Prevention and management of transfusion-induced alloimmunization: current perspectives

Abstract

Transfusion of blood components, transplantations, and exchange of blood between mother and child during pregnancy or at birth can lead to alloimmunization. Because of its clinical relevance, this review brings into focus alloimmunization against red blood cells, human platelet antigens, human leukocyte antigens, and human neutrophil antigens. In principle, an individual is able to develop antibodies after exposure to a nonautogenous antigen, but these cells actually induce alloimmunization only for a minority of patients. An individual producing alloantibodies after having contact with foreign antigens depends on various factors, such as genetic predisposition, underlying diseases, the patient's immune status, and clinical immune modulation. When alloimmunization has occurred, it could lead to problems for future transfusions or transplantations.

Immune erythrocyte antibodies in adult patients with sickle cell disease and blood donors in Lagos, Nigeria: a comparative study

“…Clinical sequelae of erythrocyte alloimmunization include hemolytic transfusion reactions (HTRs), transfusion refractoriness, and possible hemolytic disease of the fetus and newborn in affected women. 22,23 The prevalence of delayed HTR has been observed to be as high as 11 percent in SCD patients. 24 Therefore, there is a need to continually evaluate SCD patients for their alloimmunization status.…”

A Rare Case of Acute Hemolytic Anemia in a Patient with Newly Diagnosed Multiple Myeloma: Maintaining a Fine Balance between Occam's Razor and Hickam's Dictum

“…14 In patients who have hemolytic anemia due to alloimmunization, screening and antigen matching are recommended to prevent further complications. 15 There are instances of alloimmunization which have occurred in the immediate post-transplant period leading to hemolysis and complicating the management due to the increased transfusion requirement post-ASCT. 16 17 Cold antibody-mediated hemolysis is usually IgM, and RBC hemolysis occurs at 3 to 4°C.…”

Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion

“…[ 24 ] Newly designed filters (third and fourth generation) are capable of removing up to 3 logs (99.9%) of contaminated WBCs. [ 25 ] They have pores ranging from 5 to 50 mm and are able to meet current hemocomponents’ quality standards. [ 26 ]…”

“…Although fresh donated RBCs seem to induce HLA alloimmunization, RBCs stored for at least 15 days pretend to induce immune tolerance against foreign HLA antigens. [ 25 ] For PCs derived from whole blood, the standard requires that each unit contains no more than 0.83 × 10 5 WBC per unit. Currently, the removal of WBCs from PCs by filtration (using third and fourth generation) is the best approach to reduce the incidence of primary HLA alloimmunization.…”