Red‐blood‐cell alloimmunization and number of red‐blood‐cell transfusions

Zalpuri, Saurabh; Zwaginga, Jaap Jan; Cessie, Saskia le; Elshuis, J.; Schonewille, Henk; Bom, Johanna G. van der

doi:10.1111/j.1423-0410.2011.01517.x

Cited by 92 publications

(94 citation statements)

References 22 publications

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“…We provide further evidence for an increased risk of alloimmunization in SCD compared to the general population, independent of the cumulative transfusion exposure [5,6,11,39,41]. This susceptibility for alloimmunization in SCD has previously been explained by the antigenic differences between donors and recipients, SCD specific factors such as chronic inflammation and patient-related factors such as genetic background [2].…”

Section: Discussionmentioning

confidence: 81%

“…These findings provide further support for the existence of a responder phenotype in SCD. Interestingly, this has not been observed in the general population, suggesting an effect specific but not limited to the SCD population [5]. This highlights the importance of identification of factors determining patients to be responders or not.…”

Section: Discussionmentioning

confidence: 91%

“…This population consisted mainly of patients of Caucasian ethnicity, and excluded patients routinely receiving Rh and K matched RBC units and infants under 6 months of age [5]. Median age was 62 years (interquartile range [IQR] 51-71) and the median number of RBC units per patient was 6 (IQR 3-11).…”

Section: Methodsmentioning

confidence: 99%

“…The exact number of cumulative transfusions from birth to first antibody formation is often not reported and in many studies it is unclear if the transfusion history has been fully traced, including transfusions outside the reporting centers [9,10,12,[14][15][16]28]. Yet, the exposure to foreign RBC antigens is a prerequisite for alloimmunization and higher incidences of alloimmunization have been observed in patients with a higher number of transfusions [5,7,8,27,29]. The cumulative number of transfusions may therefore be an important confounding factor in reports on the incidence and risk factors of alloimmunization in SCD.…”

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confidence: 99%

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Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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“…However, in multitransfused patients, alloimmunizaton occurs in up to 70% of patients. 8,9 In countries where phenotyping is mandatory (eg. Before proceeding to extended Rh phenotyping, the donor's ABO grouping was done.…”

Section: Introductionmentioning

confidence: 99%