Alloimmunization in sickle cell anemia in the era of extended red cell typing

O’Suoji, Chibuzo; Liem, Robert I.; Mack, Alexandra; Kingsberry, Paris S.; Ramsey, Glenn; Thompson, Alexis A.

doi:10.1002/pbc.24530

Cited by 69 publications

(63 citation statements)

References 21 publications

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“…Significant differences in RBC antigen frequencies between Caucasian donors and African and Afro-Caribbean recipients contribute to increased rates of alloimmunisation (Vichinsky et al, 1990). The use of Rh-and K-matched units has reduced alloimmunisation and haemolytic transfusion reactions, but sensitisation continues against Rh variants that are identifiable on molecular genotyping but not by serological methods (Lasalle-Williams et al, 2011;Noizat-Pirenne & Tournamille, 2011;Chou et al, 2013;Miller et al, 2013;O'Suoji et al, 2013).…”

Section: Alloimmunisation In Scdmentioning

confidence: 99%

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

et al. 2016

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Section: Alloimmunisation In Scdmentioning

confidence: 99%

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

et al. 2016

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“…Although single-institution and prospective multi-institutional studies have shown that limited C-, E-, and K-phenotype-matched RBCs significantly reduce the incidence of alloantibody production in SCD, 37,38,52 there remains no universal standard of care. More than 90% of institutions with Comprehensive Sickle Cell Centers provide RBCs that are prophylactically matched for C, E, and K to patients with SCD, 53 but only one-third of transfusion services nationally have such a policy.…”

Section: Strategies To Prevent Alloimmunization Rbc Antigen-matching mentioning

confidence: 99%

“…In a recent single-institution study of pediatric patients with SCD for whom limited RBC antigen-matching for C, E, K is practiced, 16 of 180 transfused patients formed 9 anti-C, 7 anti-E, and 5 anti-K antibodies. 38 The majority of cases were ascribed to transfusion at outside institutions that may not provide C-, E-, and K-matched RBCs, but 5 antibodies against Rh antigens occurred in patients who had Rh variants revealed by RH genotyping. We also recently reported a high rate of Rh alloimmunization in 182 transfused patients with SCD despite C-, E-, and K-matched RBCs primarily from African-American donors.…”

Section: Prevalence Of Alloimmunizationmentioning

confidence: 99%

“…In comparison, the incidence of alloimmunization in patients with SCD ranges from 18% to 76% with ABO and D matching alone; 5% to 14.5% with limited phenotype matching for C, E, and K antigens; and 7% for extended minor RBC antigen-matching beyond C, E, and K (for review, see Chou et al, 36 Lasalle-Williams et al, 37 O'Suoji et al 38 Despite prophylactic C, E, and K matching, many patients with SCD continue to form antibodies with common Rh specificities (D, C, E, c, e). In a recent single-institution study of pediatric patients with SCD for whom limited RBC antigen-matching for C, E, K is practiced, 16 of 180 transfused patients formed 9 anti-C, 7 anti-E, and 5 anti-K antibodies.…”

Section: Prevalence Of Alloimmunizationmentioning

confidence: 99%

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Transfusion therapy for sickle cell disease: a balancing act

Chou

2013

Hematology

108

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Transfusion therapy is a key intervention in decreasing morbidity and mortality in patients with sickle cell disease (SCD). Current indications for acute and chronic transfusion therapy have significantly increased the number of RBC units transfused to patients with SCD worldwide. This review summarizes transfusion management for the treatment or prevention of neurologic and perioperative complications, acute chest syndrome, and acute anemia associated with SCD. Despite the recognized benefits of transfusion therapy, it is not without the risks of iron overload, alloimmunization, and delayed hemolytic transfusion reactions. Transfusional iron overload management includes automated RBC exchange, noninvasive imaging to monitor iron burden, and iron chelation with parenteral or oral agents. Although limited and extended RBC antigen matching reduces antibody formation, the prevalence of RBC alloimmunization in patients with SCD remains high. Recent studies demonstrate that RH genetic diversity in patients with SCD contributes to Rh alloimmunization, suggesting that even more refined RBC matching strategies are needed. Advances in molecular blood group typing offer new opportunities to improve RBC matching of donors and recipients and can be of particular benefit to patients with SCD.

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“…The exact number of cumulative transfusions from birth to first antibody formation is often not reported and in many studies it is unclear if the transfusion history has been fully traced, including transfusions outside the reporting centers [9,10,12,[14][15][16]28]. Yet, the exposure to foreign RBC antigens is a prerequisite for alloimmunization and higher incidences of alloimmunization have been observed in patients with a higher number of transfusions [5,7,8,27,29].…”

mentioning

confidence: 99%

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization.

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Alloimmunization in sickle cell anemia in the era of extended red cell typing

Cited by 69 publications

References 21 publications

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

Transfusion therapy for sickle cell disease: a balancing act

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

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