A Prospective Study of the Incidence
of Red Cell Allo-lmmunisation
following Transfusion

Redman, Martin; Regan, Fiona; Contreras, Marcela

doi:10.1159/000462061

Cited by 59 publications

(8 citation statements)

References 9 publications

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“…The family history of these two individuals is unknown but they could have some Caucasian ancestors or from one of the Black African groups in which a higher incidence of K+ has been reported; 10.3% in a small sample of 106 Bantus and 5.2% among 201 Hottentots were K+ (Mourant et al, 1976). As the incidence of the K antigen is so very low, the likelihood of anti-K being found in the general hospital population in Malawi is very small, whereas in the United Kingdom anti-K is the commonest antibody found after anti-E (Redman et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

The prevalence of red cell antigens and antibodies in Malawi

M’baya

Mfune

Mogombo

et al. 2010

Transfusion Medicine

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As there were no reliable data in Malawi for the prevalence of red cell alloantibodies or antigens in the population, a study was conducted to screen 1000 patients for the presence of antibodies and to type them for ABO, RhD, C, c, E, e and K antigens and to test 500 donors for these antigens plus Fy(a), Fy(b), Jk(a), Jk(b), S and s. Red cell antibodies were identified in 11 patients [1.1%]; 2 were anti-D, 2 anti-S, 1 anti-Le(a+b) and 6 anti-M, 4 of which were found in non-transfused males suggesting they might be naturally acquired. The antigen frequencies found were similar to those previously published for Central Africa but 98.2% of donors were found to be Fy(a-b-). All patients tested were K negative and only three donors were found to be K positive, one being a Caucasian. Approximately 3.5% of Malawians are D negative, lower than the usual 8% quoted for Black Africans. These data confirm the assumption that pre-transfusion antibody screening is not currently required but that use of the indirect antiglobulin test in the cross-match is necessary. Haemolytic disease of the newborn (HDN) appears to be rare, or under reported, in Malawi, and more work is needed to find the real incidence of this condition.

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Section: Discussionmentioning

confidence: 99%

The prevalence of red cell antigens and antibodies in Malawi

M’baya

Mfune

Mogombo

et al. 2010

Transfusion Medicine

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“…Some reports indicate that multitransfused females register higher rates of alloantibody formation than males [18]. However, studies by Blumberg et al [19] and Redman et al [6] showed no difference in gender regarding alloimmunization rates.…”

Section: Introductionmentioning

confidence: 96%

“…Immune anti-RBC antibodies are generally formed early in the course of multiple transfusions, usually before the 10th transfusion [2,3]. In patients with disorders that often require multiple blood transfusions the rate of RBC alloimmunization has been reported in the range of 5-30% [2][3][4][5][6][7][8][9][10]. This range is even wider (3-76%) in patients with haemoglobinopathies [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…During pretransfusion testing, the patient's blood sample is usually screened for unexpected alloantibodies [22]. Antibodies against antigens of the Rh and Kell blood group systems are the specificities most frequently found in alloimmunized patients in Western Europe and the United States [3,5,6,9]. In Uganda, no such pretransfusion screening for immune antibodies is carried out on blood transfusion recipients.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

et al. 2010

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The prevalence of RBC alloimmunization in transfused Ugandans was 6.1% and was associated with the number of donor exposures. This immunization rate is similar to that observed in transfused Caucasians despite differences in RBC antigen distributions. Patients with malaria were less likely to develop RBC alloantibodies. Alloantibodies were mainly against E and S antigens. We recommend the introduction of pretransfusion antibody tests in Uganda depending on the recipient's diagnosis.

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“…The antigens most frequently involved belong to the Rh, Kell, Kidd, Duffy, Lewis and MNS blood group systems [17,18]. RBC alloimmunization rates ranging from 18% to 76% have been reported in transfused patients with SCD [17,[21][22][23] while other multiply transfused (OMT) patients had alloimmunization rates of approximately 5-20% [24][25][26] indicating that patients with SCD are at a significantly higher risk of developing alloantibodies to RBC antigens unless preventive strategies are in place.…”

Section: Rbc Alloimmunization In Sickle Cell Diseasementioning

confidence: 99%

Red blood cell alloimmunization and antigen matching in sickle cell disease – the African perspective

Natukunda

2012

ISBT Science Series

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In sickle cell disease (SCD), blood transfusion facilitates improved blood and tissue oxygenation, reduces the propensity to sickling by diluting host cells, and suppresses the production of red blood cells (RBCs) containing sickle haemoglobin (HbS). Delivery of RBC transfusions to patients with SCD varies by method (simple vs. exchange) and frequency (episodic vs. chronic). However, due to the genetic differences between blood donors and recipients, repeated transfusions increase the risk of developing alloantibodies to RBC antigens. The antigens most frequently involved belong to the Rh, Kell, Kidd, Duffy, Lewis, and MNS blood group systems. Consequences of RBC alloimmunization include delays and difficulties in obtaining compatible blood for future transfusions, the occurrence of delayed haemolytic transfusion reactions (DHTRs), the hyperhaemolysis syndrome and autoimmunization. In Europe and USA, RBC alloimmunization rates ranging from 18% to 76% have been reported in SCD while other multiply transfused (OMT) patients had alloimmunization rates of 5% to 20% indicating that SCD patients are at a higher risk of developing RBC alloantibodies. To prevent alloimmunization in SCD patients, the standard practice in Europe and USA is to determine their extended RBC phenotype (ABO, Rh, Kell, Kidd, Duffy, Lewis, MNS) before commencing transfusion therapy and perform antigen matching for C, E and K antigens for patients without prior alloantibody formation. However in Africa, lower RBC alloimmunization prevalence rates of 6–10% have been reported in SCD patients and no differences were observed between SCD and OMT patients. This may be explained by the presumed high phenotypic compatibility between donors and SCD patients who were all Black Africans. Also, a low transfusion load (a median 3 U of blood were transfused) in SCD patients might have led to the poor response to alloantigenic challenge. Anti‐K alloimmunization was notably rare among African SCD patients compared to anti‐S. In many African countries, pre‐transfusion immunohaematologic testing includes neither the detection of RBC alloimmunization nor preventive antigen matching. Most transfusion laboratories are understaffed and underequipped; they perform ABO/D typing plus room temperature saline cross‐matches and do not screen for RBC alloantibodies. Hence, immunized SCD patients are not diagnosed and do not have the opportunity of receiving antigen‐negative blood. Furthermore, data on the occurrence of DHTRs are lacking. Introducing pre‐transfusion RBC alloantibody screening in all African countries will significantly improve the transfusion management of SCD patients. A program of limited phenotype matching for C, E and S antigens is recommended to prevent additional alloantibody formation in immunized SCD patients in Africa.

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A Prospective Study of the Incidence of Red Cell Allo-lmmunisation following Transfusion

Cited by 59 publications

References 9 publications

The prevalence of red cell antigens and antibodies in Malawi

The prevalence of red cell antigens and antibodies in Malawi

Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

Red blood cell alloimmunization and antigen matching in sickle cell disease – the African perspective

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