Unmasking delayed hemolytic transfusion reactions in patients with sickle‐cell disease: Challenges and opportunities for improvement

Delayed haemolytic transfusion reaction in paediatric patients with sickle cell disease: A retrospective study in a French national reference centre

“…4 These data regarding antibody screening tests and monitoring of HbA levels, advocate in favour of the need to establish standardised guidelines for the monitoring of patients with SCD after RBC transfusion, as well as for establishing a national transfusion database for patients with SCD. 26 Partial antigens in RHD and RHCE loci are frequent in people of African origin. 27 In our cohort, very few patients had screening for partial antigens; however, the relevance of antibodies against missing epitopes of a partial antigen in the pathogenesis of DHTR is questionable, especially if multiple antibodies are present.…”

Leukoreduction filters: Still stuck on sickle trait red cells

“…The BEST Collaborative studied 10,103,703 RBC units distributed by six U.S. blood centers from 2009 to 2016 and found that although overall RBC distributions declined by 27.2%, the distribution of antigen‐negative RBCs (defined as a unit ordered with a specific RBC phenotype) increased by 39.5% 5 . This increase in the overall distribution of antigen‐negative units is likely due to several factors, including increased RBC transfusions and exchanges for sickle cell disease (SCD) and the expanding practice of prophylactic extended phenotype matching for these and other chronically‐transfused patients 5–7 . Further, of the approximately 100,000 Americans with SCD, patients are overwhelmingly Hispanic and non‐Hispanic AAs 8 .…”

“…The higher likelihood of serendipitous extended phenotype matching with racially‐matched donors underlies the increasing need to diversify the U.S. donor base 9 . SCD patients are one of the most frequently alloimmunized transfused populations, with a reported alloimmunization rate ranging from 20% to 50% compared to the 2% to 5% rate in the general population 6,7 . One of the explanations for this higher rate of alloimmunization is polymorphic differences in immunogenic RBC antigens between white donors and predominantly AA patients; racial matching is preferred to mitigate the risk of alloimmunization in those chronically transfused 6 …”

“…9 SCD patients are one of the most frequently alloimmunized transfused populations, with a reported alloimmunization rate ranging from 20% to 50% compared to the 2% to 5% rate in the general population. 6,7 One of the explanations for this higher rate of alloimmunization is polymorphic differences in immunogenic RBC antigens between white donors and predominantly AA patients; racial matching is preferred to mitigate the risk of alloimmunization in those chronically transfused. 6 It has been long known that whole blood (WB) and RBC components collected from donors presumed to have SCT often occlude leukocyte reduction filters (LRFs), resulting in filtration failure.…”

“…5 This increase in the overall distribution of antigen-negative units is likely due to several factors, including increased RBC transfusions and exchanges for sickle cell disease (SCD) and the expanding practice of prophylactic extended phenotype matching for these and other chronically-transfused patients. [5][6][7] Further, of the approximately 100,000 Americans with SCD, patients are overwhelmingly Hispanic and non-Hispanic AAs. 8 The higher likelihood of serendipitous extended phenotype matching with racially-matched donors underlies the increasing need to diversify the U.S. donor base.…”