Alloimmunisation against red blood cells in sickle cell disease: transfusion challenges in high-income and low-income countries

Pirenne, France; Floch, Aline; Diop, Saliou

doi:10.1016/s2352-3026(23)00066-2

Cited by 6 publications

(2 citation statements)

References 60 publications

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“…Factors that affected the detection of antibodies in this cohort and could be better accounted for in a prospective, controlled study include antibody evanescence (failure to detect the antibody in the optimal time frame) and true exposures to each antigen (eg, a random unit may or may not be Fy(a + )). Innate and external factors have been shown to influence the risk of alloimmunization 40 , 41 and could be considered as additional variables for a personalized score, including inflammation 14 and transfusion indications. Transfusions in acute situations promote alloimmunization more than those in transfusion programs 7 , 24 , 26 , 28 while being at the highest risk for DHTR with hyperhemolysis 18 , 42 (DHTR events are recorded in another national database and could not be extracted for this study).…”

Section: Discussionmentioning

confidence: 99%

Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion

Floch,

Viret,

Malard

et al. 2023

Blood Advances

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Red blood cell (RBC) transfusion is a major therapy for sickle cell disease (SCD). Patients are at risk of forming antibodies to RBC antigens which can result in the impossibility to find compatible units and cause hemolytic transfusion reactions. This retrospective study investigates the evolution of RBC consumption, the frequencies, specificities and chronology of appearance of antibodies in a population of patients consistently receiving RH-K matched RBC units (RBCu) from a predominantly European donor population. Over the 11 year period in the Paris area, 6496 patients were transfused at least once for a total of 239944 units. Antibodies were made by 1742 patients. The first antibodies of a patient were predictive of subsequent immunization. By the 17th RBC unit transfused (by the 20th, excluding warm autoantibodies), 75% of patients who would make antibodies had made their first. By the 16th, 90% who would make antibodie(s) to a high frequency antigen had made their first antibody to these antigens. Females made their first antibodies slightly earlier than males. Multitransfused patients (>50 units) had a higher immunization prevalence than rarely transfused patients (<12 units) but fewer clinically significant antibodies. Patients with SCD and prophylactic RH-K matching not immunized by the 20th RBCu are likely to have a low alloimmunization risk (to antigens other than RH-K), i.e. be low responders, especially relative to the most clinically significant antibodies. This number of 20 units is a point before which close monitoring of patients is most important, but remains open to future adjustment.

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Section: Discussionmentioning

confidence: 99%

Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion

Floch,

Viret,

Malard

et al. 2023

Blood Advances

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“…Besides the ABO 2 and Rh 3 blood group systems, 45 blood group systems are known, which encode 362 antigens 4 . Alloimmunization is a serious risk for patients requiring recurrent transfusions, especially for patients with rare blood groups 5 . The generation of ex vivo cultured red blood cells (cRBCs) for transfusion purposes holds great promise to overcome such challenges in future blood transfusion medicine 6 – 12 .…”

Section: Introductionmentioning

confidence: 99%

Production and stability of cultured red blood cells depends on the concentration of cholesterol in culture medium

Claessen,

Yagci,

et al. 2024

Sci Rep

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The production of cultured red blood cells (cRBC) for transfusion purposes requires large scale cultures and downstream processes to purify enucleated cRBC. The membrane composition, and cholesterol content in particular, are important during proliferation of (pro)erythroblasts and for cRBC quality. Therefore, we tested the requirement for cholesterol in the culture medium during expansion and differentiation of erythroid cultures with respect to proliferation, enucleation and purification by filtration. The low cholesterol level (22 µg/dl) in serum free medium was sufficient to expand (pro)erythroblast cultures. Addition of 2.0 or 5.0 mg/dL of free cholesterol at the start of differentiation induction inhibited enucleation compared to the default condition containing 3.3 mg/dl total cholesterol derived from the addition of Omniplasma to serum free medium. Addition of 5.0 mg/dl cholesterol at day 5 of differentiation did not affect the enucleation process but significantly increased recovery of enucleated cRBC following filtration over leukodepletion filters. The addition of cholesterol at day 5 increased the osmotic resistance of cRBC. In conclusion, cholesterol supplementation after the onset of enucleation improved the robustness of cRBC and increased the yield of enucleated cRBC in the purification process.

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La drépanocytose : une transfusion à risque

Pirenne

2024

Bulletin de l'Académie Nationale de Médecine

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Alloimmunisation against red blood cells in sickle cell disease: transfusion challenges in high-income and low-income countries

Cited by 6 publications

References 60 publications

Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion

Eleven years of alloimmunization in 6496 patients with sickle cell disease in France who received transfusion

Production and stability of cultured red blood cells depends on the concentration of cholesterol in culture medium

La drépanocytose : une transfusion à risque

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