Study of red blood cell alloimmunization in multitransfused thalassemic children of Jammu region

Abstract

Introduction:Thalassemia is one of the most common genetic disorder of hemoglobin synthesis in Jammu region. Although RBC transfusion is life saving for these patients, it may be associated with some complications like RBC alloimmunization. Thus, the aim of this study was to determine the frequency of alloimmunization and the most common alloantibodies involved.Material and Methods:This was a descriptive study involving a total of 70 thalassemic patients in the age range of 2-17 years receiving regular blood transfusions, registered at SMGS Blood Bank, Jammu. Relevant clinical and laboratory data was collected with reference to age at the start of transfusions, total number of transfusions received and splenectomy status. Antibodies screening, antibody identification, and cross matching was done on allpatient samples included in the study, during the period between November 2009 and October 2010.Results:In this study, a total of six alloantibodies six patients (8.5%) and one autoantibody (1.42%) was detected. All identified alloantibodies belonged to Rh system (i.e. anti-E, in 3 patients (50%), anti D, in one patient (16.66%)) and Kell system (anti-K, in two patients (33.34%)). Higher frequency of alloimmunization was found, with increase in number of transfusions and in those who received transfusions after 1 year of age. Alloimmunization was not significantly associated with gender and splenectomy status (P-value > 0.05).Conclusion:Red cell alloantibodies developed in 8.5% of thalassemic patients and 1.42% had autoantibodies. The most common alloantibodies identified were anti Rh system antibodies (anti-E and anti-D) present in 50% and 16.66% of patients respectively. Alloimmunization is not an uncommon problem faced by blood banks and finding compatible units for regularly transfused thalassemic patients may become very difficult. In order to reduce alloimmunization, a policy for performing extended red cell phenotyping of these patients is essential and at least antigen E and Kell negative blood should be provided for transfusion to these patients.

Alloimmunization in multitransfused liver disease patients: Impact of underlying disease

“…This is similar to the previous reports of alloimmunization. [62324] As is evident from these findings, antibodies against the Rh and Kell system are the most commonly implicated alloantibodies. This re-iterates the need for extended Rh and Kell phenotype-matched RBCs in patients requiring repeated transfusions to prevent RBC alloimmunization.…”

Frequency of Red Cell Alloimmunization and Autoimmunization in Thalassemia Patients: A Report from Eastern India

“…The rate of alloimmunization was reported as high as 23% in few countries [ 15 , 16 ] to 7.7% in some other nations [ 17 , 18 ] depending on demography and homogeneity of population. Different studies were reported from different parts of India showing the alloimmunization rate in between 3.4% and 8.6% [ 19 – 22 ]. In this study the rate of alloimmunization was 5.6% which was consistent with the rate of alloimmunization observed in other parts of India.…”

Alloimmunization against Rh and Kell blood groups antigens is the main obstacle for blood transfusion in transfusion dependent thalassemia patients in Iran

“…With regards to these studies it seems that alloimmunization and even autoimmunization are a major concern in transfusion dependent thalassemia patients [5,7,22]. In Iranian patients with β-thalassemia major, transfusion related reaction was reported with a prevalence of about 15% in some studies [15,20]. Sometime, in patients with alloimmunization is significant and can have lifethreatening consequences.…”

“…Although as low as 0.7% of autoantibody was reported in other countries, most studies reported a significantly higher incidence of autoimmunization in other countries [18,[22][23][24][25]. In Kell blood group system, the most commonly alloantibodies directed against K antigen [14,[18][19][20]. In Rh blood group system, majority of antibody directed against D, E and C antigens (Table 3).…”

“…Similar to Iran the most common antibodies against transfused red blood cells were anti-Rh and anti-Kell antibodies in other countries [14][15][16][17][18][19][20][21][22]. The rate of alloimmunization varies between these countries from ~4% in India and Pakistan to ~75% in Kuwait [16,21,22].…”