Transfusion Practice, Post-Transfusion Complications and Risk Factors in Sickle Cell Disease in Senegal, West Africa.

Abstract

Context and Objectives: Blood transfusions (BT) remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. We aim to assess infectious markers, red cell alloimmunization and iron overload secondary to BT in SCD patients.
 Materials and Methods: This is a case-control study included 253 SCD (153 SCD-transfused and 100 SCD non-transfused). We evaluated the transfusion practice (modalities, indications), post-transfusion complications (infections, alloimmunization, iron overload) and risk factors of these complications (socio-demographic, clinical, biological).
 Results: Median age was 28.5 years (5 - 59). Sex ratio was 0.86. Homozygous SCD was more common (95.3%). Simple BT was performed in 92.8% and transfusion exchange in 18.9%. Transfusion indications were dominated by acute anemia (57.06%) and vaso-occlusive crisis (VOCs) (14%). Red blood cell concentrates (RBC) were administered to 93.46%. Median number of RBC received per patient was 10 (2 - 48). The prevalence of VHC in SCD-transfused was 1.33% and 2% for VHB. Anti-HIV antibodies were not found. Red cell alloimmunization frequency was 16%. The most common alloantibodies were anti-rhesus (34.19%) and anti-Kell (23.67%). Iron overload was detected in 7.84%. The number of RBC transfused was the only risk factor for alloimmunization (p = 0.03) and iron overload (p = 0.023). BT frequency was not related to infectious transmission.
 Conclusion: Despite advances in blood safety, BT therapy is still a risk for SCD polytransfused patients. Although infectious transmission has rare, the risk of alloimmunization and iron overload is high in these patients.

Homozygous Sickle Cell Disease after Age of 40: Follow-Up of a Cohort of 209 Patients in Senegal, West Africa

“…In a study of transfusion practices among SCD patients in our country, simple transfusion was performed in 92.81% and exchange transfusion in 18.95% [ 26 ]. Our study confirms this finding, showing that simple transfusion was most frequently used.…”

Red blood cell alloantibodies in paediatric transfusion in sub‐Saharan Africa: A new cohort and literature review

“…In general, the proportion of transfused sickle cell anaemia patients varies from different studies, between 30% and 90% [ 60 ]. This variation can be related to environmental factors, disease genetic factors and other factors including the low availability of blood, difficulties in accessing to health care and inadequacies of the transfusion system [ 60 , 61 ]. Thus, it is obvious to understand that the British Society for Haematology (BSH) guidelines, the American Society of Haematology (ASH) 2020 guidelines, and the USA National Institutes of Health Expert Panel (NIHEP) recommend prophylactic matching for Rh (C, E or C/c, E/e), and K in addition to ABO and D in patients with SCD [ 42 , 43 , 44 , 47 ].…”

A Review of the Relationship between the Immune Response, Inflammation, Oxidative Stress, and the Pathogenesis of Sickle Cell Anaemia

“…These risks include alloimmunisation, blood-borne diseases and iron overload. The build-up of alloantibodies [118] is most likely due to incompatibility in antigenicity between donors and recipients and may lead to delayed transfusion reactions [56]. Due to the interaction between oxidative stress and inflammation, some researchers have discovered that using antioxidants to treat only oxidative stress may not always be successful [2,15,75].…”

“…Alloimmunisation is an important complication resulting from chronic blood transfusions. Studies investigating the effects of alloimmunisation on the lymphocyte counts of patients with SCD have reported significant changes [ 24 , 47 , 53 , 54 , 55 , 56 ]. One such study demonstrated a significant decline in regulatory CD4+ T lymphocytes and an increase in regulatory CD8+ T lymphocytes [ 57 ], suggesting that these patients may be at risk of developing autoimmunity.…”