One third of alloantibodies in patients with sickle cell disease transfused with African blood are missed by the standard red blood cell test panel

Antwi-Boateng, Lilian; Schonewille, Henk; Ligthart, Peter; Javadi, Ahmad; Veldhuisen, Barbera; Osei‐Akoto, Alex; Dei‐Adomakoh, Yvonne; Bates, Imelda; Schoot, C. Ellen van der

doi:10.3324/haematol.2021.278451

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Moreover, reactions against antigens other than the ones that were matched for might have occurred, as seen in other patients with SCD. 20 Reflex genotyping of blood donors self-identifying as Black can help identify potential blood donors efficiently. However, the number of variants detected by the commercially available genotyping kit used is limited, and important resources were mobilized, notably to sequence and/or genotype the RHCE.…”

Section: Discussionmentioning

confidence: 99%

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Management of a patient with sickle cell disease and multiple red blood cell alloantibodies in preparation for a hematopoietic stem cell transplantation

Cigna,

Leiva‐Torres,

Baillargeon

et al. 2024

Transfusion

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BackgroundHematopoietic stem cell transplant (HSCT) is currently the only widely available curative option for patients with sickle cell disease (SCD). Alloimmunization in this population is frequent and can complicate transfusion management during the HSCT period. The case of a pediatric patient with severe SCD clinical phenotype, multiple alloantibodies (9), and hyperhemolysis syndrome who underwent haploidentical HSCT is described.Study Design and MethodsThe patient was known for an anti‐e, despite RHCE*01.01 allele, which predicts a C‐ c+ E‐ weak e+ phenotype. Donors matching the patient's extended phenotype were targeted for RHCE genotyping.ResultsDonors homozygotes or heterozygotes for RHCE*01.01 were selected for compatibility analyses and ranked based on strength of reactions. Discordance between zygosity and strength of reactions was observed, as the most compatible donors were heterozygotes for RHCE*01.01. In total, the patient received seven RBC units from two different donors during HSCT process without transfusion reaction or development of new alloantibodies. Six months post‐HSCT, his hemoglobin level is stable at around 120 g/L and his chimerism is 100%.DiscussionThis case highlights the complexity of transfusion management during HSCT of alloimmunized patients with SCD. Collecting sufficient compatible units requires early involvement of transfusion medicine teams and close communication with the local blood provider. Genotyping of donors self‐identifying as Black is useful for identifying compatible blood for those patients but has some limitations. HSCT for heavily alloimmunized patients is feasible and safe with early involvement of transfusion medicine specialists. Further research on the clinical impact of genotypic matching is needed.

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Section: Discussionmentioning

confidence: 99%

“…This could be due to his hyper‐responsiveness, suggesting that precautions are needed for this type of individuals. Moreover, reactions against antigens other than the ones that were matched for might have occurred, as seen in other patients with SCD 20 …”

Section: Discussionmentioning

confidence: 99%

Management of a patient with sickle cell disease and multiple red blood cell alloantibodies in preparation for a hematopoietic stem cell transplantation

Cigna,

Leiva‐Torres,

Baillargeon

et al. 2024

Transfusion

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“…16,17 Beyond these problems with testing methods and algorithms, there are questions about the ability of Caucasian-sourced panels to detect and identify all antibodies to antigens present in SSA populations, such as RH10 or V, RH20 or VS, RH23 or DW, RH30 or Go a of the RH system, MNS6 or He of the MNS system or KEL6 or Js a of the KEL system. 10 Boateng et al 18 have previously highlighted their limitations, with more than 30% of antibodies present in immunised patients not detected.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and specificity of red blood cell antibodies in patients transfused in tertiary hospitals in Burkina Faso

Sawadogo

Nébié

Traoré

et al. 2023

Transfusion Medicine

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Background Sub‐Saharan African countries face the challenge of immunological transfusion safety that puts many patients at risk of post‐transfusion hemolytic reactions. This is because pre‐transfusion testing for irregular/unexpected antibodies that helps to prevent these risks are neither universally available nor accessible. The aim of our study was to determine the prevalence of red blood cell alloantibodies and their specificity in patients transfused in Burkina Faso. Materials and Methods This was a cross‐sectional study including patients who had received at least one blood transfusion. Indirect antiglobulin testing using LISS‐enhanced medium gel column agglutination technique was used for antibodies screening and identification. Enzymatic technique with papain‐treated red cell reagent was performed in attempt to solve some difficulties if necessary as well as auto‐control test and RH‐KEL phenotyping when possible to help antibodies identification. Results A total of 832 patients were included, 51.6% of whom were female, and the median (IQR) age was 34 (20–49) years. Of these, 43.7% had chronic kidney disease and 20.4% were sickle cell patients. The median (IQR) number of immunisation episodes (blood transfusion and pregnancies) was 3 (2–6) with the median (IQR) number of blood units received per patient of 2 (1–5). The proportion of patients with RBCs antibodies was 6.4% (53/832), with mainly anti‐Rh antibodies. A combination of 2 antibodies was found in 7 patients and a combination of 3 antibodies in one patient. Antibodies of unknown specificity (AUS) were encountered in 29%. Independent factors associated with antibody positivity were age (OR = 1.02; p = 0.026), sickle cell disease (OR = 3.23; p = 0.017) and receiving more than 10 blood units (OR = 7.33; p = 0.01). Conclusion In this study, the proportion of patients with RBC antibodies was quite similar to that observed in Sub‐Saharan African countries. However, the availability and accessibility of pre‐transfusion compatibility tests as well as the quality of methods used should be improved to ensure the safety of blood transfusions.

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“…While the detection of an anamnestic alloantibody response has become the hallmark of DHTR diagnosis, up to a third of reactions that present clinically as DHTRs occur in patients where no alloantibody is identified post‐transfusion and the DAT is negative, 10 thus failing to meet the NHSN testing criteria for diagnosing these reactions as DHTRs. It is possible that alloantibody‐negative DHTRs may reflect inadequate alloantigen representation among commonly employed screening tools designed to detect RBC alloantibodies, gaps in the sensitivity of alloantibody detection in general, or other reasons altogether 11,12 . However, regardless of the underlying cause, failure to identify alloantibodies or a positive DAT raises the possibility of inadequate DHTR detection under NHSN guidelines.…”

Section: Dhtrs Are An Under‐recognized Cause Of Morbidity and Mortali...mentioning

confidence: 99%

“…It is possible that alloantibody-negative DHTRs may reflect inadequate alloantigen representation among commonly employed screening tools designed to detect RBC alloantibodies, gaps in the sensitivity of alloantibody detection in general, or other reasons altogether. 11,12 However, regardless of the underlying cause, failure to identify alloantibodies or a positive DAT raises the possibility of inadequate DHTR detection under NHSN guidelines. As a result, the current federal reporting guidelines, by definition, may miss a substantial portion of clinically significant DHTRs.…”

Section: Dhtrs Are Underdiagnosedmentioning

confidence: 99%

Unmasking delayed hemolytic transfusion reactions in patients with sickle‐cell disease: Challenges and opportunities for improvement

et al. 2022

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One third of alloantibodies in patients with sickle cell disease transfused with African blood are missed by the standard red blood cell test panel

Abstract: Not available.

Cited by 12 publications

References 15 publications

Management of a patient with sickle cell disease and multiple red blood cell alloantibodies in preparation for a hematopoietic stem cell transplantation

Management of a patient with sickle cell disease and multiple red blood cell alloantibodies in preparation for a hematopoietic stem cell transplantation

Prevalence and specificity of red blood cell antibodies in patients transfused in tertiary hospitals in Burkina Faso

Unmasking delayed hemolytic transfusion reactions in patients with sickle‐cell disease: Challenges and opportunities for improvement

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