Red blood cell alloimmunization in sickle cell disease: assessment of transfusion protocols during two time periods

Campbell‐Lee, Sally; Gvozdjan, Kristina; Choi, Kevin; Chen, Yi‐Fan; Saraf, Santosh L.; Hsu, Lewis L.; Strauss, Ronald G.; Triulzi, Darrell J.

doi:10.1111/trf.14588

Cited by 21 publications

(20 citation statements)

References 24 publications

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“…This study shows that the risk of alloimmunization increases with the number of blood units transfused. This finding is in agreement with previous reports that RBC allosensitization is more likely in patients with increased frequency of blood transfusion [ 34 – 36 ]. The alloimmunized SCD patients in Palestine received a high rate of transfusion (53.3 ± 22.2; range 20-98 RBC units).…”

Section: Discussionsupporting

confidence: 94%

Frequency of Red Blood Cell Alloimmunization in Patients with Sickle Cell Disease in Palestine

Samarah

Srour

Yaseen³

et al. 2018

Advances in Hematology

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Background Transfusion of red blood cells (RBC) is an essential therapeutic tool in sickle cell disease (SCD). Repeated RBC transfusions can cause alloimmunization which causes difficulty in cross-matching and finding compatible blood for transfusions. This study aimed to investigate the frequency of RBC alloimmunization and related risk factors among Palestinian SCD patients. Materials and Methods A multicenter cross-sectional study on 116 previously transfused SCD patients from three centers in West Bank, Palestine. Demographic, medical data and history of transfusion were recorded. Blood samples were collected from transfused consenting SCD patients. Gel card method was used for antibody screening and identification. In all patients, autocontrol and direct antiglobulin (DAT) test were performed using polyspecific (anti-IgG + C3d) anti-human globulin (AHG) gel cards for the detection of autoantibodies. Results Of the SCD patients, 62 (53.4%) patients were HbSS and 54 (46.6%) patients were sickle β-thalassemia (S/β-thal). There were 53 (45.7%) females and 63 (54.3%) males. Mean age was 18.8 years (range 3-53 years). The frequency of RBC alloimmunization among SCD patients was 7.76%, with anti-K showing the highest frequency (33.3%) followed by anti-E (22.2%), anti-D (11.1%), anti-C (11.1%), and anti-c (11.1%). All reported IgG alloantibodies were directed against antigens in the Rh (66.7%) and Kell (33.3%) systems. Older ages of patients, increased number of blood units transfused, and splenectomy were the commonest risk factors for alloimmunization in our study. Conclusions RBC alloimmunization rate among Palestinian SCD patients is low compared to neighboring countries and countries all over the world but still warrants more attention. Phenotyping of donors/recipients' RBC for Rh antigens and K1 (partial phenotype matching) before their first transfusion may reduce the incidence of alloimmunization.

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Section: Discussionsupporting

confidence: 94%

Frequency of Red Blood Cell Alloimmunization in Patients with Sickle Cell Disease in Palestine

Samarah

Srour

Yaseen³

et al. 2018

Advances in Hematology

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“…Perhaps immune tolerance develops when RhD-positive RBCs are transfused over time, or perhaps the patient's indication for transfusion changes over time with a subsequent change in their risk of alloimmunization over a longer period of time. Furthermore, although in some previous studies of multiply transfused patients with thalassemia, 15,16 acute leukemia, 17 and sickle cell disease, 18 leukoreduction was found to reduce the RBC-alloimmunization rate, there was no significant difference in the RhDalloimmunization rate between the patients in this study who received exclusively leukoreduced RhD-positive RBCs compared to those who did not receive any leukoreduced RhD-positive RBCs. Perhaps the absence of a leukoreduction effect on RhD-alloimmunization rates relates to the nature of the patients in this study compared to those who had been previously studied.…”

Section: Discussioncontrasting

confidence: 71%

Rate of RhD‐alloimmunization after the transfusion of multiple RhD‐positive primary red blood cell‐containing products

et al. 2021

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Introduction Early transfusion reduces mortality in bleeding patients. In this setting, RhD‐positive blood products might be transfused. This study determined the association between the RhD‐alloimmunization rate and the number of RhD‐positive products transfused. Methods RhD‐negative patients between 13 and 50 years who were transfused with ≥1 RhD‐positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD‐positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3–5, 6–10, 11–20, and >20 RhD‐positive transfusions and the RhD‐alloimmunization rate was determined for each group. Results There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%–40.3%) recipients who became RhD‐alloimmunized. There was no significant dosage effect in the RhD‐alloimmunization rates as the exposure to RhD‐positive units increased from one RhD‐positive unit to more than 20 RhD‐positive units (p = .270 for non‐parametric trend test). In an exploratory analysis, patients who received 100% of their RhD‐positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD‐alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p = .001). Conclusion These results suggest that there may not be an increased RhD‐alloimmunization risk with transfusing multiple RhD‐positive units after one RhD‐positive unit has been transfused. These findings need confirmation in larger studies.

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“…Patients on chronic transfusion therapy prior to HCT are generally at higher risk of developing autoand alloimmunization. Patients with sickle cell disease (SCD) have high rates of of RBC alloimmunization (23.8-45.7%) despite leukoreduction and prophylactic antigen matching [56,57].…”

Section: Non-abo Blood Groups Incompatibilitymentioning

confidence: 99%

Post–hematopoietic stem cell transplantation immune-mediated anemia: a literature review and novel therapeutics

et al. 2022

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Anemia following allogeneic hematopoietic stem cell transplantation (HCT) can be immune- or non-immune mediated. Auto- or alloimmunity due to blood groups incompatibility remain an important cause if post-HCT immune-mediated anemia. ABO incompatibility is commonly encountered in HCT and may lead to serious clinical complications including acute hemolysis, pure red cell aplasia, and passenger lymphocyte syndrome. It remains controversial whether ABO incompatibility may affect HCT outcomes, such as relapse, non-relapse mortality, graft-versus-host disease and survival. Non-ABO incompatibility is less frequently encounterd but can have similar complications to ABO incompatibility, causing adverse clinical outcomes. It is crucial to identify the driving etiology of post-HCT anemia in order to prevent and treat this condition. This requires a comprehensive understanding of the mechanism of anemia in blood group incompatible HCT, and the temporal association between HCT and anemia. In this review, we summarized the literature on post-HCT immune-mediated anemia with a focus on ABO and non-ABO blood group incompatibility, described the underlying mechanism of anemia, and outlined preventive and treatment approaches.

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Red blood cell alloimmunization in sickle cell disease: assessment of transfusion protocols during two time periods

Cited by 21 publications

References 24 publications

Frequency of Red Blood Cell Alloimmunization in Patients with Sickle Cell Disease in Palestine

Frequency of Red Blood Cell Alloimmunization in Patients with Sickle Cell Disease in Palestine

Rate of RhD‐alloimmunization after the transfusion of multiple RhD‐positive primary red blood cell‐containing products

Post–hematopoietic stem cell transplantation immune-mediated anemia: a literature review and novel therapeutics

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