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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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Ouadghiri S, El Morabit K, Elansari N, Atouf O, Elkababri M, Hessissen L, Essakalli M. Human leukocyte antigen immunization in transfusion-dependent Moroccan patients with beta-thalassemia major: prevalence and risk factors. Hematol Transfus Cell Ther 2023:S2531-1379(23)00086-X. [PMID: 37244818 DOI: 10.1016/j.htct.2023.03.023] [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: 09/28/2022] [Revised: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Beta-thalassemia major patients need a regular blood transfusion to have an initial normal growth. However, these patients have an increased risk of developing alloantibodies. Our main goal was to study HLA alloimmunization in Moroccan Beta-thalassemia patients by confronting it with transfusion and demographic criteria, exploring the involvement of HLA typing profile in the development of HLA antibodies and in turn determining risk factors for their development. METHODS The study consisted of 53 Moroccan pediatric patients with Beta-thalassemia major. Screening for HLA alloantibodies was performed using Luminex technology Whereas HLA genotyping was done with sequence-specific primers (PCR-SSP). RESULTS In this study, 50.9% of patients have been identified as positive for HLA antibodies, with 59.3% having both HLA Class I and Class II antibodies. A significant increase frequency of DRB1*11 allele was revealed in non-immunized patients (34.6% vs. 0%, p = 0.001). Our results also revealed that the majority of our HLA immunized patients were women (72.4% vs. 27.6%, p = 0.001), and transfused with more than 300 units of RBC units (66.7% vs. 33.3%, p = 0.02). There were statistically significant differences when comparing these frequencies. CONCLUSIONS This paper revealed that the transfusion dependent Beta-thalassemia major patients are exposed to risk of developing HLA antibodies following transfusions with leukoreduced RBC units. The HLA DRB1*11 was a protective factor against HLA alloimmunization in our beta-thalassemia major patients.
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Affiliation(s)
- Sanae Ouadghiri
- Blood Transfusion, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco.
| | | | - Naoual Elansari
- Pediatric Oncology center of the children's Hospital, Ibn Sina University Hospital, Rabat, Morocco
| | - Ouafae Atouf
- Blood Transfusion, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Maria Elkababri
- Pediatric Oncology center of the children's Hospital, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Laila Hessissen
- Pediatric Oncology center of the children's Hospital, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
| | - Malika Essakalli
- Blood Transfusion, Ibn Sina University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco
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Li N, Wu B, Wang J, Yan Y, An P, Li Y, Liu Y, Hou Y, Qing X, Niu L, Ding X, Xie Z, Zhang M, Guo X, Chen X, Cai T, Luo J, Wang F, Yang F. Differential proteomic patterns of plasma extracellular vesicles show potential to discriminate β-thalassemia subtypes. iScience 2023; 26:106048. [PMID: 36824279 PMCID: PMC9941134 DOI: 10.1016/j.isci.2023.106048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The observed specificity of β-thalassemia-subtype phenotypes makes new diagnostic strategies that complement current screening methods necessary to determine each subtype and facilitate therapeutic regimens for different patients. Here, we performed quantitative proteomics of plasma-derived extracellular vesicles (EVs) of β-thalassemia major (TM) patients, β-thalassemia intermedia (TI) patients, and healthy controls to explore subgroup characteristics and potential biomarkers. Plasma quantitative proteomics among the same cohorts were analyzed in parallel to compare the biomarker potential of both specimens. EV proteomics showed significantly more abnormalities in immunity and lipid metabolism in TI and TM, respectively. The differential proteomic patterns of EVs were consistent with but more striking than those of plasma. Notably, we also found EV proteins to have a superior performance for discriminating β-thalassemia subtypes. These findings allowed us to propose a diagnostic model consisting of five proteins in EVs with subtyping potential, demonstrating the ability of plasma-derived EVs for the diagnosis of β-thalassemia patients.
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Affiliation(s)
- Na Li
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Bowen Wu
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jifeng Wang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Yumeng Yan
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Peng An
- Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Yuezhen Li
- Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Yuning Liu
- Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Yanfei Hou
- Department of Nutrition and Health, China Agricultural University, Beijing 100193, China
| | - Xiaoqing Qing
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lili Niu
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiang Ding
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhensheng Xie
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Mengmeng Zhang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiaojing Guo
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiulan Chen
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tanxi Cai
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jianming Luo
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021 China
| | - Fudi Wang
- The Fourth Affiliated Hospital, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Fuquan Yang
- Key Laboratory of Protein and Peptide Pharmaceuticals & Laboratory of Proteomics, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
- University of Chinese Academy of Sciences, Beijing 100049, China
- Corresponding author
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5
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Garraud O, Chiaroni J. An overview of red blood cell and platelet alloimmunisation in transfusion. Transfus Clin Biol 2022; 29:297-306. [PMID: 35970488 DOI: 10.1016/j.tracli.2022.08.140] [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: 01/19/2023]
Abstract
Post-transfusion alloimmunisation is the main complication of all those observed after one or more transfusion episodes. Alloimmunisation is observed after the transfusion of red blood cell concentrates but also of platelet concentrates. Besides alloimmunisation due to antigens carried almost exclusively by red blood cells such as those of the Rhesus-Kell system, alloimmunisation often raises against HLA antigens; the main responsibility for that, apart from platelet transfusions, lies with residual leukocytes in the products transfused, hence the central importance of effective leukoreduction right from the blood product preparation stage. Alloimmunization is not restricted to transfusion, but it is also observed during pregnancies, carrying out microtransfusions of blood from the fetus immunizing the mother through the placenta (in a retrograde way). Preexisting maternal-fetal immunization can complicate a transfusion program and intensify the creation of alloantibodies in several blood and tissue group systems. The occurrence of autoantibodies, created by several pathogenic reasons, can also interfere with the propensity of certain recipients of blood components to produce alloantibodies. The genetic condition of individuals is in fact strongly linked to the ability or not to recognize antigenic variants foreign to their own biological program and mount an alloimmune response. Some hemoglobin diseases, in carriers of which transfusions can be iterative and lifelong, are complicated by frequent alloimmunizations and amplification of the complications of these alloimmunizations, imposing even stricter transfusion rules. This review details the mechanisms favoring the occurrence of alloimmunization and the immunological principles for the production of molecular and cellular tools for alloimmunization. It concludes with the main preventive measures available to limit the occurrence of these frequent complications of varying severity but sometimes severe.
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Affiliation(s)
- Olivier Garraud
- Sainbiose-Inserm_U1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France.
| | - Jacques Chiaroni
- Etablissement Français du Sang Provence-Alpes-Côte d'Azur-Corse, 13005 Marseille, France; Biologie des Groupes Sanguins, EFS, CNRS, ADES, Aix Marseille University, 13005 Marseille, France
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6
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Patterson S, Singleton A, Branscomb J, Nsonwu V, Spratling R. Transfusion Complications in Thalassemia: Patient Knowledge and Perspectives. Front Med (Lausanne) 2022; 9:772886. [PMID: 35299838 PMCID: PMC8923080 DOI: 10.3389/fmed.2022.772886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/19/2022] [Indexed: 01/19/2023] Open
Abstract
Chronic transfusion, used to manage clinically significant forms of thalassemia, carries complication risks including iron overload, alloimmunization, and allergic or hemolytic reactions. Dissemination and implementation of evidence-based guidelines for minimizing these risks are complicated by the small numbers and increasing dispersion of the thalassemia population. This elevates patients' role in understanding and communicating with providers about treatment. The present study sought to assess thalassemia patients' knowledge of transfusion, complications, and guidelines; their experience of clinicians' following guidelines; and their perspectives on ways to store and share personal transfusion data. A convenience sample of 32 patients participated in structured interviews. Most, if not all, understood iron overload, chelation therapy, blood typing, and cross-matching. Awareness of each of five of evidence-based transfusion guidelines that were discussed ranged from 72 to 88%. Patients expressed privacy concerns about each of three data storage options, slightly less for a registry than for a wallet card or smartphone app. The registry also avoided concerns that the other options placed extra burden on patients. Recommendations include increased education on the meaning and significance of packed, washed red blood cells, leuko-reduction, and detailed cross-matching, and implementation of a nationwide registry to make transfusion data available to providers anywhere at the point of care. Registry implementation should be sensitive to patients' privacy and security concerns, but also help them appropriately weigh those against safety benefits. These actions could help reduce transfusion complications in thalassemia by improving patient efficacy and increasing adherence to evidence-based guidelines.
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Affiliation(s)
- Sashoy Patterson
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States
| | - Ashley Singleton
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States
| | - Jane Branscomb
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, United States
| | - Vivien Nsonwu
- School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - Regena Spratling
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, United States
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Tauscher C, Moldenhauer S, Bryant S, DiGuardo M, Jacob EK. Antibody incidence and red blood cell transfusions in patients on daratumumab. Transfusion 2021; 61:3468-3472. [PMID: 34617617 DOI: 10.1111/trf.16687] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/16/2021] [Accepted: 09/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Daratumumab (Dara), an anti-CD38 monoclonal antibody for hematologic malignancies, interferes with routine blood bank testing, specifically affecting the antibody screen and identification panels. In 2016, the AABB recommended performing a baseline phenotype or genotype before a patient (Pt) begins taking anti-CD38 to avoid this interference and potential problems with transfusion. The objective of this study was to assess red blood cell (RBC) utilization and subsequent incidence of alloimmunization to the transfused RBCs in patients receiving Dara. METHODS AND MATERIALS We monitored 244 patients taking Dara to determine their red blood cell transfusions and incidence of clinically significant antibody formation before and following administration of Dara. Poisson generalized estimating equations with log link were used comparing the post-Dara incidence and prevalence to those prior, with significance defined as p < .05. RESULTS From September 1, 2015 to December 22, 2018, 244 patients on Dara were identified, of which 145 patients (59.4%) received a red blood cell transfusion. Antibody screens were performed on 97 of the 145 patients at least 2 weeks following RBC transfusion. Four of the total transfused patients (2.8% total, 4.1% patients with follow-up antibody screen testing) formed new clinically significant alloantibodies, which was not significantly different from Asare's hematologic incidence (p = .98/p = .49). CONCLUSIONS This study showed our patients on Dara did not form alloantibodies following RBC transfusion at a higher incidence than similar patient populations.
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Affiliation(s)
- Craig Tauscher
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sheila Moldenhauer
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sandra Bryant
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaret DiGuardo
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eapen K Jacob
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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8
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Ang AL, Lim CY, Ng WY, Lam JCM. Non-transfusion dependent thalassemia is independently associated with higher alloimmunization risk than transfusion dependent thalassemia and would benefit the most from extended red cell antigen-matching. Transfusion 2021; 61:2566-2577. [PMID: 34258773 DOI: 10.1111/trf.16590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Alloimmunization prevalence is conventionally used to identify RBCs alloimmunization risk factors among thalassemia patients, but it may be confounded by differences in transfusion exposure especially between non-transfusion dependent thalassemia (NTDT) and transfusion dependent thalassemia (TDT) patients. To better identify thalassemia patients with high alloimmunization risks, we used cumulative incidence of first alloimmunization as a function of RBCs transfused to compare alloimmunization risks between TDT and NTDT and to evaluate other risk factors. We also proposed practical strategies to prevent alloimmunization in thalassemia. STUDY DESIGN AND METHODS Adult TDT and NTDT patients who had received ≥2 transfusions and no alloimmunization before their first transfusion were included. Alloimmunization was defined as the development of clinically significant alloantibodies. We estimated the first alloimmunization incidence from transfusion by Kaplan-Meier analysis with the horizontal axis expressed as cumulative non-antigen-matched RBC units transfused. We compared this incidence between TDT and NTDT, and analyzed for other alloimmunization risk factors and the alloantibody specificities/frequencies. RESULTS The alloimmunization prevalence was similar between TDT and NTDT (27% vs. 30% respectively, p = .726). However, for the same transfusion exposure, NTDT had higher alloimmunization incidence than TDT (hazard ratio 8.59, 95% confidence interval [2.25-32.74], p = .002), independent of age at first transfusion and last follow-up, gender, and splenectomy. Anti-E, anti-c, anti-Mia , and anti-Jka were most frequent. DISCUSSION NTDT has the highest alloimmunization risk and would benefit the most from extended RBC antigen-matching, especially C, c, E, and e. Other blood group antigen-matching should be guided by the patient/donor disparities and alloantibody frequencies in different populations.
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Affiliation(s)
- Ai Leen Ang
- Department of Hematology, Singapore General Hospital, Singapore.,Blood Services Group, Health Sciences Authority, Singapore
| | - Chiew Ying Lim
- Hematology/Oncology Service, KK Women's and Children's Hospital, Singapore
| | - Weng Yik Ng
- Blood Services Group, Health Sciences Authority, Singapore
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9
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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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Genotyping of blood groups in alloimmunized patients with β-thalassemia major by T-ARMS-PCR and multiplex-aso-pcr. Transfus Apher Sci 2020; 60:102984. [PMID: 33221123 DOI: 10.1016/j.transci.2020.102984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 08/18/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Beta-thalassemia major is a severe hemolytic anemia requiring life-long blood transfusion. Planned random donor blood transfusion is associated with alloimmunization against incompatible antigens. Determination of the minor blood group systems phenotype or genotype, and administration of the compatible blood components can significantly reduce the rate of alloimmunization. The present study aimed to determine the prevalence of alloimmunization, and genotype/phenotype characteristics of the minor blood groups systems in patients with β-thalassemia major. MATERIAL AND METHODS This study was conducted on 1147 β-thalassemia major patients. Initially, antibody screening and antibody identification were performed. Then, phenotyping and genotyping for the Rh, Kell, Kidd, and Duffy blood groups were done in alloimmunized patients using monoclonal antibodies and Multiplex-Allele Specific Oligonucleotide-Polymerase Chain Reaction (Multiplex-ASO-PCR) and Tetra-primer amplification refractory mutation system-PCR (T-ARMS-PCR), respectively. Any phenotype/genotype discrepancy was assessed by direct sequencing. RESULTS Ninety-seven (8.5 %) out of 1147 patients had alloantibodies against the minor blood group antigens (44 males, 45.4 %, and 53 female, 54.6 %). The most common alloantibodies were against the RH (n: 47, 48.5 %), and the Kell (n: 23, 23.7 %) blood groups systems. Twenty-three (2.1 %) genotype/phenotype discrepancies out of 1067 tests, including 9 in the Rh (9.3 %), 8 in Duffy (34.8 %), and 6 in Kidd (26.1 %) blood groups were detected. No discrepancy was found in the Kell blood group system. Direct sequencing revealed that the results of molecular methods were correct. CONCLUSION Multiplex-ASO-PCR and T-ARMS-PCR molecular methods are fast, reliable and cost-benefit molecular methods for the minor blood group genotyping in multi-transfused β-thalassemia major patients.
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11
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Hosseini MS, Jafari L, Shiri Heris R, Gharehbaghian A. Red blood cell alloimmunization in Iran: A Comprehensive review of the literature. Asian J Transfus Sci 2020; 14:4-8. [PMID: 33162697 PMCID: PMC7607983 DOI: 10.4103/ajts.ajts_137_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/07/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND: Alloimmunization is an immune response against foreign antigens which introduced into the body through transfusion, pregnancy, or transplantation. This phenomenon is a big challenge in patients, which require regular transfusions. In the current study, we tried to have a comprehensive review on the status of alloimmunization in Iran. For this purpose, we searched for papers investigating alloimmunization in transfusion-dependent patients and also in patients with no regular transfusions who are candidate for surgery or who need blood. METHODS: We searched PubMed, Google Scholar, SID, and MAGIRAN databases using the following keywords: “blood transfusion,” “alloimmunization,” “alloantibodies,” “irregular antibodies,” “red cell antibodies,” and “Iran.” No limitation for the date of publication and language of the papers was defined. All the identified records were then screened for the relevance and duplication. RESULTS: A total of 22 papers were included in this study. All of the studies were conducted from 1999 to 2016 and providing alloimmunization data from different cities all over of Iran. In general, the results showed that the most prevalent alloantibodies are anti-Kell (anti-K antigen) and anti-Rh system, mainly anti-E, anti-D, anti-C, and anti-c. CONCLUSION: Anti-Kell and anti-Rh antibodies are the most prevalent antibodies responsible for alloimmunization in Iranian population.
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Affiliation(s)
- Maryam Sadat Hosseini
- Department of Laboratory Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Jafari
- Department of Laboratory Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shiri Heris
- Department of Laboratory Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Gharehbaghian
- Department of Laboratory Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gholamrezazade A, Amirizadeh N, Oodi A. Genotyping analysis of the MNS blood group system of thalassemia patients with alloantibodies in Iran. Transfus Apher Sci 2020; 60:103006. [PMID: 33229298 DOI: 10.1016/j.transci.2020.103006] [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: 07/23/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Serological methods are unreliable for accurate determination of blood group antigens in multi-transfused thalassemia patients. The MNS blood group system has five high-frequency antigens. Many studies demonstrated that some antibodies including anti-S, anti-s, and anti-U may cause acute and delayed transfusion reactions and hemolytic disease of the fetus and newborn. This study aimed to determine the genotype of the MNS blood group in thalassemia patients with alloantibodies by molecular methods. MATERIAL AND METHODS In this study, 104 blood samples from thalassemia patients were collected. The blood group phenotype for M, N, S and s antigens was determined by the tube hemagglutination method. MNS blood group genotyping was performed using PCR-SSP and DNA Sequencing methods. RESULTS All patients were genotyped with a total of 6 pairs of primers. Discrepancies between genotype and phenotype were observed in 22 patients with S/s alleles and 2 patients with M/N alleles, however, there was full accordance between the results of SSP-PCR and DNA sequencing. The frequency of MNS blood group alleles was determined as follows: 25 % MNSs, 23 % MNss, 21 % MMSs, 9% MMSS, 9% MMss, 8% NNss, 2%MNSS, and NNSS, NNSs, MM genotypes at 1% each. CONCLUSION In conclusion, molecular genotyping is more reliable than serological methods in multiple transfusion patients and can lead to a more compatible blood unit for transfusion in these patients.
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Affiliation(s)
- Atefe Gholamrezazade
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
| | - Naser Amirizadeh
- 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.
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13
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Kidd Blood Group Genotyping for Thalassemia Patient in Iran. Indian J Hematol Blood Transfus 2020; 36:550-555. [PMID: 32647431 DOI: 10.1007/s12288-020-01283-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/18/2020] [Indexed: 01/26/2023] Open
Abstract
We aimed to determine the JK genotype in thalassemia patients from Iran using different molecular methods to compare with phenotyping results. We also aimed to standardize for the first time, the Tetra-Primer ARMS PCR method for JK genotyping. The serology method cannot correctly determine the phenotype of blood group antigens in patients with multiple blood transfusions. Peripheral blood samples were taken from two hundred alloimmunized thalassemic patients in Tehran Adult Thalassemic Clinic. The samples were tested phenotypically by routine serological methods. After DNA Extraction, SSP-PCR was performed. DNA sequencing and PCR-RFLP were used to confirm the SSP-PCR results. Discrepancies were found between the phenotype and genotype in 32 out of 200 cases. In 16 cases phenotype was determined as Jk (a + b +) but genotype was JK*A/JK*A, in 14 cases phenotype was Jk (a + b +) while the genotype showed JK*B/JK*B, 1 case had been phenotyped as Jk (a + b -) but it was genotyped as JK*A/JK*B and 1 case had been phenotyped as Jk (a - b +) but it was genotyped as JK*A/JK*B. Serological results for a few samples could not be confirmed because of mix-field agglutination. The genotyping however verified the presence of Kidd alleles. Molecular methods are a valuable tool to predict blood group phenotypes in multi-transfused patients in order to select RBC units for a perfect matching improving blood transfusion and preventing alloimmunization. Also Tetra-Primer ARMS PCR is simple and cost effective methods that could be alternative by conventional Molecular methods.
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14
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Saliba AN, Atoui A, Labban M, Hamade H, Bou-Fakhredin R, Mufarrij A, Taher AT. Thalassemia in the emergency department: special considerations for a rare disease. Ann Hematol 2020; 99:1967-1977. [PMID: 32621178 PMCID: PMC7333588 DOI: 10.1007/s00277-020-04164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 01/19/2023]
Abstract
Thalassemia is characterized by a defect in the synthesis of one or more of the globin subunits of hemoglobin. This defect results in imbalance in the α/β-globin chain ratio, ineffective erythropoiesis, chronic hemolytic anemia, and iron overload. With advances in diagnosis, treatment, and transfusion support, the prognosis of patients with thalassemia has improved over the past few decades. An increasing number of patients with thalassemia is living with long-term complications, including cardiomyopathy, chronic liver disease, endocrinopathy, and infections. In this paper, we review common complications that bring the patient with thalassemia to urgent or emergent medical attention. We also discuss the aspects of emergency care that are most relevant while caring for the patient with thalassemia in the emergency department.
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Affiliation(s)
- Antoine N Saliba
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ali Atoui
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Labban
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Hamade
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou-Fakhredin
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Afif Mufarrij
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Ebrahimi M, Maleknia M, Parav N, Mohammadi MB, Mortazavi Y, Saki N, Rahim F. The HLA-DRB1*11 group-specific allele is a predictor for alloantibody production in the transfusion-dependent thalassemia patients. Transfus Apher Sci 2020; 59:102729. [DOI: 10.1016/j.transci.2020.102729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/22/2019] [Accepted: 12/30/2019] [Indexed: 01/19/2023]
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Sarihi R, Amirizadeh N, Oodi A, Azarkeivan A. Distribution of Red Blood Cell Alloantibodies Among Transfusion-Dependent β-Thalassemia Patients in Different Population of Iran: Effect of Ethnicity. Hemoglobin 2020; 44:31-36. [PMID: 32400249 DOI: 10.1080/03630269.2019.1709205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The best approach for prevention of alloimmunization in β-thalassemia (β-thal) patients is perfect matching of all red blood cell (RBC) antigens associated with clinically significant antibodies, but this is expensive and may limit the blood supply. Knowing the most common alloantibodies in transfusion-dependent β-thal patients make it possible to establish more cost-effective matching strategies for high-risk antigens. With this in mind, we intended to determine the most common alloantibodies in different parts of Iran. A total of 480 alloimmunized β-thal major (β-TM) patients who were referred to the Tehran Adult Thalassemia Clinic in Tehran, Iran from all provinces between 2015 and 2017, were included in this study. Antibody screening was performed on the fresh serum of all patients. Subsequently, the specification of antibodies was identified using a panel of recognized blood group antigens. Anti-K was the most common alloantibody detected in β-TM patients in all regions of Iran. The prevalence of this antibody reached to 37.7% in the western area, but in southeastern region, anti-E was predominant. Interestingly, the rare alloantibody anti-Kpa was detected with a high prevalence in the western region. The antibodies against E and D antigens were also encountered with high prevalence in most regions of the country. The present study demonstrated the distribution of alloantibodies in alloimmunized transfusion-dependent β-thal patients from diverse ethnic and racial backgrounds of the Iranian population. The results of this study can be used as a basis to establish cost-effective RBC phenotyping and matching strategies for high-risk antigens in donors and chronic transfusion recipients in different regions of Iran.
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Affiliation(s)
- Reyhaneh Sarihi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Naser Amirizadeh
- 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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17
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Ebrahimisadr P, Bakhshandeh Z, Majidiani H. Red cell alloantibodies in beta-thalassaemia major patients' blood referring to the regional blood transfusion center of Tehran, Iran. ACTA ACUST UNITED AC 2020; 11:129-133. [PMID: 33842283 PMCID: PMC8022230 DOI: 10.34172/bi.2021.20] [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: 01/17/2019] [Revised: 03/25/2020] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
Abstract
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Introduction: Thalassemia is associated with a genetic decline in the rate of synthesis of one or more types of natural hemoglobin polypeptide chains. One of the major complications in thalassemia patients is alloimmunization, which is antibody production by the patient against transfused red blood cells (RBCs). These RBCs are unknown by the recipient and the formed antibodies against them are called alloantibodies. This study aimed to evaluate the frequency of alloantibodies against RBCs in beta-thalassemia patients referred to Tehran Regional Blood Transfusion Center. Methods: In this study, antibody screening tests (Dia-cell I, II, and III) were performed on 184 thalassemia patients. An identification test by the Dia panel consisting of 11 different O RBCs groups to examine sera with Dia cells (I, II, or III) was performed. Results: In our study, males and females patients comprised 66 (35.87%) and 118 (64.13%), respectively, of whom 116 (63%) had alloimmunization. In addition, 68 thalassemia subjects (37%) lacked alloantibodies. Among 184 patients with beta-thalassemia major, anti-K (Kell system), anti-D, and anti-E (Rhesus system) had the most abundant alloantibody variants with an incidence of 24 (13%), 11 (5.98%), and 10 (5.4%), respectively. Conclusion: Before RBC transfusion, regular RBC antigen phenotypes, as well as problem-solving of alloantibody production by receiving compatible blood for Kell and RH subgroups, are suggested for all cases of transfusion-derived thalassemia.
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Affiliation(s)
- Parisa Ebrahimisadr
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Zahra Bakhshandeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Hamidreza Majidiani
- Departments of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ebrahimi M, Dayer D, Jalalifar MA, Keikhaei B, Tahan Nejad Asadi Z. Association between
HLA‐DRB1*01
and
HLA‐DRB1*15
with alloimmunisation in transfusion‐dependent patients with thalassaemia. Transfus Med 2020; 30:275-280. [DOI: 10.1111/tme.12677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/02/2020] [Accepted: 02/29/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Mina Ebrahimi
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of HealthAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
- Department of laboratory sciencesSchool of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
- Student Research CommitteeAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Dian Dayer
- Cellular and Molecular Research CenterAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Mohammad Ali Jalalifar
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of HealthAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
- Department of laboratory sciencesSchool of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Bijan Keikhaei
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of HealthAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
| | - Zari Tahan Nejad Asadi
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of HealthAhvaz Jundishapur University of Medical Sciences Ahvaz Iran
- Department of laboratory sciencesSchool of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
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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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20
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Merrill SA, Brodsky RA, Lanzkron SM, Naik R. A case-control analysis of hyperhemolysis syndrome in adults and laboratory correlates of complement involvement. Transfusion 2019; 59:3129-3139. [PMID: 31292968 DOI: 10.1111/trf.15445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/10/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hyperhemolysis syndrome (HS) is a poorly understood, severe hemolytic anemia provoked by transfusion. Both host and donor RBCs are destroyed in HS; thus, transfusion paradoxically worsens anemia. Risk factors and mechanism of HS are unknown. STUDY DESIGN AND METHODS A retrospective case-control analysis was performed on adults with HS. Patients with HS were matched 1:1 with matched, transfused controls, and HS risk factors were analyzed with multivariable logistic regression. HS samples were analyzed for complement deposition by flow cytometry, and an in vitro model of bystander hemolysis was developed. RESULTS Forty-one patients with 54 episodes of HS were identified in a 26-year period from 1992 to 2018. Of the HS episodes, only 18.5% were associated with a new alloantibody, and such patients were more tolerant of additional transfusion in the acute episode (p = 0.005). Thirteen percent of episodes were fatal, and HS recurred in 52.6%. Alloimmunization (odds ratio [OR], 17.3), non-B blood type (OR, 9.8), D antigen (OR, 9.1), and infection (OR, 5.5) were associated with HS on multivariable analysis. Hyperbilirubinemia was predictive of fatal HS (OR, 33.6). Increased complement was observed on RBCs during HS episodes, and the in vitro model of bystander hemolysis recapitulated complement decoration of sickled RBCs. CONCLUSIONS HS is associated with significant morbidity, mortality, and recurrence. Risk factors such as known alloimmunization, blood group, and infection predispose to HS. Bystander complement activation may drive HS. These factors may help physicians refine risk-benefit assessments for transfusion and guide further therapeutic development.
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Affiliation(s)
- Samuel A Merrill
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert A Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sophie M Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rakhi Naik
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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21
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El Kababi S, Benajiba M, El Khalfi B, Hachim J, Soukri A. Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors. Transfus Clin Biol 2019; 26:240-248. [PMID: 31279519 DOI: 10.1016/j.tracli.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/09/2019] [Indexed: 01/26/2023]
Abstract
Red blood cell alloimmunization is one of the major challenges to regular transfusions in β-thalassemic patients. In Morocco, rare studies have focused on this hemoglobinopathy. OBJECTIVE We aimed to study the prevalence and risk factors of red cell alloimmunization in β-thalassemic patients. PATIENTS AND METHODS Retrospective study during 9 years (2009-2018) was conducted on 160 β-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. RESULTS The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. CONCLUSION This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.
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Affiliation(s)
- S El Kababi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - M Benajiba
- National Blood Transfusion Center, Immuno-hematology, Bab-El-Irfane, rue m'fadel-Cherka, 10000 Rabat, Morocco
| | - B El Khalfi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - J Hachim
- Hematology-Oncology pediatric department, Children's Hospital Abderrahim Harouchi, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Tarik bnou ziad street, 20360 Casablanca, Morocco
| | - A Soukri
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco.
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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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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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Shao CP, Zhao CJ, Wu CL, Xu H, Wang XD, Wu XY, Yi P, Dang XT. Rh-Matched Transfusion through Molecular Typing for β-Thalassemia Patients Is Required and Feasible in Chinese. Transfus Med Hemother 2018; 45:252-257. [PMID: 30283274 DOI: 10.1159/000489471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022] Open
Abstract
Background Molecular typing for RHCE blood group alleles has been established in many countries for patients and blood donors. In the Chinese literature nearly 80% of transfused patients with alloimmunization have antibodies specific for antigens of the Rh blood group system. We investigated if it is feasible to match packed red blood cells (RBCs) for Chinese β-thalassemia patients by RHCE genotyping. Methods In this study, 481 patients with β-thalassemia were enrolled. They were genotyped for RHCE alleles by a simple PCR method with sequence-specific primers (PCR-SSP). Among these patients, 203 continuously received RBCs of the identical Rh subgroups according to the genotyping results for at least 3 months. Subsequently, their phenotypes were tested through a micro-column gel card method. For validation purposes, 400 donors were serologically typed with the same technology, of which 164 were genotyped too. Finally, the C, c, E, and e frequencies and the feasibility of the simple genotyping method were analyzed. Results All patients showed mixed-field agglutination in the Rh subgroup gel cards before the same Rh subgroups in blood donors were selected for blood transfusion. The results, however, lacked mixed-field agglutination in all 203 cases after transfusion with RBC concentrates selected for the patient's C, c, E, and e antigens for at least 3 months. The genotyping results of 164 donors were all consistent with the serological results. Whole coding regions of RHCE were sequenced in 7 individuals with weak c, E, or e antigens. In only one sample we observed a 1059G>A nucleotide mutation coding for a truncated RhCE polypeptide (GenBank KT957625), in the other 6 samples no sequence variant was found. Both patients and donors were predominantly CcEe and CCee, with a prevalence of 55.3% and 24.9% for patients or 49.3% and 31.3% for donors, respectively. It revealed that about 80% of Chinese could receive Rh-matched RBCs easily. Conclusion A simple RHCE genotyping technique is safe enough for Rh-matched transfusion of β-thalassemia patients in Chinese Han.
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Affiliation(s)
- Chao-Peng Shao
- Department of Blood Transfusion, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Cheng-Jiang Zhao
- Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Chang-Lin Wu
- Department of Blood Transfusion, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Hua Xu
- Shanxi Blood Center, Xi'an, Shanxi, China
| | - Xue-Dong Wang
- Department of Clinical Laboratory, The Fifth People's Hospital of Wuxi, The Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | | | - Ping Yi
- Department of Blood Transfusion, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
| | - Xin-Tang Dang
- Department of Blood Transfusion, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China
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Darvishi P, Sharifi Z, Azarkeivan A, Akbari A, Pourfathollah AA. HLA-DRB1*15:03 and HLA-DRB1*11: useful predictive alleles for alloantibody production in thalassemia patients. Transfus Med 2018; 29:179-184. [DOI: 10.1111/tme.12531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Affiliation(s)
- P. Darvishi
- Department of Immunology, Faculty of Medical Sciences; Ilam University of Medical Sciences; Ilam Iran
| | - Z. Sharifi
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
| | - A. Azarkeivan
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
- Iranian Blood Transfusion Organization; Adult Thalassemia Clinic; Tehran Iran
| | - A. Akbari
- Abadan School of Medical Sciences; Abadan Iran
| | - A. A. Pourfathollah
- Blood Transfusion Research Center; High Institute for Research and Education in Transfusion Medicine; Tehran Iran
- Department of Immunology, Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
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26
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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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27
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Davoudi-Kiakalayeh A, Mohammadi R, Pourfathollah AA, Siery Z, Davoudi-Kiakalayeh S. Alloimmunization in Thalassemia Patients: New Insight for Healthcare. Int J Prev Med 2017; 8:101. [PMID: 29291043 PMCID: PMC5738786 DOI: 10.4103/ijpvm.ijpvm_246_16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 06/21/2017] [Indexed: 11/26/2022] Open
Abstract
Background: Development of alloantibodies against the foreign red blood cell (RBC) (alloimmunization) is a well-known complication in thalassemia patients when performing multiple transfusions. The study was conducted to know the prevalence of alloimmunization in thalassemia patients, in the Caspian Sea coastline. Methods: This study is a descriptive, retrospective analysis of transfusion records of 190 patients with β-thalassemia major who received regular transfusions. To detect the type of alloantibodies, two cells panel tests (kits; Iranian Blood Transfusion Organization [IBTO], 3 RBC cells and IBTO, 11 RBC cells) were used.
Results: Forty-seven patients were positive for alloantibodies (24.7%). Of them, 18.4% (35 cases) had only one alloantibody, and 6.3% (12 cases) had at least two or more of alloantibodies. The vast majority of alloantibodies were anti-Kell followed by anti-E, and anti-D, respectively. Conclusions: Blood matching for Rh and K antigens in patients with transfusion-dependent thalassemia could reduce the rate of RBC alloinununization.
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Affiliation(s)
- Ali Davoudi-Kiakalayeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.,Department of Neurobiology, Care Sciences and Society, H1, Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Reza Mohammadi
- Department of Neurobiology, Care Sciences and Society, H1, Division of Family Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Ali Akbar Pourfathollah
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Zahra Siery
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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28
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Flegel WA, Gottschall JL, Denomme GA. Integration of red cell genotyping into the blood supply chain: a population-based study. LANCET HAEMATOLOGY 2017. [PMID: 26207259 DOI: 10.1016/s2352-3026(15)00090-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND When problems with compatibility arise, transfusion services often use time-consuming serological tests to identify antigen-negative red cell units for safe transfusion. New methods have made red cell genotyping possible for all clinically relevant blood group antigens. We did mass-scale genotyping of donor blood and provided hospitals with access to a large red cell database to meet the demand for antigen-negative red cell units beyond ABO and Rh blood typing. METHODS We established a red cell genotype database at the BloodCenter of Wisconsin on July 17, 2010. All self-declared African American, Asian, Hispanic, and Native American blood donors were eligible irrespective of their ABO and Rh type or history of donation. Additionally, blood donors who were groups O, A, and B, irrespective of their Rh phenotype, were eligible for inclusion only if they had a history of at least three donations in the previous 3 years, with one donation in the previous 12 months at the BloodCenter of Wisconsin. We did red cell genotyping with a nanofluidic microarray system, using 32 single nucleotide polymorphisms to predict 42 blood group antigens. An additional 14 antigens were identified via serological phenotype. We monitored the ability of the red cell genotype database to meet demand for compatible blood during 3 years. In addition to the central database at the BloodCenter of Wisconsin, we gave seven hospitals online access to a web-based antigen query portal on May 1, 2013, to help them to locate antigen-negative red cell units in their own inventories. FINDINGS We analysed genotype data for 43,066 blood donors. Requests were filled for 5661 (99.8%) of 5672 patient encounters in which antigen-negative red cell units were needed. Red cell genotyping met the demand for antigen-negative blood in 5339 (94.1%) of 5672 patient encounters, and the remaining 333 (5.9%) requests were filled by use of serological data. Using the 42 antigens represented in our red cell genotype database, we were able to fill 14,357 (94.8%) of 15,140 requests for antigen-negative red cell units from hospitals served by the BloodCenter of Wisconsin. In the pilot phase, the seven hospitals identified 71 units from 52 antigen-negative red cell unit requests. INTERPRETATION Red cell genotyping has the potential to transform the way antigen-negative red cell units are provided. An antigen query portal could reduce the need for transportation of blood and serological screening. If this wealth of genotype data can be made easily accessible online, it will help with the supply of affordable antigen-negative red cell units to ensure patient safety. FUNDING BloodCenter of Wisconsin Diagnostic Laboratories Strategic Initiative and the NIH Clinical Center Intramural Research Program.
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29
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The Role of Immune System in Thalassemia Major: A Narrative Review. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.14508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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30
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Makarovska-Bojadzieva T, Velkova E, Blagoevska M. The Impact of Extended Typing On Red Blood Cell Alloimmunization in Transfused Patients. Open Access Maced J Med Sci 2017; 5:107-111. [PMID: 28507611 PMCID: PMC5420757 DOI: 10.3889/oamjms.2017.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Red blood cell (RBC) alloimmunization is still an actual problem in our transfusion practice. In 2011, in addition to the regular ABO/D blood group typing, phenotyping for Rh (C, c, E, e) and Kell antigens was introduced for blood donors and patients undergoing blood transfusion. Our aim was to evaluate the impact of the extended RBC typing and donor/recipient matching on the incidence of RBC alloimmunization. METHODS A retrospective comparative study was conducted by reviewing RBC request records for about 36,000 patients transfused with RBC in the period from 2013 to 2015 in comparison to the similar study conducted on 47,000 transfused patients in the period from 2005 to 2008. Pre-transfusion serologic testing data were retrieved for analysis. Blood samples with positive antibody screening and positive cross-match were further subjected to antibody identification. All the tests were performed using column agglutination technique (CAT) with ID-cards and reagents from DiaMed in both studies. RESULTS Irregular RBC alloantibodies were detected in 116 (0.32%) out of 36,000 transfused patients. Multiple transfusions (15.8 units/patient) were given to 450 patients from which 79 (17.5%) had RBC allontibodies. The incidence of RBC alloimmunisation in the rest of the 35,550 transfused patients from which 37 had RBC alloantibodies was 0.10%. A total of 117 alloantibodies were identified in 96 out of the 116 patients with irregular RBC antibodies. Their specificity was as fallows: anti-E (25.6%), -C (6.0%), -c (8.5%), -e (0.85%), -Cw (5.1%), -K (12.8%), -Fya (10.2%), -Fyb (2.5%), -Jka (7.7%), -Jkb (2.5%), -M (9.4%), -S (1.7%), -s (0.85%), -Lua (1.7%), -Leb (3.4%) and anti-Leb (0.85%). Multiple antibodies were identified in 22 of the transfused patients out of which 15 (68.2%) received multiple transfusions. Anti-E was the most common antibody found in more of the 50% of the multiple antibody cases. CONCLUSIONS The overall incidence of RBC alloimmunization in transfused patients decreased from 0.51% which was the estimated incidence for the period before the introduction of the extended RBC typing (2005-2008) to 0.32% (2013-2015). This is due to the decreased incidence of RBC alloimmunization in the multiply transfused patients from 33.9% to 17.5% respectively. The current frequency of anti-E (25.6%) and -K (12.8%) antibodies in transfused patients are significantly lower than their previous estimated frequencies of 30.4% and 24.0% respectively, as well as the overall frequency of RBC antibodies to Rh+Kell antigens which decreased from 72.4% to 53.8%. Extended donor-recipient matching for C, c, E, e and Kell antigens has proved a beneficial effect on the incidence of RBC alloimmunization in multiply transfused patients.
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Affiliation(s)
| | - Emilija Velkova
- Institute of Transfusion Medicine, Skopje, Republic of Macedonia
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31
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Hendrickson JE, Tormey CA. Red Blood Cell Antibodies in Hematology/Oncology Patients. Hematol Oncol Clin North Am 2016; 30:635-51. [DOI: 10.1016/j.hoc.2016.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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32
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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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34
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Trompeter S, Baxter L, McBrearty M, Zatkya E, Porter J. Sample acceptance time criteria, electronic issue and alloimmunisation in thalassaemia. Transfus Med 2015; 25:414-7. [PMID: 26593684 DOI: 10.1111/tme.12253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/13/2015] [Accepted: 09/17/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the safety of a 1-week acceptance criteria of sample receipt in laboratory to transfusion commencement in transfusion dependent thalassaemia with respect to alloimmunisation. To determine the safety of electronic issue of blood components in such a setting. METHODS Retrospective audit of alloimmunisation (1999-2012) and blood exposure in registered thalassaemia patients at a central London thalassaemia centre where the acceptance criteria for the group and save sample from arrival in the laboratory to the time of issue of blood for transfusion for someone who has been transfused in the last 28 days was 1 week, and there was electronic issue protocol for patients who have always had a negative antibody screen (other than temporary positivity in pregnant women receiving prophylactic anti-D or anti Le-a, Anti Le-b and Anti P1 that are no longer detectable). RESULTS There were 133 patients with thalassemia variants regularly attending UCLH for review. A total of 105 patients had transfusion dependent thalassaemia (TDT) (7 E-beta thalassaemia, 98 beta thalassaemia major). Ten of the 84 patients who received their transfusions at UCLH were alloimmunised. Seven of them had been alloimmunised prior to arrival at UCLH. Only two patients developed antibodies at UCLH during this period. CONCLUSION The prevalence of alloantibody formation of 2% in UCLH transfused patients, with presumptive incidence of 0.01 alloantibodies per 100 units or 0·001 immunisations per person per year compares favourably with other reported series and suggests that 1 week interval with appropriate electronic issue is acceptable practice.
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Affiliation(s)
- S Trompeter
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Patient Services, NHS Blood and Transplant, London, UK
| | - L Baxter
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - M McBrearty
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - E Zatkya
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - J Porter
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,University College London, London, UK
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35
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Osaro E, Ladan MA, Zama I, Ahmed Y, Mairo H. Distribution of Kell phenotype among pregnant women in Sokoto, North Western Nigeria. Pan Afr Med J 2015; 21:301. [PMID: 26587150 PMCID: PMC4634022 DOI: 10.11604/pamj.2015.21.301.4636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/15/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Kell antigen is highly immunogenic and is the common cause of antibody production in mismatched blood transfusions, haemolytic transfusion reaction (HTR) and maternal alloimmunization, which causes severe anaemia in neonates. The aim of this study is to determine the prevalence and ethnic variation of the Kell phenotype among pregnant women in Sokoto, Nigeria. Methods Kell antigen status of 150 pregnant women aged 18-45 years and mean age 27.19 ±4.69 years attending antenatal clinic in UDUTH Sokoto Nigeria was determined using the conventional tube method and anti-Kell reagents (Lorne Laboratories, UK). Results Among the 150 subjects studied, 3 (2.0%) of subjects were positive and 147 (98.0) were negative for K antigen. Of the 150 pregnant subjects; 32 (21.3%) were primigravidae while 118 (78.7%) were multigravidae. Kell phenotype was more prevalent among primigravidae (3.1%) compared to multigravidae (1.7%) women. The distribution of Kell phenotype among the pregnant subjects was compared based on ethnicity. The prevalence of Kell antigen was significantly higher among the Hausa ethnic group (3.2%) compared to other ethnic groups which indicated zero prevalence (p = 0.001). Kell negative phenotype was ≥ 96.8% among all the ethnic groups. Conclusion Our observed prevalence of Kell phenotype is consistent with previous studies among Blacks and Asians but significantly lower than values observed in previous studies among Caucasians. We recommend that all pregnant women should be screened for the presence clinically significant red cell antigens including Kell antigen on their first antenatal visit. Kell negative red cell should be routinely provided for all pregnant women and women with child bearing potential to reduce the risk of Kell-associated HDFN. There is need to introduce routine screening of pregnant women for clinically significant red cell antibodies to facilitate the effective management of HDFN as well as prevent HTR. There is also need for sustained health education of pregnant women in the area to encourage early booking for antenatal care.
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Affiliation(s)
- Erhabor Osaro
- Department of Haematology and Transfusion Science, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Malami Aisha Ladan
- Department of Haematology and Transfusion Science, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Isaac Zama
- Department of Haematology and Transfusion Science, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Yakubu Ahmed
- Department of Obstetrics and Gynaecology Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Hassan Mairo
- Department of Obstetrics and Gynaecology Usmanu Danfodiyo University, Sokoto, Nigeria
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36
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Zaidi U, Borhany M, Ansari S, Parveen S, Boota S, Shamim I, Zahid D, Shamsi T. Red cell alloimmunisation in regularly transfused beta thalassemia patients in Pakistan. Transfus Med 2015; 25:106-10. [PMID: 25870030 DOI: 10.1111/tme.12196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/18/2015] [Accepted: 03/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Pakistan routine blood group typing of thalassemia patients identifies ABO and Rh(D) antigens only. Therefore, other antigen incompatibilities between blood donor and blood recipient may cause alloimmunisation. OBJECTIVE The aim of this study was to estimate the frequency of alloimmunisation and to evaluate the risk factors associated with its development in beta (β)-thalassemia patients receiving regular blood transfusions. MATERIALS AND METHODS In total 162 β thalassemia patients were included in this study. An extended red cell antigen panel was performed to detect antibodies. Patients received red cell concentrates, which were matched for ABO and Rh(D) antigens. Clinical and laboratory data were collected and analysed to estimate the frequency of alloantibodies and the factors influencing immunisation in patients on regular blood transfusion. RESULTS The median age of patients was 6·7 (range: 0·5-25) years. A total of 14 (8·6%) patients developed alloantibodies against red cell antigens. The most frequently occurring alloantibodies was anti-E (2·5%), anti-K (1·8%), anti-e (1·2%) and anti-D (0·6%). Five (3·1%) patients developed more than one red blood cell (RBC) alloantibody. Age at first transfusion in alloimmunised patients was 1·22 ± 0·87 years. The frequency of blood transfusion in alloimmunised patients was 23 ± 8·81 days and in those without alloimmunisation was 31·8 ± 16 days (p = 0·02). Logistic regression analysis showed no independent risk factor associated with alloimmunisation. CONCLUSION The frequency of transfusion was increased in patients who developed alloantibodies. Typing patients and donors to match for Rh and Kell antigens would prevent more than 90% of RBC alloantibodies and reduce the frequency of transfusion in thalassemia patients.
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Affiliation(s)
- U Zaidi
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - M Borhany
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - S Ansari
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - S Parveen
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - S Boota
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - I Shamim
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - D Zahid
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - T Shamsi
- Department of Blood Transfusion, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
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Guidelines for the Standard Monitoring of Patients With Thalassemia: Report of the Thalassemia Longitudinal Cohort. J Pediatr Hematol Oncol 2015; 37. [PMID: 26201037 PMCID: PMC4511957 DOI: 10.1097/mph.0000000000000307] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic transfusion therapy has played a central role in extending life expectancy for patients with hemoglobinopathies such as thalassemia. However, this life-saving therapy is associated with numerous complications that now comprise the bulk of management considerations for patients with thalassemia. This review reports on the experience of the Thalassemia Longitudinal Cohort and reviews available literature to establish guidelines for the management of patients with thalassemia.
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Padmore R, Berardi P, Erickson K, Desjardins D, Giulivi A, Tokessy M, Neurath D, Saidenberg E. Acute extravascular hemolytic transfusion reaction due to anti-Kpa antibody missed by electronic crossmatch. Transfus Apher Sci 2014; 51:168-71. [DOI: 10.1016/j.transci.2014.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 08/11/2014] [Indexed: 11/24/2022]
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39
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Fasano RM, Booth GS, Miles M, Du L, Koyama T, Meier ER, Luban NLC. Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease. Br J Haematol 2014; 168:291-300. [PMID: 25256676 DOI: 10.1111/bjh.13123] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/29/2014] [Indexed: 01/23/2023]
Abstract
Sickle cell disease (SCD) patients are at increased risk of red blood cell (RBC) alloimmunization. Recipient inflammatory state at time of transfusion has been shown to regulate alloimmunization in murine models, but evidence is lacking in SCD patients. We retrospectively studied a cohort of alloimmunized SCD patients to determine the influence of pro-inflammatory SCD-related complications at time of transfusion on alloimmunization. For each transfusion, the presence of pro-inflammatory state, degree of RBC antigen matching, unit age, storage solution and alloantibody detection date were ascertained. Transfusion-associated pro-inflammatory events were compared between transfusions resulting and not resulting in new alloantibodies. Univariate analysis and multivariate logistic regression were performed. Fifty-two patients received 3166 pre-storage leuco-reduced transfusions of which 128 resulted in alloantibodies. Transfusions during inflammatory events were associated with increased alloantibody risk on univariate and multivariate analysis; acute chest syndrome and vaso-occlusive crisis showed strongest associations with alloimmunization. Increased antigen matching demonstrated a protective effect on alloimmunization (univariate and multivariate analysis). Although an association was seen between citrate-phosphate-dextrose (adenine) stored units and alloimmunization on univariate analysis, no effect was found on multivariate analysis. Identifying recipient pro-inflammatory states at time of transfusion that promote alloimmunization can impact RBC unit selection decisions for SCD patients at risk for alloimmunization.
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Affiliation(s)
- Ross M Fasano
- Department of Transfusion Medicine, Children's National Medical Centre, Washington, DC, USA; Department of Haematology, Children's National Medical Centre, Washington, DC, USA
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Azarkeivan A, Ahmadi MH, Zolfaghari S, Shaiegan M, Ferdowsi S, Rezaei N, Lotfi P. RBC alloimmunization and double alloantibodies in thalassemic patients. ACTA ACUST UNITED AC 2014; 20:223-7. [PMID: 25130935 DOI: 10.1179/1607845414y.0000000189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
PURPOSE Alloimmunization is a common consequence of chronic blood transfusion. Double alloantibody production may complicate the condition of such patients especially for finding matched blood. In this study, we evaluated the frequency of alloantibodies in thalassemic patients with previous history of transfusion reactions. SAMPLES AND METHODS This study was performed on 441 multiply transfused thalassemia patients Antibody screening test was carried out using three cell-panel by gel method. Positive patients were followed up for antibody identification using 11-cell panel. Direct combs' test was performed to detect auto antibodies. RESULTS In a total of 441 cases (362 thalassemia major and 79 intermedia), 234 were males (53.1%) and 207 females (46.9%); mean age 22 years, range 3-61 years. Alloimmunization was detected in 50(11.3%) patients, including 37(74%) patients with one alloantibody, 8(16%) with two antibodies, 4(8%) patients with unknown antibodies and one patient (2%) with autoantibody. The most common alloantibodies were anti-Rh antibodies (-E/e/C/c/Cw) (26%), anti-K (28%), anti-D (16%), and anti-Colton (4%). Double antibodies were detected in eight out of 50 patients, including: Anti-D+anti-C (8%), anti-D+anti-E (2%), anti-Kell+anti-D (2%), and anti-Kell+KPa (2%). A significant association was observed between the transfusion reaction history and the alloantibody detection results (p < 0.05). CONCLUSION Antibody production against RBC antigens makes hard condition in regular blood transfusion. Double antibodies production may more complicate this situation. Thus, it is advisable to phenotype patients and matches the red cells in multiply transfused thalassemia patients.
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Hendrickson JE, Tormey CA, Shaz BH. Red blood cell alloimmunization mitigation strategies. Transfus Med Rev 2014; 28:137-44. [PMID: 24928468 DOI: 10.1016/j.tmrv.2014.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 01/31/2023]
Abstract
Hemolytic transfusion reactions due to red blood cell (RBC) alloantibodies are a leading cause of transfusion-associated death. In addition to reported deaths, RBC alloantibodies also cause significant morbidity in the form of delayed hemolytic transfusion reactions. These alloantibodies may also cause morbidity in the form of anemia, with compatible RBC units at times being unable to be located for highly alloimmunized patients, or in the form of hemolytic disease of the newborn. Thus, preventing RBC alloantibodies from developing in the first place, or mitigating the dangers of existing RBC alloantibodies, would decrease transfusion-associated morbidity and mortality. A number of human studies have evaluated the impact on RBC alloimmunization rates of providing partially phenotypically or genotypically matched RBCs for transfusion, and a number of animal studies have evaluated the impact of single variables on RBC alloimmunization. The goal of this review is to take a comprehensive look at existing human and animal data on RBC alloimmunization, focusing on strategies that may mitigate this serious hazard of transfusion. Potential factors that impact initial RBC alloimmunization, on both the donor and recipient sides, will be discussed. These factors include, but are not limited to, exposure to the antigen and an ability of the recipient's immune system to present that antigen. Beyond these basic factors, coexisting "danger signals," which may come from the donor unit itself or which may be present in the recipient, also likely play a role in determining which transfusion recipients may become alloimmunized after RBC antigen exposure. In addition, to better understanding factors that influence the development of RBC alloantibodies, this review will also briefly discuss strategies to decrease the dangers of existing RBC alloantibodies.
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Affiliation(s)
| | - Christopher A Tormey
- Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT
| | - Beth H Shaz
- New York Blood Center, New York, NY; Emory University School of Medicine, Atlanta, GA.
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Hussein E, Desooky N, Rihan A, Kamal A. Predictors of Red Cell Alloimmunization in Multitransfused Egyptian Patients With β-Thalassemia. Arch Pathol Lab Med 2014; 138:684-8. [DOI: 10.5858/arpa.2013-0016-oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Context.—Thalassemia is a major health problem in Egypt. Red blood cell alloimmunization is an important complication in transfusion-dependent patients.
Objectives.—To determine alloimmunization prevalence in Egyptian patients with β-thalassemia and to evaluate risk factors that could influence alloimmunization, with the hope of minimizing transfusion-associated risks in those patients.
Design.—Records of 272 patients with β-thalassemia who are receiving regular blood transfusions, matched for ABO-Rh(D), were analyzed. Alloantibody identification was performed by DiaMed-ID microtyping system. Autoantibodies were detected by direct Coombs test.
Results.—Alloimmunization incidence was 22.8% with 123 alloantibodies detected in 62 patients. The most common alloantibody was Rh-related (37.4%; 46 of 123), comprising anti-E (14.6%; 18 of 123), anti-D (8.9%; 11 of 123), anti-C (8.9%; 11 of 123), and anti-c (4.9%; 6 of 123), followed by anti-Kell (26%; 32 of 123), → anti-MNS (9.8%; 12 of 123), → anti-Kidd (8.9%; 11 of 123) → anti-Duffy (8.1%; 10 of 123), → anti-Le (5.7%; 7 of 123), → anti-Lu (2.4%; 3 of 123), and → anti-P1 (1.6%; 2 of 123). Anti-D antibodies developed in 34.5% of all Rh-negative patients. Eighty percent of all anti-D antibodies developed in patients older than 18 years. Males had the highest alloimmunization incidence. Alloimmunization incidence increased with the number of units transfused (P = .01). Patients who received unfiltered blood had a higher alloimmunization rate than did those who always received leukoreduced blood (P < .001). Splenectomized patients had a higher alloimmunization rate (32%; 40 of 125) than did those who did not have a splenectomy (16.3%; 24 of 147; P = .003). Autoantibodies occurred in 1.5% (4 of 272) of all patients.
Conclusion.—Transfusion of leukoreduced and phenotypically matched cells for selective antigens may help reduce expenses and risks of alloimmunization in patients with thalassemia.
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Affiliation(s)
- Eiman Hussein
- From the Cairo University Blood Bank, Clinical Pathology Department, Cairo University, Cairo, Egypt
| | - Nermeen Desooky
- From the Cairo University Blood Bank, Clinical Pathology Department, Cairo University, Cairo, Egypt
| | - Abeer Rihan
- From the Cairo University Blood Bank, Clinical Pathology Department, Cairo University, Cairo, Egypt
| | - Abeer Kamal
- From the Cairo University Blood Bank, Clinical Pathology Department, Cairo University, Cairo, Egypt
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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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Applying molecular immunohaematology to regularly transfused thalassaemic patients in Thailand. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:28-35. [PMID: 24120606 DOI: 10.2450/2013.0058-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/18/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Red blood cell transfusion is the principal therapy in patients with severe thalassaemias and haemoglobinopathies, which are prevalent in Thailand. Serological red blood cell typing is confounded by chronic transfusion, because of circulating donor red blood cells. We evaluated the concordance of serological phenotypes between a routine and a reference laboratory and with red cell genotyping. MATERIALS AND METHODS Ten consecutive Thai patients with β-thalassemia major who received regular transfusions were enrolled in Thailand. Phenotypes were tested serologically at Songklanagarind Hospital and at the National Institutes of Health. Red blood cell genotyping was performed with commercially available kits and a platform. RESULTS In only three patients was the red cell genotyping concordant with the serological phenotypes for five antithetical antigen pairs in four blood group systems at the two institutions. At the National Institutes of Health, 32 of the 100 serological tests yielded invalid or discrepant results. The positive predictive value of serology did not reach 1 for any blood group system at either of the two institutions in this set of ten patients. DISCUSSION Within this small study, numerous discrepancies were observed between serological phenotypes at the two institutes; red cell genotyping enabled determination of the blood group when serology failed due to transfused red blood cells. We question the utility of serological tests in regularly transfused paediatric patients and propose relying solely on red cell genotyping, which requires training for laboratory personnel and physicians. Red cell genotyping outperformed red cell serology by an order of magnitude in regularly transfused patients.
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Jackman RP, Deng X, Bolgiano D, Utter GH, Schechterly C, Lebedeva M, Operskalski E, Luban NL, Alter H, Busch MP, Slichter SJ, Norris PJ. Leukoreduction and ultraviolet treatment reduce both the magnitude and the duration of the HLA antibody response. Transfusion 2013; 54:672-80. [PMID: 23808544 DOI: 10.1111/trf.12317] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/12/2013] [Accepted: 05/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both leukoreduction and ultraviolet (UV) light treatment of blood products have been shown to reduce the incidence of HLA antibody development in recipients, but the impact of these treatments on the magnitude and persistence of the antibody response is less clear. STUDY DESIGN AND METHODS Longitudinal samples from 319 subjects taken from four different study cohorts were evaluated for HLA antibodies to determine the effects of leukoreduction and UV treatment on HLA antibody generation and persistence. RESULTS Subjects receiving leukoreduced or UV-treated blood products were less likely to generate Class I HLA antibodies, and those receiving leukoreduced blood were also less likely to generate Class II HLA antibodies. Among those receiving nonleukoreduced blood, 55% developed Class I HLA antibodies and 51% developed Class II HLA antibodies compared with 28% (Class I) and 15% (Class II) for those receiving leukoreduced blood and 36% (Class I) and 54% (Class II) for those receiving UV-treated blood. Among alloimmunized subjects, leukoreduction resulted in a significant twofold reduction in the magnitude of Class I HLA antibodies, and UV treatment resulted in a significant threefold reduction in the magnitude of Class II HLA antibodies. Both treatments resulted in shorter persistence of Class I HLA antibodies. CONCLUSIONS These data demonstrate that leukoreduction and UV treatment of blood products results not only in a reduction in the incidence of HLA antibody production, but also in lower and more transient HLA antibody levels among sensitized transfusion recipients.
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Affiliation(s)
- Rachael P Jackman
- Blood Systems Research Institute, San Francisco, California; Puget Sound Blood Center, Seattle, Washington; University of California, Davis, California; National Institutes of Health, Bethesda, Maryland; University of Southern California, Los Angeles, California; Children's National Medical Center, Washington, DC; Department of Laboratory Medicine, University of California, San Francisco, California; Department of Medicine, University of California, San Francisco, California; University of Washington School of Medicine, Seattle, Washington
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Alloimmunisation in thalassaemics: a comparison between recipients of usual matched and partial better matched blood. An evaluation at a tertiary care centre in India. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s100-4. [PMID: 23399366 DOI: 10.2450/2012.0154-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/13/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is an ongoing controversy regarding provision of usually matched blood (i.e. matched for ABO-D antigens) or phenotypically matched blood (also matched for Rh and Kell antigens) for multiply transfused thalassaemics, especially in developing countries. A pilot study conducted at our centre revealed an alloimmunisation rate of 3.79% with Rh and Kell alloantibodies accounting for 90% of all antibodies. The present cross-sectional study was conducted to assess the impact of a policy of partial better matching (for Rh cDE and Kell antigens) of blood on alloimmunisation in thalassaemics. MATERIAL AND METHODS In this cross-sectional study three groups of patients were considered. Group 1 comprised 211 thalassaemics who received usually matched (UM) blood until April 2009. Their rates of alloimmunisation have already been published in a prior study. Group 2 consisted of 46 thalassaemics who were enrolled after April 2009 and have received partially better matched (PBM) blood (matched for ABO, Rh cDE and Kell antigens) since the initiation of transfusion therapy. Group 3 (UM→PBM) comprised the patients from group 1 who, from April 2009, were given partial better matched blood. Antibody screening (using a 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibodies. RESULTS None of the thalassaemic patients in group 2 (PBM) developed alloantibodies. Eight thalassaemics in group 3 (UM→PBM) developed new alloantibodies (after April 2009). DISCUSSION According to the results of the present study, providing at least partially better matched blood appears to improve the efficacy of transfusion for chronically transfused thalassaemics. Large-scale, comprehensive, multicentre studies need to be carried out to formulate realistic, evidence-based, economically feasible transfusion policies for thalassaemic children based on the red blood cell antigen profile of the population.
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Chou ST, Liem RI, Thompson AA. Challenges of alloimmunization in patients with haemoglobinopathies. Br J Haematol 2012; 159:394-404. [PMID: 23034087 DOI: 10.1111/bjh.12061] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Red blood cell (RBC) transfusions can be life-sustaining in chronic inherited anaemias, such as thalassaemia, and the indications for blood transfusions in patients with sickle cell disease continue to expand. Complications of transfusions, such as allosensitization, can create significant medical challenges in the management of patients with haemoglobinopathies. This review summarizes key findings from the medical literature related to alloimmunization in haemoglobinopathies and examines potential measures to mitigate these risks. Areas where future studies are needed are also addressed.
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Affiliation(s)
- Stella T Chou
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Sanz C, Nomdedeu M, Belkaid M, Martinez I, Nomdedeu B, Pereira A. Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia. Transfusion 2012; 53:710-5. [DOI: 10.1111/j.1537-2995.2012.03819.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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