Lower alloimmunization rates in pediatric sickle cell patients on chronic erythrocytapheresis compared to chronic simple transfusions

Wahl, S.; García, Alberto Torres; Hagar, Ward; Gildengorin, Ginny; Quirolo, Keith; Vichinsky, Elliott

doi:10.1111/j.1537-2995.2012.03659.x

Cited by 65 publications

(62 citation statements)

References 26 publications

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“…Therefore, there was no clear association identified between the numbers of exposures per transfusion episode with alloimmunization. This is in accordance with previous reports comparing alloimmunization rates between SCD patients receiving chronic simple or exchange transfusions, which concluded that red cell exchange therapy does not increase the risk of alloimmunization, despite exposure to more RBC units per transfusion episode (Heddle et al, 1995;Wahl et al, 2012).…”

Section: Discussionsupporting

confidence: 82%

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

et al. 2014

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SummarySickle cell disease (SCD) patients are at increased risk of red blood cell (RBC) alloimmunization. Recipient inflammatory state at time of transfusion has been shown to regulate alloimmunization in murine models, but evidence is lacking in SCD patients. We retrospectively studied a cohort of alloimmunized SCD patients to determine the influence of pro-inflammatory SCD-related complications at time of transfusion on alloimmunization. For each transfusion, the presence of pro-inflammatory state, degree of RBC antigen matching, unit age, storage solution and alloantibody detection date were ascertained. Transfusion-associated pro-inflammatory events were compared between transfusions resulting and not resulting in new alloantibodies. Univariate analysis and multivariate logistic regression were performed. Fifty-two patients received 3166 pre-storage leuco-reduced transfusions of which 128 resulted in alloantibodies. Transfusions during inflammatory events were associated with increased alloantibody risk on univariate and multivariate analysis; acute chest syndrome and vaso-occlusive crisis showed strongest associations with alloimmunization. Increased antigen matching demonstrated a protective effect on alloimmunization (univariate and multivariate analysis). Although an association was seen between citrate-phosphate-dextrose (adenine) stored units and alloimmunization on univariate analysis, no effect was found on multivariate analysis. Identifying recipient pro-inflammatory states at time of transfusion that promote alloimmunization can impact RBC unit selection decisions for SCD patients at risk for alloimmunization.

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Section: Discussionsupporting

confidence: 82%

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

et al. 2014

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“…Unexplained Rh antibodies in patients with SCD were occasionally observed in previous studies, including one anti-D in a D1 patient, one anti-C in a C2 patient, and three anti-E in both E1 and E2 patients, despite Rh matching. 10,11,35 A recent study reported 5 patients with Rh variants discovered by RH genotyping after immunization to Rh antigens for which their RBCs were positive by serologic phenotype.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The incidence of alloimmunization in patients with SCD ranges from 7% to 47%, dependent on age, RBC exposures, and extent of antigen matching for blood groups other than ABO and RhD. [4][5][6][7][8][9][10][11][12] An estimated 4% to 11% of patients with SCD who receive transfusions develop overt delayed hemolytic transfusion reactions (DHTRs), [13][14][15] but mild DHTRs may be unrecognized. Sensitization to Rh antigens (D, C, c, E, and e) and to K comprise the majority of the RBC antibodies encountered in SCD.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors

Chou

Jackson

Vege

et al. 2013

Blood

388

492

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• Rh serologic phenotype-matched transfusions from minority donors do not prevent all Rh alloimmunization in patients with SCD.• Variant RH genes are common in patients with SCD and contribute to Rh alloimmunization and transfusion reactions.Red blood cell (RBC) transfusion is a key treatment of patients with sickle cell disease (SCD) but remains complicated by RBC immunization. In the present study, we evaluated the effects of antigen matching for Rh D, C, and E, and K and transfusion from African American donors in 182 patients with SCD. Overall, 71 (58%) chronic and 9 (15%) episodically transfused patients were alloimmunized. Fifty-five (45%) chronic and 7 (12%) episodically transfused patients were Rh immunized. Of 146 antibodies identified, 91 were unexplained Rh antibodies, one-third of which were associated with laboratory evidence of delayed transfusion reactions. Fifty-six antibodies occurred in patients whose RBCs were phenotypically positive for the corresponding Rh antigen and 35 in patients whose RBCs lacked the antigen and were transfused with Rh-matched RBCs. High-resolution RH genotyping revealed variant alleles in 87% of individuals. These data describe the prevalence of Rh alloimmunization in patients with SCD transfused with phenotypic Rh-matched African American RBCs. Our results suggest that altered RH alleles in both the patients and in the donors contributed to Rh alloimmunization in this study. Whether RH genotyping of patients and minority donors will reduce Rh alloimmunization in SCD needs to be examined. (Blood. 2013;122 (6):1062-1071

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“…Automated exchange transfusion programmes consume more red cell units than chronic partial exchange or simple transfusion procedures (Hilliard et al, 1998). However, a retrospective study of children on chronic transfusions reported a significantly lower rate of alloimmunisation for those on automated apheresis compared to children on simple transfusions even though blood consumption was significantly higher in the erythrocytapheresis group (Wahl et al, 2012). Concerns about increased alloimmunisation with exchange transfusion may be unjustified and erythrocytapheresis should not be withheld from those likely to benefit from it.…”

Section: Alloimmunisationmentioning

confidence: 99%

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

et al. 2016

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Lower alloimmunization rates in pediatric sickle cell patients on chronic erythrocytapheresis compared to chronic simple transfusions

Abstract: Chronic ECP should be considered in patients requiring optimal management of HbS levels and iron burden. Concerns about increased alloimmunization with ECP may be unjustified.

Cited by 65 publications

References 26 publications

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors

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

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