Management of alloimmunized patients

Alternative to Blood Replacement in the Critically Ill

This article reviews treatments and strategies that can be used to reduce, or as adjuncts to, blood transfusion to manage blood volumes in patients who are critically ill. Areas addressed include iatrogenic anemia, fluid management, pharmaceutical agents, hemostatic agents, hemoglobin-based oxygen carriers, and management of patients for whom blood is not an option.

Clinically significant red blood cell antibodies in chronically transfused patients: a survey of Chinese thalassemia major patients and literature review

BACKGROUND

Red blood cell (RBC) alloimmunization is reported to occur at an incidence of 5.2% to 23.5% among patients with thalassemia requiring chronic transfusion. With very limited data on alloimmunization among the Chinese population, a territory-wide study has been performed to look at its prevalence among Chinese thalassemia major patients.

STUDY DESIGN AND METHODS

A retrospective study was conducted by reviewing RBC request records for patients with thalassemia major in Hong Kong from 2006 to 2009. Demographic information and serologic data were retrieved for analysis.

RESULTS

A total of 382 patients were identified and consisted of 190 males and 192 females with a median age of 23 ± 10.4 (range, 0.25 to 52) years. Eighty-eight patients (23.0%) were reported to have RBC antibodies. Of them, 114 alloantibodies, 18 autoantibodies, and 19 unidentified antibodies were identified. Anti-E (42, 39.3%), anti-Mi(a)/Mur (33, 30.85%), anti-c (14, 13.1%), and anti-Jk(a) (seven, 6.55%) were the commonest antibodies reported. However, one case of anti-K (0.9%) and two cases of anti-Fy(b) (1.9%) were reported. Seven of the 18 patients with autoantibodies contained a total of 13 alloantibodies. They were anti-E (five, 38.4%), anti-Mi(a)/Mur (four, 30.8%), anti-Jk(a) (two, 15.4%), anti-c (one, 7.7%), and anti-Fy(b) (one, 7.7%).

CONCLUSION

It is the first comprehensive study on Chinese thalassemia major patients. Clinically significant alloantibodies are different from those observed in the Western population, although antibodies developed against Rh antigens are still common. Chinese patients are less likely to have antibodies against Kell and Duffy blood group antigens, but are more prone to develop antibodies against the Miltenberger antigens.