Retrospective study on prevalence, specificity, sex and age distribution of alloimmunization in two general hospitals in Athens

Abstract

Objective: Blood transfusion is a common lifesaving treatment but it is often complicated with alloimmunization. Previously studies in Greece have concentrated on alloimmunization in multiply transfused thalassemic patients or antenatal women. However, the relative frequency of red blood cell (RBC) alloantibodies in the general patient population has not been studied so far. The aim of the present retrospective study was to estimate the prevalence and specificity of RBC alloantibodies in a large cohort of patients in two general hospitals and their association with age, sex, and the patients’ clinic of hospitalization. Materials and Methods: Data from 2012 to 2016 from the “Sismanogleio” and “Thriasio” general hospitals in Athens, Greece, were studied retrospectively. Statistical analysis was performed with SAS for Windows 9.4. Results: Six hundred twenty-six patients (626/53800, 1.16%) were alloimmunized for one or more alloantibodies. The mean age was 67.99±17.56 years. Most antibodies were found in women [62.66% (438/699) in women vs. 37.34% (261/699) in men (p=0.0007)], while the vast majority of antibodies (66.81%) were found in patients aged 61-90. The most frequent antibody was anti-Kell (26.61%), followed by anti-E (16.02%), anti-D (15.02%), anti-Jka (5.87%), and anti-M (5.72%). Anti-C (81.48%, n=27) and anti-Cw (54.17%, n=24) tended to be found more often in patients with multiple antibodies. Most alloimmunized cases were found in general surgery (42.65%) and internal medicine departments (38.66%). Conclusion: According to our results, the alloimmunization data in a general patient population in Greece were consistent with the majority of studies in the international literature. Whether a strategy at national level needs to be directed towards extending matching for the whole population or towards applying sensitive and compulsory indirect antiglobulin tests before any transfusions in order to efficiently prevent alloimmunization remains an issue of debate.

Significance of Detecting Antierythrocyte Antibodies in Pretransfusion Testing

“…The most common antibodies from this category are antibodies against high-specificity antigens from the blood group system Rh (anti-D, anti-c, anti-C and anti-E) and Kell ( 5 , 6 ). Their clinical importance is reflected in the fact that in the optimal environment of the bloodstream in-vivo they react very quickly with the appropriate antigens on the recipient’s erythrocytes and may lead to an acute hemolytic reaction.…”

“…According to Erikstein et al, anti-E antibody was also identified as the most common antibody in Norway (20 %), followed by anti-M (18 %), anti-K (10 %), and anti-D (9 %) ( 10 ). In a study conducted by Politou et al in three Greek hospitals on a sample of 53,800 patients who were transfused from 2012 to 2016, the antibody with the highest frequency was anti-K (26,61%), followed by anti-E (16,02%), anti-D (15,02%), anti-Jka (5,87%) and anti-M antibody (5,72%) ( 5 ).…”

Red Blood Cell Alloimmunization in Pregnancy: A Review of the Pathophysiology, Prevalence, and Risk Factors

“…The risk of RBC alloimmunization during pregnancy occurs when the fetus inherits a different set of RBC antigens than the mother. For example, if the mother is RhD-negative and the fetus is RhD-positive, the mother's immune system may produce antibodies against the fetal Rh antigens, recognizing them as foreign [ 9 ]. The Rh antigen (D, C, c, E) is one of the RBC antigens that frequently engage in RBC alloimmunization during pregnancy [ 9 ].…”

“…The reported rate of alloimmunization in the general population ranges from 0.46% to 2.4% [ 9 ]. Besides pregnancy, patients who received transfusions are among the most affected by alloimmunization.…”

Risk factors for red blood cell alloimmunization in multi-transfused oncology patients at Moi Teaching and Referral Hospital, Kenya

“…The reported range may be explained by genetic heterogeneity between the donor and recipient populations, variations in transfusion practices, and variations in the specificity and sensitivity of the test methodologies [27]. It is recommended that preemptive antigen matching for Rh (C, c, E, e) and K be performed on oncology patients and women of reproductive age to prevent alloimmunization and increase transfusion safety by lowering alloantibody formation [23].…”