Red blood cell immunization in sickle cell disease: evidence of a large responder group and a low rate of anti-Rh linked to partial Rh phenotype

Silvy, Monique; Tournamille, Christophe; Babinet, Jérôme; Pakdaman, Sadaf; Cohen, S.; Chiaroni, Jacques; Galactéros, Frédéric; Bierling, Philippe; Bailly, Pascal; Noizat‐Pirenne, F.

doi:10.3324/haematol.2014.104703

Cited by 64 publications

(69 citation statements)

References 15 publications

(7 reference statements)

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“…Relatively low alloimmunization rates were found in populations with little exposure, higher rates at increased exposures and the majority of antibodies appear to be formed before 20 RBC units or less [7,8,28,29,38]. A subgroup of patients appears to alloimmunize after only limited exposure while a significant proportion of patients remains unaffected despite numerous transfusions [39,40]. Moreover, we found that the risk of second alloantibody formation appears to be higher compared to first alloimmunization.…”

Section: Discussionmentioning

confidence: 62%

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: 62%

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

et al. 2016

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“…The prevalence of partial RH antigens and variant RH alleles in SCD patients has recently been investigated in France [11,17] and elsewhere [15,18,19]. SCD patients with variant alleles have been shown to have a higher risk of alloimmunization, in both these and other studies [20].…”

Section: Part I: Overview and Presentation Of The French Strategymentioning

confidence: 99%

“…There is evidence to suggest that individuals may be high or low ‘responders', depending on their propensity to produce antibodies [11,12], but the responder status of a patient cannot be predicted until a positive result is obtained in an antibody screening test. Delayed hemolytic transfusion reactions (DHTRs) are a major concern in SCD patient care, and are generally associated with the production of antibodies [13,14].…”

Section: Introductionmentioning

confidence: 99%

Genotyping in Sickle Cell Disease Patients: The French Strategy

Floch

Tournamille

Chami

2018

Transfus Med Hemother

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This review presents the French strategy for blood group genotyping in high-responder and newly diagnosed sickle cell disease (SCD) patients. In addition to FY, JK, and MNS genotyping, the RH blood group system is now explored in SCD patients in France. Molecular typing has been used for the deduction of partial RH2 (C) antigens since 2010, and the gradual implementation of systematic RHD and RHCE genotyping nationwide was initiated in late 2014. In our laboratory, 962 RH:2 (C-positive) SCD patients have been tested since 2010, and 1,148 SCD patients of all RH phenotypes have been genotyped for clinically relevant alleles of RHD and RHCE since late 2014.

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“…Alloimmunization is more frequent in SCD patients than in other patients and represents a major concern in transfusion medicine. 1 The high incidence of alloimmunization in this population is partly explained by the large disparity of blood groups between European donors and recipients of African descent. However, some SCD patients never become immunized, and can be qualified as "low responders".…”

Section: Introductionmentioning

confidence: 99%

Red blood cell alloimmunization is influenced by the delay between Toll-like receptor agonist injection and transfusion

et al. 2015

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Red blood cell immunization in sickle cell disease: evidence of a large responder group and a low rate of anti-Rh linked to partial Rh phenotype

Cited by 64 publications

References 15 publications

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

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

Genotyping in Sickle Cell Disease Patients: The French Strategy

Red blood cell alloimmunization is influenced by the delay between Toll-like receptor agonist injection and transfusion

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