patients 17 (77.3%), followed by Kell 5 (22.7%). RBC alloimmunization was significantly associated with a family history of a blood disorder and splenectomy.
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Affiliation(s)
| | | | | | - Maryam Haider
- Jinnah Medical and Dental College, Karachi, Pakistan
| | | | - Sameer Saleem Tebha
- Jinnah Medical and Dental College, Karachi, Pakistan,Sameer Saleem Tebha, Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, 22-23 Shaheed-e-Millat Road, Bihar Muslim Society BMCHS Sharafabad, Karachi, 74000, Pakistan.
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Baruah D, Devi G, Musfique J, Bharali A, Dutta UC. Distribution and frequency of principal Rh blood group antigens (D, C, c, E, and e) and their phenotypes in the blood donors attending blood bank in a tertiary care hospital in Barpeta district of Assam. Asian J Transfus Sci 2022; 16:167-174. [PMID: 36687546 PMCID: PMC9855209 DOI: 10.4103/ajts.ajts_64_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/25/2020] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ABO and Rhesus grouping system antigens have been found to have the highest immunogenicity and propensity to produce alloantibodies that cause most of the transfusion reactions. The Rhesus antigens that produce most of the immunogenic transfusion reactions are D, C, c, E, and e. Knowledge of the distribution of these Rh antigens in a population helps to render compatible blood in alloimmunized patients. AIM The aim was to study the distribution and frequency of principal Rh blood group antigens (D, C, c, E, and e) and their phenotypes in the blood donors attending blood bank in a tertiary care hospital in Barpeta district of Assam. MATERIALS AND METHODS The study was conducted in 315 voluntary blood donors in the blood bank of a tertiary care center. Rh-D typing was done by conventional tube method. Specific monoclonal antisera, i.e., anti-C, anti-c, anti-E, and anti-e, were used and tests were performed by conventional tube method for detection of the presence of rest of the major Rh antigens. RESULTS The samples were analyzed for the five major Rhesus antigens. "D" antigen was found to be the most common antigen (99.05%), followed by e (97.14%), C (92.38%), c (51.43%), and E (20.95%). In order of descending frequency, the most common phenotypes were DCCee - 45.71%, DCcee - 30.48%, DCcEe - 11.43%, DccEe - 4.76%, DCcEE - 1.90%, DCCEe - 1.90%, Dccee - 1.90%, DCCEE - 0.95%, and dccee - 0.95%. CONCLUSION D antigen is the most common antigen in our study population, whereas "e" antigen is the most common in most of the studies done from other parts of India. Data on frequencies of major Rh antigens in the local donor population will help in transfusing alloimmunized patients with corresponding antibody-negative blood ensuring blood safety.
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Affiliation(s)
- Dipankar Baruah
- Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Gitali Devi
- Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Jabin Musfique
- Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Abhijit Bharali
- Multi-Disciplinary Research Unit, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Umesh Chandra Dutta
- Department of Pathology, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
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Kasraian L, Khodadi E, Talei A, Morvarid MR, Haddadi D, Foruozandeh H. Red Blood Cell Alloimmunization Rates and Related Factors of Patients with Thalassemia in Shiraz, Iran. Lab Med 2021; 53:194-198. [PMID: 34644379 DOI: 10.1093/labmed/lmab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The development of antibodies against red blood cell (RBC) antigens is one of the most significant adverse effects of chronic blood transfusions. This study aimed to estimate the frequency and causes of RBC immunization in patients with major thalassemia. METHODS The findings could help determine the limitation of current practices and help future developments in the selection of suitable blood units for the transfusion support of patients with thalassemia. RESULTS The alloimmunization rate was detected in 52 of 650 patients with major thalassemia (8%). The most frequent antibodies were against K (50%), D (26%), and E (15.4%). Sex, age, and splenectomy did not have any impact on the immunization rate. Immunization was lower in patients who had received only leuko-reduced blood units. CONCLUSION It is recommended that antibody screening before the first transfusion and extended RBC matching particularly for the most frequent antigens (ABO/Rh/Kell) should be performed for patients with thalassemia.
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Affiliation(s)
- Leila Kasraian
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine-Microbiology Department, Shiraz, Iran
| | - Elahe Khodadi
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abolfazl Talei
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine-Microbiology Department, Shiraz, Iran
| | | | - Davood Haddadi
- Medical Department, Shiraz University of Medical Science, Shiraz, Iran
| | - Hossein Foruozandeh
- Cellular and Molecular Biology Research Center, Larestan University of Medical Sciences, Larestan, Iran
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El-Beshlawy A, Salama AA, El-Masry MR, El Husseiny NM, Abdelhameed AM. A study of red blood cell alloimmunization and autoimmunization among 200 multitransfused Egyptian β thalassemia patients. Sci Rep 2020; 10:21079. [PMID: 33273689 PMCID: PMC7713136 DOI: 10.1038/s41598-020-78333-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
The development of hemolytic erythrocyte alloantibodies and autoantibodies complicates transfusion therapy in thalassemia patients. These antibodies ultimately increase the need for blood and intensify transfusion complications. There is a scanty data on the frequency of RBC alloimmunization and autoimmunization in Egyptian β thalassemia patients as pretransfusion antibody screening is not routinely performed. We studied the frequency of alloimmunization and autoimmunization among 200 multiply transfused β thalassemia patients and investigated the factors that possibly affect antibody formation. Of the 200 patients in our study, 94 were males and 106 females, with the age range of 2–37 years. Alloantibodies were detected in 36 (18%) of the patients, while autoantibodies were detected in 33 (16.5%). The dominant alloantibodies were directed against Kell (33%) and Rh (24.4%) groups. Alloimmunization had a significant relationship with treatment duration and the frequency of transfusion (P = 0.007, 0.001, respectively). The presence of autoantibodies was significantly related to age (P = 0.001), total number of transfused units (P = 0.000) and splenectomy (P = 0.000). The high prevalence of alloimmunization in the study population disclosed the need for providing phenotypically matched cells for selective antigens especially for Kell and Rh subgroups to reduce risk of alloimmunization and increase the efficiency of blood transfusion.
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Affiliation(s)
- Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Roshdy El-Masry
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M El Husseiny
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Asmaa M Abdelhameed
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt. .,Armed Forces College of Medicine (AFCM), Cairo, Egypt.
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Abdulqader AMR, Mohammed AI, Mohammed NI. Red Cell Alloimmunization and Autoimmunization in Multi-Transfused Thalassemia Patients in Sulaymaniyah Province-Iraq. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.2.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Ali Ibrahim Mohammed
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
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9
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Al-Riyami AZ, Daar S. Red cell alloimmunization in transfusion-dependent and transfusion-independent beta thalassemia: A review from the Eastern Mediterranean Region (EMRO). Transfus Apher Sci 2019; 58:102678. [DOI: 10.1016/j.transci.2019.102678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 01/19/2023]
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10
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Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:4-15. [PMID: 30653458 DOI: 10.2450/2019.0229-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. MATERIALS AND METHODS We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. RESULTS The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). DISCUSSION Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.
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Poornima AP, Fazal S, Shaiji PS, Usha KC, Kailas L. Red Blood Cell Alloimmunization in Multitransfused Pediatric Population in a Tertiary Care Hospital. Indian J Pediatr 2019; 86:245-249. [PMID: 30515703 DOI: 10.1007/s12098-018-2815-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/23/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To estimate the prevalence and specificity pattern of red blood cell (RBC) alloimmunization among pediatric multitransfused patients, and to identify the factors associated with alloimmunization. METHODS This was a descriptive cross-sectional study conducted among mutitransfused pediatric patients over a period of two years. The relevant clinical details of patients were collected, and RBC antibody screening was done. Samples with positive antibody screen were subjected to antibody identification. Patient factors were analysed to find any significant relation to the development of RBC alloimmunization. RESULTS Alloantibodies were obtained in 4 (6.35%) of the total 63 patients, and autoantibody in 1 (1.59%). The specificities of alloantibodies identified were all against Rh antigens-one each of anti E, anti c, anti Cw and anti D + anti C. A significant association was seen between development of alloimmunization and first transfusion at more than 2 y of age. CONCLUSIONS RBC alloimmunization against Rhesus (Rh) antigens is a significant problem for multitransfused children in our population. Extended RBC phenotyping at least for antigens of the Rh system and provision of antigen matched RBCs may be an option for such children, where ongoing transfusion requirement is anticipated.
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Affiliation(s)
- A P Poornima
- Department of Transfusion Medicine, Government Medical College, Thiruvananthapuram, Kerala, 695011, India.
| | - Shiffi Fazal
- Department of Transfusion Medicine, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - P S Shaiji
- Department of Transfusion Medicine, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - K C Usha
- Department of Transfusion Medicine, Government Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - Lalitha Kailas
- Department of Pediatrics, Government Medical College, Thiruvananthapuram, Kerala, India
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Thedsawad A, Taka O, Wanachiwanawin W. Prevalence and clinical significances of red cell alloimmunization and red cell bound immunoglobulin G in polytransfused patients with thalassemias. Hematology 2018; 24:208-214. [DOI: 10.1080/16078454.2018.1549818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Anchalee Thedsawad
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Orathai Taka
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanchai Wanachiwanawin
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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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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Al-Riyami AZ, Al-Muqbali A, Al-Sudiri S, Murthi Panchatcharam S, Zacharia M, Al-Mahrooqi S, Al-Hosni S, Al-Marhoobi A, Daar S. Risks of red blood cell alloimmunization in transfusion-dependent β-thalassemia in Oman: a 25-year experience of a university tertiary care reference center and a literature review. Transfusion 2018; 58:871-878. [DOI: 10.1111/trf.14508] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/04/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Arwa Z. Al-Riyami
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ayman Al-Muqbali
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | - Saif Al-Sudiri
- College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
| | | | - Mathew Zacharia
- Department of Child Health; Sultan Qaboos University Hospital; Muscat Oman
| | - Sabah Al-Mahrooqi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Saif Al-Hosni
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Ali Al-Marhoobi
- Department of Hematology; Sultan Qaboos University Hospital; Muscat Oman
| | - Shahina Daar
- Department of Hematology, College of Medicine and Health Sciences; Sultan Qaboos University; Muscat Oman
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Gundrajukuppam DK, Vijaya SBK, Rajendran A, Sarella JD. Prevalence of Principal Rh Blood Group Antigens in Blood Donors at the Blood Bank of a Tertiary Care Hospital in Southern India. J Clin Diagn Res 2016; 10:EC07-10. [PMID: 27437223 DOI: 10.7860/jcdr/2016/16621.7726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rhesus (Rh) antigen was discovered in 1940 by Karl Landsteiner and Wiener. Due to its immunogenicity along with A, B antigens, Rh D antigen testing was made mandatory in pre-transfusion testing. Presently there are more than 50 antigens in Rh blood group system but major ones are D, C, E, c, and e. Very few reports are available regarding their prevalence in India and no reports are available from Andhra Pradesh. AIM To study the prevalence of principal Rh blood group antigens like D, C, E, c & e in the voluntary blood donors attending our blood bank. MATERIALS AND METHODS A prospective cross-sectional non interventional study was carried out on 1000 healthy blood donors from August 2013 to July 2014 at our blood bank. Donors were grouped and typed for ABO and Rh major antigens using monoclonal blood grouping reagents as per the manufacturer's instructions. Statistical analysis was carried out using SPSS version 16. Comparison of categorical data between antigen positive and negative individuals was done using Chi-square test. Descriptive statistics for the categorical variables were performed by computing the frequencies (percentages) in each category. Incidence was given in proportion with 95% confidence interval. RESULTS A total of 1000 blood samples from donors were phenotyped. Among Rh antigens, e was the most common antigen (98.4%), followed by D-94.1%, C-88%, c-54.9% and E-18.8% with DCe/DCe (R1R1) (43.4%) being the most common phenotype and the least common phenotype is r'r' (0.1%). CONCLUSION Database for antigen frequency to at least Rh blood group system in local donors helps to provide antigen negative blood to patients with multiple alloantibodies, minimize alloimmunization rate, and thereby improve blood safety.
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Affiliation(s)
| | | | - Arun Rajendran
- Assistant Professor, Department of Transfusion Medicine, SVIMS , Tirupati, Andhra Pradesh, India
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Abdelrazik AM, Elshafie SM, El Said MN, Ezzat Ahmed GM, Al-Gamil AKA, El Nahhas MGM, Sady AAB. Study of red blood cell alloimmunization risk factors in multiply transfused thalassemia patients: role in improving thalassemia transfusion practice in Fayoum, Egypt. Transfusion 2016; 56:2303-7. [PMID: 27351342 DOI: 10.1111/trf.13695] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND β-Thalassemia is considered the most common chronic hemolytic anemia in Egypt. Alloimmunization can lead to serious clinical complications in transfusion-dependent patients. The objective of this study was to determine the frequency and types of alloantibodies, and, in addition, to study the risk factors that might influence alloimmunization in multiply transfused thalassemia patients in Fayoum, Egypt, with the goal that this study could help minimize some of the transfusion-associated risks in those patients. STUDY DESIGN AND METHODS A total of 188 multiply transfused thalassemia patients attending Fayoum University Hospital were analyzed. Alloantibody identification was performed by DiaMed-ID microtyping system. RESULTS Alloimmunization prevalence was 7.98%. The most common alloantibody was D-related; anti-D was the most frequent alloantibody found in eight of the 188 patients (4.25 %), followed by anti-C in two patients (1.1%), anti- E in two (1.1 %), anti-c in two (1.1 %), anti-Fya in two (1.1%), anti-K in one (0.53 %), and an unknown antibody in one patient (0.53%). Higher rates of alloimmunization were found in female patients, in patients with β-thalassemia intermedia, in splenectomized patients, in D- patients, and in patients who started blood transfusion after 3 years of age. CONCLUSION The study reemphasizes the need for cost-effective strategy for thalassemia transfusion practice in developing countries. Red blood cell antigen typing before transfusion and issue of antigen-matched or antigen-negative blood can be made available to alloimmunized multiply transfused patients. Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.
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Affiliation(s)
| | | | - Manal Niazi El Said
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
| | - Ghada M Ezzat Ahmed
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
| | | | | | - Ahmed Ali Badie Sady
- Clinical Pathology Department, Faculty of Medicine, DewanAam El Mohafza, Fayoum, Egypt
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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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Davari K, Soltanpour MS. Study of alloimmunization and autoimmunization in Iranian β-thalassemia major patients. Asian J Transfus Sci 2016; 10:88-92. [PMID: 27011679 PMCID: PMC4782503 DOI: 10.4103/0973-6247.172179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Thalassemia is one of the most common monogenic disorders characterized by reduced production of globin chains. Although regular red blood cell (RBC) transfusion support is the main treatment for these patients, it may be associated with complications such as RBC alloimmunization. Aim: The study aimed to determine the incidence of alloimmunization and autoimmunization to RBC antigens in β-thalassemia major patients from Zanjan, Zanjan Province, Iran. Materials and Methods: A total of 49 β-thalassemia major patients comprising 24 females and 25 males (mean age: 18.59 ± 8.16 years; range: 2-40 years) from Northwest Iran were included in a cross-sectional study. Alloantibody screening and identification were done using 3-cell and 10-cell reagent red blood cells, respectively. Autoantibody detection was performed using direct Coomb's test. Results: The incidence of alloimmunization was 16.32% with 10 alloantibodies identified in 8 patients. The most common clinically significant alloantibody identified in alloimmunized patients was anti-Kell (K-antigen) (60%) followed by anti-Rhesus (Rh) (E, c-antigens). The rate of alloimmunization was significantly lower in patients transfused with leukoreduced RBCs compared with those transfused with nonleukoreduced RBCs (9.53% vs 57.14%, P = 0.001). There was no significant correlation between alloantibody formation and the age, gender, hemoglobin levels, number of transfused units, and splenectomy. Conclusion: Transfusion of leukoreduced and phenotypically matched red blood cells for Kell (K) and Rh (E, c) antigens may help reduce the alloimmunization rate in Iranian β-thalassemia major patients. Moreover, autoimmunization to RBC antigens was rare in our patients.
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Affiliation(s)
- Kambiz Davari
- Department of Pediatrics, School of Medical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Soleiman Soltanpour
- Department of Laboratory Sciences, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
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Frequency of Red Cell Alloimmunization and Autoimmunization in Thalassemia Patients: A Report from Eastern India. Adv Hematol 2015; 2015:610931. [PMID: 26425124 PMCID: PMC4575732 DOI: 10.1155/2015/610931] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/05/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Red blood cell (RBC) alloimmunization and autoimmunization remain a major problem in transfusion dependent thalassemic patients. There is a paucity of data on the incidence of RBC alloimmunization and autoimmunization in thalassemic patients from eastern part of India, as pretransfusion antibody screening is not routinely performed. Aims. To assess the incidence of RBC alloimmunization and autoimmunization in transfusion dependent thalassemic patients in eastern India. Materials and Methods. Total 500 thalassemia cases were evaluated. The antibody screening and identification were performed with commercially available panel cells (Diapanel, Bio-rad, Switzerland) by column agglutination method. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG + C3d) gel cards in all patients. Results. A total of 28 patients developed RBC alloimmunization (5.6%) and 5 patients had autoantibodies (1%). Alloantibody against c had the highest incidence (28.57%) followed by E (21.42%). Five out of 28 (17.85%) patients had developed antibodies against both c and E. Conclusion. Data from this study demonstrate that the RBC alloantibody and autoantibody development rates are significant in our region. Thus, pretransfusion antibody screening needs to be initiated in eastern India in order to ensure safe transfusion practice.
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Romdhane H, Amara H, Abdelkefi S, Souyeh N, Chakroun T, Jarrey I, Bouslama M, Belhedi S, Houissa B, Boughammoura L, Jemni Yacoub S. [Clinico-biological and immunohaematological profile of patients with β-thalassemia in Tunisia: about 26 cases]. Transfus Clin Biol 2014; 21:309-13. [PMID: 25458984 DOI: 10.1016/j.tracli.2014.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/01/2014] [Indexed: 11/25/2022]
Abstract
AIM OF THE STUDY To study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care. PATIENTS AND METHODS A retrospective study (2010-2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level>10g/dL by regular transfusions every 3-4 weeks. Iron chelation therapy, in order to maintain serum ferritin<1500ng/mL, was introduced when serum ferritin exceeded 800-1000ng/mL. RESULTS The mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications. CONCLUSION Improving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.
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Affiliation(s)
- H Romdhane
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie.
| | - H Amara
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - S Abdelkefi
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - N Souyeh
- Service de pédiatrie clinique, hôpital Farhat-Hached, Sousse, Tunisie
| | - T Chakroun
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - I Jarrey
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - M Bouslama
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - S Belhedi
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - B Houissa
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
| | - L Boughammoura
- Service de pédiatrie clinique, hôpital Farhat-Hached, Sousse, Tunisie
| | - S Jemni Yacoub
- Centre régional de transfusion sanguine, hôpital Farhat-Hached, Sousse, Tunisie
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Philip J, Kumar S, Chatterjee T, Mallhi RS. Prevalence of Alloimmunization to Human Platelet Antigen Glycoproteins and Human Leucocyte Antigen Class I in β Thalassemia Major Patients in Western India. Indian J Hematol Blood Transfus 2014; 30:309-12. [PMID: 25435733 DOI: 10.1007/s12288-013-0297-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022] Open
Abstract
Present management of β thalassemia major by regular packed red blood cell (PRBC) transfusions poses risk of alloimmunization not only to red blood cell antigens, but also to human platelet antigens (HPA) and Human leucocyte antigens class I (HLA I). However data in this context is very limited in Indian population. The aim of the study was to determine the prevalence of alloimmunization to HPA and HLA I in β thalassemia major patients who have received multiple PRBC transfusions over the years. A cross sectional study was performed at our tertiary care blood bank. β thalassemia major patients of more than 6 years of age were included who were receiving fresh, leucoreduced and irradiated PRBC units regularly with annual requirement of more than ten PRBC transfusions. A total of 9 out of 80 (11.25 %) patients were found to be alloimmunized for HPA antigens of various specificity and 24 out of 80 (30 %) developed antibodies to HLA I. The awareness of development of alloimmunization to HPA and HLA antigens in multi PRBC transfused thalassemics, despite use of leucofilters will prompt us, to look for improvement in our current PRBC preparations to minimise platelet alloimmunisation. Further studies are required to validate the findings and build the base line data in this regard. This is of importance, especially in view of providing suitable cross-matched platelets when required in future especially when considering future haematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Joseph Philip
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, India
| | - Sudeep Kumar
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, India
| | - T Chatterjee
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, India
| | - R S Mallhi
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, India
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Dhawan HK, Kumawat V, Marwaha N, Sharma RR, Sachdev S, Bansal D, Marwaha RK, Arora S. Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients. Asian J Transfus Sci 2014; 8:84-8. [PMID: 25161344 PMCID: PMC4140069 DOI: 10.4103/0973-6247.137438] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies. MATERIALS AND METHODS The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards. RESULTS Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C(w) = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system. CONCLUSION Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.
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Affiliation(s)
| | - Vijay Kumawat
- Department of Pathology, Shaheed Hasan Khan Mewati, Government Medical College, Nalhar (Mewat), Haryana, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, PGIMER, Chandigarh, India
| | | | - Suchet Sachdev
- Department of Transfusion Medicine, PGIMER, Chandigarh, India
| | | | | | - Satyam Arora
- Department of Transfusion Medicine, RML Hospital, New Delhi, India
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Goss C, Giardina P, Degtyaryova D, Kleinert D, Sheth S, Cushing M. Red blood cell transfusions for thalassemia: results of a survey assessing current practice and proposal of evidence-based guidelines. Transfusion 2014; 54:1773-81. [PMID: 24611697 DOI: 10.1111/trf.12571] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the absence of curative treatment, such as stem cell transplant, regular transfusions remain the mainstay of therapy for individuals with thalassemia major, a syndrome that results from marked ineffective erythropoiesis and the resultant anemia. The primary objectives of transfusion therapy are twofold: to suppress ineffective erythropoiesis and to ensure appropriate growth and development through childhood. In practice, a number of different transfusion protocols are in use across the developed world, with on-demand transfusion still being the paradigm in most of the developing world with limited resources. STUDY DESIGN AND METHODS To investigate perceived differences in transfusion practice, a self-reported electronic survey was disseminated to eight US thalassemia treatment centers in February 2011. The survey was divided into sections ranging from laboratory and clinical practices to emerging transfusion-transmitted diseases. RESULTS The survey response rate was 100%. The total number of transfused patients was 411. One-hundred percent of institutions used leukoreduced blood. No centers routinely provided cytomegalovirus-seronegative red blood cells (RBCs). Half the centers provided irradiated RBCs; only one routinely provided washed RBCs, and none transfused RBCs of defined storage age. Seventy-five percent of centers routinely phenotyped thalassemia patients' RBC antigens; 50% prophylactically matched for Rh and K antigens. The frequency of antibody investigations varied widely, and 25% of centers routinely medicated patients before transfusion. CONCLUSION Eight thalassemia centers in the United States were surveyed to determine the uniformity of transfusion practice. The variability of the results was surprising. Consequently, we performed a literature review and propose an evidence-based protocol for routine transfusion therapy for patients with thalassemia.
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Affiliation(s)
- Cheryl Goss
- Departments of Transfusion Medicine and Pediatrics, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
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Matteocci A, Pierelli L. Red blood cell alloimmunization in sickle cell disease and in thalassaemia: current status, future perspectives and potential role of molecular typing. Vox Sang 2013; 106:197-208. [PMID: 24117723 DOI: 10.1111/vox.12086] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 07/18/2013] [Accepted: 08/21/2013] [Indexed: 01/19/2023]
Abstract
Red blood cell (RBC) transfusions are a milestone in the treatment for sickle cell anaemia (SSA) and for thalassaemia. RBC alloimmunization remains a major challenge of chronic transfusion therapy, and it can lead to adverse life-threatening events. The alloimmunization risk could depend on multiple factors such as the number of transfusions and, most of all, the genetic background. Different ethnic groups are predisposed to immunization because of a significant degree of RBC antigenic mismatch between donor and recipient. There is no universal agreement and standards for the most appropriate selection of RBC units in chronically transfused subjects. Current practice only deals with compatibility of ABO, Rh and K antigens. Molecular RBC antigenic matching extended to other blood group systems is an innovative strategy to ensure a better quality and effectiveness of transfusion therapy.
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Affiliation(s)
- A Matteocci
- Immunohematology and Transfusion Medicine Unit, Transfusion Medicine Department, San Camillo Forlanini Hospital, Rome, Italy
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Is Female Sex a Risk Factor for Red Blood Cell Alloimmunization After Transfusion? A Systematic Review. Transfus Med Rev 2012; 26:342-53, 353.e1-5. [DOI: 10.1016/j.tmrv.2011.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Xu LH, Fang JP, Weng WJ, Huang K, Zhang YT. Autoimmune hemolytic anemia in patients with β-thalassemia major. Pediatr Hematol Oncol 2012; 29:235-40. [PMID: 22475299 DOI: 10.3109/08880018.2012.666782] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hemolysis is a common feature in patients with β-thalassemia major. As a result, autoimmune hemolytic anemia complicating β-thalassemia is easily overlooked. Here, the authors described the clinical features and management of 7 patients with β-thalassemia major and autoimmune hemolytic anemia. These patients had fever, cough, and tea-colored urine on admission. The laboratory investigations showed a significant drop in hemoglobin and increased serum bilirubin. Coombs' tests revealed that anti-immunoglobulin G (IgG) and anti-C3 was positive in 7 and 5 cases, respectively, whereas anti-Rh E alloantibody was positive in 3 cases. All the patients received corticosteroids treatments and blood transfusions. Patients with anti-Rh E alloantibodies also received immunoglobulin treatments. Six of the patients responded well to the management, but 1 patient developed recurrent autoimmune hemolytic anemia that required cyclosporin A treatment. All the patients remained well by following up for more than 6 months.
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Affiliation(s)
- Lu-Hong Xu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen University, Guangzhou, China
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