Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions

Aygün, Banu; Padmanabhan, Savitri; Paley, Carole; Chandrasekaran, Visalam

doi:10.1046/j.1537-2995.2002.00007.x

Cited by 320 publications

(304 citation statements)

References 19 publications

(31 reference statements)

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“…However, alloimmunization to minor red blood cell (RBC) antigens is frequent in chronically transfused recipients. In such transfused patients, almost 50% will have developed alloantibodies by adulthood, with a significant portion having made alloantibodies to several red cell antigens [3] causing complications ranging in severity from life-threatening delayed hemolytic transfusion reactions and autoimmunization to practical difficulties in obtaining matched blood [4][5][6][7]. While several factors including host genetics can influence the recipient's immune system to react to RBC alloantigens, the inflammatory status of transfusion recipients appears to be critical in determining the immunogenicity of transfused RBCs [8].…”

Section: Introductionmentioning

confidence: 99%

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Prevention of red cell alloimmunization by CD25 regulatory T cells in mouse models

Heck

Yazdanbakhsh

2007

American J Hematol

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Transfusion therapy is currently an effective therapeutic intervention in a number of diseases, including sickle cell disease. However, its use is complicated by a high incidence of red blood cell (RBC) alloimmunization in the transfusion recipients. The identification of T regulatory cells (Tregs) among the CD4 þ CD25 þ T cell subset as key regulators of peripheral tolerance in mice as well as humans has opened an exciting era in the prevention and treatment of autoimmune disease and for improving organ transplantation. However, their potential in inducing transfusion tolerance remains to be explored. We used red cells from mice transgenic for human glycophorin A blood group antigen as donor cells and transfused wild-type mice to induce alloantibodies, as an experimental system to study RBC alloimmunization. We found that depletion with anti-CD25 enhanced the alloantibody production, indicating that CD25 Tregs play an important role in regulation of alloantibody responses. More importantly, adoptive transfer of purified population of-cells from naïve mice prevented the induction of IgG and IgM alloantibody production in transfusion recipients, with a concomitant reduction in activated splenic B cells and macrophages. Similarly, adoptive transfer of purified populations of CD4 þ CD25 þ cells from naïve mice into naïve syngeneic recipients inhibited the anti-Ig response to rat RBCs in the recipients but transfer of control CD4 þ CD25 -cells did not. Altogether, our results demonstrate that Tregs participate in the control of transfusion-associated RBC alloantibody responses, opening up the possibility that Treg immunotherapy may be exploited for suppressing transfusion immunization events. Am. J. Hematol. 82:691-696, 2007.

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Section: Introductionmentioning

confidence: 99%

“…A strategy to reduce RBC alloimmunization has been to use phenotypically matched units prior to transfusion, although there is controversy in the implementation of this approach [3]. Induction of immune tolerance to prevent alloimmunization from transfusion is a potential approach that remains to be explored.…”

Section: Introductionmentioning

confidence: 99%

Prevention of red cell alloimmunization by CD25 regulatory T cells in mouse models

Heck

Yazdanbakhsh

2007

American J Hematol

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“…Attempting to identify blood lacking the antigen to which an antibody is formed can be difficult [6,7]. Matching red blood cell components between donors and recipients for more than ABO and Rh blood groups may decrease the rate of alloimmunization and the number of hemolytic reactions among recipients [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers and motivators to blood and cord blood donations in young African-American women

Grossman

Watkins

Fleming³

et al. 2005

Am. J. Hematol.

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The primary aim of this study was to assess potential barriers and motivators to blood and cord blood donation among African-American women. A telephone survey of AfricanAmerican women, ages 18-30 years, in the St. Louis metropolitan area was performed. The survey was administered by trained telemarketing personnel using a ComputerAssisted Direct Interview (CADI) system. One hundred sixty-two women were surveyed. Common barriers to blood donation were inconvenience of donor sites (19%), fear of needles (16%), and too much time required to donate (15%). Potential motivators were increasing awareness of need for blood (43%), increasing the number of convenient donor locations (19%), and encouragement by spiritual leaders to have blood drives at their church (17%). Lack of awareness was the only identified barrier to cord blood donation. Most women surveyed (88%) indicated that they definitely or probably would donate cord blood. Strategies to increase the proportion of African-American blood and cord blood donations may include educating potential donors about the process and benefits of donation to particular patient populations and engaging church leadership in supporting blood and cord blood donations. Am.

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“…The responsibility of anti-MNS1 and anti-LE2 antibodies in our patient was unlikely because of poor signification [3,4], and antigen-negative crossmatch-compatible blood transfusion was given. The recipient red blood cells destruction observed in HS (''bystander effect'') may be due to activated macrophages, stimulation of auto-immunization, or attaching of activated components of complement [4].…”

Section: Zohya Khaliquementioning

confidence: 79%

Erythrocytapheresis in the prevention of recurrent myocardial infarction in sickle cell disease

Khalique¹,

Pavlů²,

Lefroy³

et al. 2009

American J Hematol

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Erythrocytapheresis is an established therapy for the prevention of stroke in sickle cell disease [1]. We report its use in the prevention of recurrent acute coronary syndromes.A 50-year-old woman, with homozygous sickle cell disease presented in December 2005 with central chest pain, T wave inversion in V1-V3 and biphasic T waves in V4-V6. She was treated with aspirin, clopidogrel, and enoxaparin. Her troponin I peaked at 8.23 lg/L 12 hr later. Cardiac magnetic resonance imaging (MRI) showed subendocardial hyperenhancement in the lateral wall of the left ventricle consistent with an infarct. Coronary angiography showed no obstruction [2]. A long-term red cell exchange program was considered but deferred in the absence of evidence of recurrent myocardial infarction in sickle cell disease.Nine months later the patient presented with central chest pain of sudden onset. Electrocardiography showed new onset atrial fibrillation with T wave inversion across V1-V4. Serum troponin I was elevated at 0Á19 lg/ L and rose to 4Á61 lg/L 12 hr later. Cardiac MRI was unchanged compared with the previous study. Treatment with enoxaparin was commenced and electrocardioversion undertaken, successful only with amiodarone preloading.In light of the recurrence of myocardial infarction, a red cell exchange program to achieve a target hemoglobin S level of <30% was implemented. Thirty-four months after this second event, the patient is maintained on a regular red cell exchange program and remains well in sinus rhythm. We have recommended erythrocytapheresis is continued on an indefinite basis.Although regular red cell transfusions to suppress the level of hemoglobin S are well established in the primary and secondary prevention of stroke in sickle cell disease [1], they have not previously been shown to reduce the risk of recurrent myocardial infarction. We believe hematologists should be aware of the potential benefit of such an approach.

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Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions

Cited by 320 publications

References 19 publications

Prevention of red cell alloimmunization by CD25 regulatory T cells in mouse models

Prevention of red cell alloimmunization by CD25 regulatory T cells in mouse models

Barriers and motivators to blood and cord blood donations in young African-American women

Erythrocytapheresis in the prevention of recurrent myocardial infarction in sickle cell disease

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