Red blood cell alloimmunisation in multi-transfused patients from an haemodialysis service in Burkina Faso

Abstract

Background: In Burkina Faso, red blood cell (RBC) transfusion remains the crucial anaemia treatment following chronic renal failure (CRF) as erythropoietin and its analogues are unavailable. However, blood group matching beyond the ABO and Rhesus is not common in Burkina Faso. Thus, alloimmunisation is a potential issue for transfused patients.Objective: Our study aimed to identify anti-erythrocyte antibodies in multi-transfused CRF patients at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso.Methods: This cross-sectional study, conducted from October 2018 to November 2019, included CRF patients who had received at least two RBC units. We screened patients for the presence of RBC antibodies using three commercial Cells panels and identified antibody specificities for positive screenings using 11 Cells panels for an indirect antiglobulin test (IAT) in a low ionic strength microcolumn gel-card system.Results: Two hundred and thirty-five patients (45.1% female; average age: 41.5 years) were included. The median number of blood units received per patient was 10 (interquartile range: 5–20). The overall alloimmunisation rate was 5.9% (14/235). Antibodies identified included: anti-D (1 case), anti-C (1 case), anti-D+C (4 cases), anti-CW (1 case), anti-E (1 case), anti-S (1 case) and anti-Lea (1 case). In four positive patients, the specificity of the antibodies was indeterminate. No risk factors were associated with alloimmunisation.Conclusion: In Burkina Faso, screening for RBC alloantibodies should be mandated for patients at risk. The high rate of indeterminate antibodies suggests the need to develop a local RBC antibody panel adapted to the local population.

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

“…This study, unlike previous studies in Burkina Faso, included a larger number of patients, roughly representative of the transfused population in the country. The overall prevalence of antibodies (6.4%) is consistent with recent findings with 5.9% in haemodialysis patients 3 and 5.7% in multi‐transfused patient, regardless of diagnosis 12 . It is also consistent with those previously reported in two systematic reviews and meta‐analysis from SSA countries 6,7 .…”

“…It is also consistent with those previously reported in two systematic reviews and meta‐analysis from SSA countries 6,7 . However, this prevalence was relatively low compared to Europeans and North American studies that reported 18 to 76% of patients with alloantibodies, despite the mandatory donor and recipient Rh‐Kell antigens matching before transfusion 3 . Several hypotheses may explain these differences.…”

“…Such results has been previously reported 19,21–24 . However, our colleagues Nébié et al 3 and Yonli et al 12 did not find this association although our study was conducted in the same setting and on almost the same patient profile. This could be due to methodological differences regarding the sample size of the studies and the inclusion or not of pregnancy as a risk factor in the analysis.…”

“…The principle is that the anti‐human antibodies in the gel column trap the irregular antibody if it is present in the patient's plasma and bind it to the informative RBC (RBC expressing the corresponding antigen). The two‐step technical procedure (screening test and identification) has been already described elsewhere 3 …”

“…In a recent systematic review, childhood malaria anaemia (with 20% of blood units), sickle cell disease (18% of blood units) and obstetric haemorrhage (16% of blood units) were cited as the main health problems requiring blood transfusion 1 . Despite the significant advances in transfusion safety over the past two decades, in Sub‐Saharan African (SSA) countries, matching of recipient and donor ABO and RhD antigens is most often the only mandatory pre‐transfusion test before red blood cell (RBC) transfusions 2–5 . No extended RBC antigen phenotyping or irregular antibody screening are routinely performed.…”