Alloimmunization screening after transfusion of red blood cells in a prospective study

Abstract

BackgroundSeveral irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients.Objectivea prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data.MethodsBlood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions.ResultsFifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions.ConclusionsGiven the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions.

Prevalence of red blood cell antibodies among transfused patients at Komfo Anokye teaching (Kath) hospital, Ghana

“…Most of our antibody specificities identified are similar to antibodies commonly encountered and reported in other pub- Whole blood transfused (%) 8 (80) 84 (93.3) lished studies (Santos et al, 2007;Alves et al, 2012), again confirming the high frequency of antibodies against Rhesus system antigens.…”

“…In other less transfused groups, alloimmunisation is between 1-10%. The prevalence depends largely on how often antibody screening and identification were performed (Alves et al, 2012 ;Cheng et al, 2012 ;Schonewille et al, 2006 ;Santos et al, 2007;Melanie and Shulman, 2005 ;Aygun et al, 2002).…”

Aloimunização Eritrocitária Em Pacientes Com Anemia Falciforme Atendidos No Hemocentro De Caruaru, Pernambuco, Brasil

“…Não se observou qualquer correlação entre aloimunização e os diferentes tipos sanguíneos do sistema ABO, à semelhança de outros autores (SANTOS, 2007;ALVES, 2012).…”

“…Alguns estudos, mostram que quanto maior o número de transfusões, maior o risco de aloimunização (PINTO, 2011;SANTOS, 2007;NATUKUNDA, 2010;HELMAN, 2011;ALVES, 2012). Natukunda et al (2010) avaliaram 214 pacientes transfundidos por diversas doenças, destes, 13 apresentaram anticorpos antieritrocitários, sendo que 11 receberam mais que 10 transfusões, evidenciando ser fator significante receber mais que 10 CH para o risco de se tornar aloimunizado, fato também observado nestes achados.…”

Red cell transfusion and the immune system

“…Archiving and review of serologic records in centralised databases mitigates risk [29][30][31]. Delaney et al noted that > 13% of patient records were amended with historical data that otherwise would have been unknown to the primary care staff had there not been data centralisation in King County, Washington [32].…”