Clinical and epidemiological profile of alloimmunized and autoimmunized multi-transfused patients against red blood cell antigens in a blood center of Minas Gerais

Abstract

BackgroundThe large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients.MethodsIn a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Sixty-eight had onco-hematological diseases, 64 had hemoglobinopathies and 21 had chronic renal failure. Descriptive analyses were carried out with the proportions being compared using the chi-square test, with the significance level set at 5%.ResultsThe Rh system was the most frequently involved (53.11%) and anti-E and anti-K (Kell system) were the most prevalent alloantibodies (21.87% each). Autoantibodies were found in ten patients (6.54%) with the percentages of autoimmunization in alloimmunized and non-alloimmunized individuals being 29.16% and 2.32%, respectively (p = 0.0001). There was a significant difference between autoimmunization and the number of transfusions (16.21% in 6–10 vs. 5.26% <6 vs. 2.56% >10; p = 0.0203) and diseases (19.04% in chronic renal failure vs. 6.25% in hemoglobinopathies vs. 2.94% in onco-hematological diseases; p = 0.0329).ConclusionThe results show a strong correlation between alloimmunization and autoimmunization. Moreover, they reinforce the need for further studies on the clinical and epidemiological profile of multi-transfused patients in relation to alloimmunity and autoimmunity, especially the latter, for a better understanding of its etiopathogenesis and physiopathogenesis.

Erythrocyte antigens and antibodies in the Chilean population

“…For example, in a study of 153 polytransfused patients in Minas Gerais, Brazil, a higher frequency of anti-E (21.87%) and anti-K (21.87%) was observed. 16 Another study of 227 polytransfused patients in Sao Paulo, Brazil, reported the highest findings to be anti-E (22.06%), anti-D (13.18%), and anti-K (11.75%). 17 Meanwhile, in a study of 152 transfused patients from Medellín, Colombia, it was observed that the vast majority of antibodies in the samples could not be identified (23.68%), followed by the presence of anti-E (17.10%), autoantibodies (11.18%), and anti-K (10.53%).…”

Red blood cell alloantibodies and autoantibodies: different presentation, same physiopathology

“…In this issue of Hematology, Transfusion and Cell Therapy, do Valle-Neto et al describe the alloimmunization profile of a cohort of multi-transfused patients from Minas Gerais, including both sickle cell disease (SCD) and non-SCD patients. 3 The group reported a significant prevalence of autoantibodies within the cohort (6.54%), which was much higher in the group of alloimmunized patients (29.16%) in comparison to the non-alloimmunized group (2.32%). This data elegantly reinforces previous evidence in the literature regarding the high frequency of RBC autoantibodies among alloimmunized patients under chronic transfusion therapy, and highlights that both alloantibodies and autoantibodies are probably formed through similar paths of adaptive immune response.…”

Transfusion in Haemoglobinopathies: Review and recommendations for local blood banks and transfusion services in Oman

“…44,[50][51][52] Although the development of these autoantibodies is less frequent compared to the development of alloantibodies, they can cause clinically significant haemolysis and difficulty in obtaining compatible RBC units. 53 The most common antibodies observed in patients with SCD and homozygous β-thalassaemia are those against the rhesus (Rh), particularly the C and E antigens, and the Kell (K) systems. 54 Other antibodies that tend to develop are against the Kidd, Duffy, Lewis and MNS systems.…”