Alloimmunization in Patients with Sickle Cell Disease in French Guiana

Elenga, Narcisse; Niel, L

doi:10.1155/2015/812934

Cited by 10 publications

(14 citation statements)

References 16 publications

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“…Anti‐M was the most frequent antibody, with a prevalence of 5·1%, whereas the prevalence of anti‐Le a and anti‐Le b antibodies was 2·3% and 1·7% respectively. This finding agrees with the results of a recent study in French Guiana, which reported anti‐M, anti‐Le a and anti‐Le b antibodies to be the most frequent, with a prevalence of 3·4%, 5·6% and 2·8%, respectively, among 178 SCD patients transfused mostly with blood from French European donors (Elenga & Niel, ). These antibodies are usually irregular natural immunoglobulin M (IgM), but DTT was not used and the so‐called pre‐warm technique is not implemented in France.…”

Section: Discussionsupporting

confidence: 92%

Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre

et al. 2017

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Patients with sickle cell disease (SCD) show a high prevalence of red blood cell (RBC) alloimmunization, but few studies have focused on children. We aimed to study the prevalence and risk factors of RBC alloimmunization in SCD children. We retrospectively analysed the medical and transfusion files for 245 SCD children hospitalized in our centre in 2014 and included 175 patients who had received at least one RBC unit in their lifetime. The main clinical and immuno-haematological characteristics of alloimmunized and non-alloimmunized patients were compared. The prevalence of alloimmunization was 13·7% [95% confidence interval (CI) (8·6-18·6)], and 7·4% [95% CI (3·5-11·3)] after excluding the probable irregular natural antibodies (anti-M, anti-Le , anti-Le , anti-Le ). Main risk factors for alloimmunization were increased number of RBC units received (median of 65 vs. 10 units per patient; P = 0·01) and the presence of one or more red cell autoantibodies (46·2% vs. 4·7%; P < 0·0001). The alloimmunization rate was higher for episodically transfused than chronically transfused patients (1·43 vs. 0·24/100 units received; P < 0·001). The presence of red cell autoantibodies appears to be a major risk factor for alloimmunization in SCD children and could justify specific transfusion guidelines.

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Section: Discussionsupporting

confidence: 92%

Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre

et al. 2017

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“…Twenty case reports and series that included 36 patients reported an improvement in hemoglobin values after treatment with IVIg, high-dose steroids, eculizumab, and/or rituximab. 59,61,[65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] Regarding mortality, 1 retrospective study compared 53 patients who received supportive care only with 46 patients who received an immunosuppressive regimen and found 3 deaths in each group. 80 Another retrospective study examined 23 DHTR episodes, with 4 episodes managed by supportive care alone, 5 with immunosuppression with or without additional red cell transfusion, and 14 with red cell transfusion alone.…”

Section: Recommendationmentioning

confidence: 99%

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

et al. 2020

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Background: Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. Objective: Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. Methods: The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. Results: The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. Conclusions: The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.

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“…The authors explained that since blood cannot be collected locally, use of blood mostly from French Caucasian blood donors is causing alloimmunization in the Guianese population due to ethnic/geneticdifferences 13 . Natukunda et al 6 reported that the rate of RBC alloimmunization in Ugandan SCD patients was 6.1%.…”

Section: Discussionmentioning

confidence: 99%

“…Many factors should be considered to minimize alloimmunization prevalence in this group of patients who need more frequent transfusions. The main factors which increase alloimmunization risk include increased patient age 3,11 , female gender 2,14 , history of pregnancy 2,6 , not applying leukoreduction 15 , use of long term stored blood products 14,15 , the number of transfused RBC units 2,14 , transfusion for acute vasoocclusive indications and elevated inflammatory status of the patients 2 , ethnic/genetic differences 3,6,13 .…”

Section: Discussionmentioning

confidence: 99%

Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

Solmaz

Karacaoğlu

Gereklioğlu

et al. 2016

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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AbstractÖz Purpose: We aimed to investigate erythrocyte alloimmunization frequency and related factors in our region where SCD is common. Material and Methods: This study was planned as a single center, cross-sectional and retrospective cohort study. A total of 216 patients who had been followed up due to SCD [Hemoglobin (Hb) SS, Hb S-β thalassemia, Hb S-α thalassemia] were included in this study. Patients were divided to two groups according to amount of transfusion. The patients who had received less than 6 transfusions per year and who did not have the history of erythropheresis were allocated to Group 1, and the patients who had received 6 or more simple transfusion per year or who had undergone erythrocyte exchange were allocated to Group 2. Results: Of 216 SCD patients included in the study. Alloimmunization was detected in 67 (31.0%) out of 216 patients who underwent transfusion, and in 17 (30.4%) out of 56 patients in Group 1 and in 50 (31.3%) out of 160 patients in Group 2. When the patients were analyzed according to alloimmunization development, our study revealed that neither SCD complications are a risk factor for alloimmunization nor alloimmunization increases mortality rates. Conclusion: High alloimmunization frequency found in our study suggests the insufficient adherence of alloimmunization-prevention policies in RBC transfusions performed except experienced institutions. Therefore alloimmunization may be reduced or prevented through performing extended red cell typing among SCD patients.Amaç: Orak hücre hastalığının sık görüldüğü bölgemizde eritrosit alloimmmünizasyon sıklığını ve ilişkili durumları araştırmayı amaçladık. Gereç ve Yöntem: bu çalışma tek merkezli, zamansal kesitli ve geriye dönük kohort çalşıması olarak planlanmıştır.Toplamda 216 orak hücre hastalığı [Hemoglobin (Hb) SS, Hb S-β talasemi, Hb S-α talasemi] tanısı olan hasta çalışmaya dahil edilmiştir. Hastalar transfüzyon miktarına gore iki gruba ayrılmıştır. Yılda 6'dan daha az transfüzyon alan ya da eritroferez öyküsü olmayan hastalar Grup 1'e, yılda 6 ve daha fazla basit transfüzyon alan ya da eritroferez işlemine alınan hastalar Grup 2'ye dahil edilmiştir. Bulgular: Çalışmamıza 216 hasta dahil edilmiştir. Transfüzyon tedavisi alan toplam 216 hastanın 67 (%31.0)'sinde, Grup 1'deki 56 hastanın 17'sinde (%30.4), Grup 2'deki 160 hastanın 50'sinde (%31.3) tespit edilmiştir. Hastalar alloimmünizasyon gelişimi açısından analiz edildiğinde, çalışmamız ne orak hücre komplikasyonlarının alloimmünizasyon gelişimi için ne de alloimmünizasyonun ölüm için bir risk faktörü olmadığını göstermiştir. Sonuç:Çalışmamamızda bulunan yüksek alloimmünizasyon sıklığı, tecrübeli merkezler dışında yapılan transfüzyonlarda alloimmünizasyonu önleyici politikalara yeteri kadar uyulmadığı konusunda fikir vermektedir. Bu nedenle orak hücre anemili hastalarda alloimmünizasyon, ayrıntılı eritrosit antijen tanımlama işlemi yapılarak azaltılabilir veya önlenebilir.

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Alloimmunization in Patients with Sickle Cell Disease in French Guiana

Cited by 10 publications

References 16 publications

Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre

Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

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