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Ning S, Morin PA, Elahie A, Li N, Liu Y, Barty R, Clarke G, Zeller M, Heddle NM. KEL1 negative red cell transfusions for females of current or future child-bearing potential: A clinical impact and feasibility study. Transfusion 2023; 63:59-68. [PMID: 36519693 DOI: 10.1111/trf.17201] [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: 03/16/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anti-K is an alloantibody stimulated in response to the KEL1 antigen and may cause hemolytic disease of the fetus and newborn (HDFN). Provision of KEL1 negative blood to females of child-bearing potential was not our practice. We assessed the impact of our policy and assessed feasibility of a KEL1 negative transfusion policy. STUDY DESIGN AND METHODS This is a cohort study spanning Jan 1, 2007-Jun 30, 2017 in Hamilton, Canada. Data were obtained via our institution's transfusion database. Chart reviews of females age ≤45 with anti-K were performed; data on RBC KEL1 phenotype were obtained from the blood supplier when needed to ascertain the cause of alloimmunization. Descriptive analysis of hospital KEL1 negative inventory demand and supply was performed. RESULTS From Jan 2007-Jun 2017, 8.6% of all RBC units transfused were provided to females age ≤45. There were 111 females with detectable anti-K. Median age at time of antibody detection was 34 years (interquartile range 27-40) and 28 of 111 (25.2%) patients may have been alloimmunized by transfusion. Of 49 pregnancies, seven had complications due to anti-K. We estimated that our existing RBC inventory (with 16% units known to be KEL1 negative in 2017) is sufficient to meet demand and support a KEL1 negative transfusion policy for females age ≤45. CONCLUSION Transfusion was responsible for alloimmunization in 25% of females with anti-K over 10 years. Analysis of supply and demand can be used to inform feasibility of a KEL1 negative transfusion policy.
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Affiliation(s)
- Shuoyan Ning
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Hamilton, Ontario, Canada
- Department of Pathology, Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada
| | - Pierre-Aurele Morin
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Allahna Elahie
- Department of Pathology, Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada
| | - Na Li
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yang Liu
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Gwen Clarke
- Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada
| | - Michelle Zeller
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Hamilton, Ontario, Canada
- Department of Pathology, Hamilton Regional Laboratory Medicine Program, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Centre for Innovation, Ottawa, Ontario, Canada
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Luken JS, Folman CC, Lukens MV, Meekers JH, Ligthart PC, Schonewille H, Zwaginga JJ, Janssen MP, van der Schoot CE, van der Bom JG, de Haas M. Reduction of anti-K-mediated hemolytic disease of newborns after the introduction of a matched transfusion policy: A nation-wide policy change evaluation study in the Netherlands. Transfusion 2021; 61:713-721. [PMID: 33528025 PMCID: PMC7986406 DOI: 10.1111/trf.16276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND During pregnancy, maternal red blood cell (RBC) antibodies can lead to life-threatening fetal hemolysis and anemia. Women can become immunized by a pregnancy or an unmatched transfusion. Our aim was to quantify the effect of a nationwide K-matched transfusion policy for women of childbearing age potential to prevent K-immunization in pregnancy. STUDY DESIGN AND METHODS In this nation-wide policy change evaluation study we determined the occurrence of RBC antibodies before and after introduction of a K-matched transfusion policy and evaluated the cause K alloimmunization 10 years after introduction of this measure. K-matched transfusion for females under 45 years of age is advised in the Dutch transfusion guideline since 2004. We used laboratory data from pregnancies with RBC antibodies identified in the period 1999-2018 obtained as part of a population-based screening program in the Netherlands. RESULTS Tests of 36 286 pregnancies produced a positive antibody screening result which concerned anti-K in 1550 pregnancies. The occurrence of anti-K decreased from 67.9 to 20.2 per 100 000 pregnancies. The relative risk reduction was 0.70 which largely exceeded the relative risk reduction of 0.27 for antibodies against RBC antigens for which no preventive matching is required. The number of pregnancies at risk for anti-K-mediated disease decreased from 9.7 to 4.2 per 100 000 pregnancies. CONCLUSIONS A K-matched transfusion policy is associated with a major decrease in a number of pregnant women with anti-K and pregnancies at risk for anti-K-mediated disease. A relatively simple measure is now shown to impact prevention of hemolytic disease in the fetus and newborn.
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Affiliation(s)
- Jessie S Luken
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Claudia C Folman
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Johan H Meekers
- Department of Laboratory Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Peter C Ligthart
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Henk Schonewille
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Department, Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - C Ellen van der Schoot
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, University of Amsterdam, Amsterdam, 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
| | - Masja de Haas
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
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Gupta GK, Balbuena-Merle R, Hendrickson JE, Tormey CA. Immunohematologic aspects of alloimmunization and alloantibody detection: A focus on pregnancy and hemolytic disease of the fetus and newborn. Transfus Apher Sci 2020; 59:102946. [PMID: 32962917 DOI: 10.1016/j.transci.2020.102946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Alloimmunization to non-ABO, red blood cell (RBC) antigens remains one of the most clinically-relevant complexities faced by blood banking practitioners. In the setting of transfusion therapy, these antibodies raise risks for incompatibilities, while for pregnant patients they can mediate deadly forms of hemolytic disease of the fetus and newborn. As such, a thorough understanding of pathways that lead to alloimmunization, as well as the tools used by blood banks to detect alloantibodies, is critical to transfusion practice. In this review, in which alloimmunization in the setting of pregnancy will be emphasized, we will review: 1) the clinical impacts of RBC alloantibodies in the peri-partum period; 2) the current pathophysiologic mechanisms thought to influence non-ABO antigen alloimmunization; 3) the strengths and weaknesses of laboratory tools used in aiding alloimmunization detection; and 4) future directions of the transfusion community related to alloimmunization impacting pregnancy.
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Affiliation(s)
- Gaurav K Gupta
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Raisa Balbuena-Merle
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States; Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States.
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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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