Position paper on International Collaboration for Transfusion Medicine (ICTM) Guideline ‘Red blood cell specifications for patients with hemoglobinopathies: a systematic review and guideline’

Trompeter, Sara; Massey, Edwin; Robinson, S.

doi:10.1111/bjh.16405

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…In addition, the benefit of preventive extended matching on the reduction of alloantibody formation has been extensively demonstrated in other high‐risk patients, e.g. in patients with haemoglobinopathies 13,14 and myelodysplastic syndrome 15 . Importantly, most studies did not directly compare extended with non‐extended matched patients, and reported prevalence rather than incidence 16,17 .…”

Section: Discussionmentioning

confidence: 99%

The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion‐induced red blood cell alloimmunisation

et al. 2021

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Summary Maternal alloantibodies directed against fetal red blood cell (RBC) antigens may cause potentially life‐threatening haemolytic disease of the fetus and newborn (HDFN). Dutch transfusion guidelines therefore prescribe preventive cEK matching for all (pre‐)fertile females. To quantify the impact of cEK matching, we compared overall and antigen‐specific cumulative RBC alloimmunisation incidences in females and males aged <45 years. Among a multicentre cohort comprised of patients who received their first and subsequent RBC unit between 2005 and 2019, first‐formed RBC alloantibodies were detected in 47 of 2998 (1·6%) females and 49 of 2507 (2·0%) males. Comparing females and males, overall alloimmunisation incidences were comparable (3·1% [95% confidence interval (CI) 2·1–4·4] versus 3·5% (95% CI 2·4–4·9, P = 0·853) after 10 units transfused). However, cEK alloimmunisation incidences were significantly lower among females (0·6% (95% CI 0·3–1.5) versus 2·2% (95% CI 1·5–3·4, P = 0·001) after 10 units transfused). Yet, despite cEK‐matching guidelines being in effect, 6·5%, 3·6% and 0·2% of all RBC units remained mismatched for c, E or K antigens respectively. Most of these mismatches were almost always due to emergency settings. Even though cEK alloimmunisation was not prevented completely, implementation of cEK matching resulted in an alloantigen‐exposure risk reduction of up to 98%.

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Section: Discussionmentioning

confidence: 99%

The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion‐induced red blood cell alloimmunisation

et al. 2021

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“…However, patients with SCD are at an increased risk of alloimmunisation following RBC transfusion, from both higher numbers of RBC units transfused and differences in the RBC antigens expressed (particularly RH genetic diversity) between recipient and donor populations. 1 Alloimmunisation rates are reduced by the provision of extended RH and K matched RBC units for this group of patients 2 and this is recommended by both BSH 3,4 and ASH guidelines. 5 Current BSH guidelines on RBC transfusion in SCD 3 recommend that these patients have extended RBC antigen typing performed (including C, c, E, e, K, k, Jk a , Jk b , Fy a , Fy b , S and s) at baseline.…”

Section: Introductionmentioning

confidence: 99%

Sickle cell disease patients in two London trusts: Genotyping including RH variants

Hui

Gurung

Layton

et al. 2021

Transfusion Medicine

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Background All SCD patients need extended RBC antigen typing (by serology or genotyping) for provision of extended RH, K matched blood and to guide RBC selection in those with complex transfusion requirements. Genotyping can also identify RH variants which can cause sensitisation even when extended RH phenotypically matched blood is provided and alloantibodies associated with RH variants can cause HTRs. Objectives To review the use of RBC genotyping in SCD patients at two London trusts (ICHNT, LNWH) with a focus on RH variants. Methods Retrospective review with data collected from clinical notes, local and national pathology reporting systems. Results A 311/482 (64%) ICHNT patients and 181/346 (52%) LNWH patients had extended genotyping. Of genotyped patients, 68 (22%) ICHNT and 31 (17%) LNWH patients had RH variants. Eight ICHNT patients had RH variants and corresponding antibodies associated with RH variants; 4/8 received multiple transfusions with antigen positive RBCs but had no evidence of haemolysis. One LNWH patient had a RH variant with corresponding alloantibody but could not be investigated further for possible HTR. Conclusions Most patients (59%) had genotyping and a significant number had RH variants (99, 20%). A small proportion (9, 9%) had antibodies associated with RH variants, but with no evidence of clinically significant HTRs despite transfusions in four of them with antigen positive RBCs. All SCD patients should have RBC genotyping including RH variants (preferentially over extended phenotyping) to guide better selection of RBC units. However, where antigen negative blood cannot be provided, the risk of alloimmunisation is not inevitable and subsequent HTRs from antibodies associated with RH variants might not always occur.

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“…Developing a precision transfusion model, however, requires understanding of the red cell genotype distribution in the local haemoglobinopathy and donor populations and also the risk and specificity of alloimmunisation in different cohorts. 8 Such data are limited, and results from one country cannot readily be extrapolated to another because of the different ethnic mix of both donors and patients. 9 Several factors make this issue increasingly important.…”

Section: Introductionmentioning

confidence: 99%

“…With the advent of methods for high‐throughput genotyping, including Rh variants to establish the range of major and minor blood groups for both donors and patients, this is theoretically practicable. Developing a precision transfusion model, however, requires understanding of the red cell genotype distribution in the local haemoglobinopathy and donor populations and also the risk and specificity of alloimmunisation in different cohorts 8 . Such data are limited, and results from one country cannot readily be extrapolated to another because of the different ethnic mix of both donors and patients 9 …”

Section: Introductionmentioning

confidence: 99%

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The haemoglobinopathy survey: The reality of transfusion practice in sickle cell disease and thalassaemia in England

Trompeter

Estcourt

Mora

et al. 2020

Transfusion Medicine

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Objectives: To establish, in an unselected population of London haemoglobinopathy patients, transfusion requirements, blood antigens/alloantibodies, transfusion modalities, burden of transfusion reactions and donor exposure. Background: Haemoglobinopathy patients are among the most highly transfused patient populations, and the overall population and number of patients on long-term transfusion programmes are increasing. To provide a safe and efficacious transfusion service for patients, it is important to understand current practice, morbidity associated with transfusion, efficacy of different transfusion modalities and geno-/phenotype requirements. Methods: Data on 4451 transfusion episodes in 760 patients from 12 London hospitals were collected retrospectively over a 6-month period in 2011. Results: Alloimmunisation prevalence was 17% for sickle cell disease (SCD) and 22% for thalassaemia, most commonly anti-Rh/Kell/Kp a /C w. Rh phenotypes differed

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Position paper on International Collaboration for Transfusion Medicine (ICTM) Guideline ‘Red blood cell specifications for patients with hemoglobinopathies: a systematic review and guideline’

Cited by 11 publications

References 5 publications

The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion‐induced red blood cell alloimmunisation

The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion‐induced red blood cell alloimmunisation

Sickle cell disease patients in two London trusts: Genotyping including RH variants

The haemoglobinopathy survey: The reality of transfusion practice in sickle cell disease and thalassaemia in England

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