Abstract
BackgroundCurrently, no data are available on the prevalence of red blood cell (RBC) antibody formation amongst Kenyan patients with multiple transfusion needs, such as patients with sickle cell disease (SCD) or haematological malignancies (HM) and solid (SM) malignancies.ObjectivesWe determined the prevalence and specificities of RBC alloantibodies and autoantibodies in two patient groups with recurrent transfusion demands at Kenyatta National Hospital, Nairobi, Kenya.MethodBetween February and August 2014, 300 samples from SCD, HM and SM patients were collected and screened for alloantibodies. Samples from 51 healthy blood donors were screened for irregular antibodies and phenotyped.ResultsAmongst the 228 patients with viable samples (SCD, n = 137; HM, n = 48; SM, n = 43), the median transfusion frequency was two to three events per group, 38 (16.7%) were RBC immunised and 32 (14.0%) had a positive direct antiglobulin test. We identified specific alloantibodies in six patients (2.6%). Four of these six were SCD patients (2.9%) who had specific RBC alloantibodies (anti-Cw, anti-M, anti-Cob, anti-S); amongst HM patients one had anti-K and one had anti-Lea. RBC autoantibody prevalence was 3.1% (7/228). Amongst the healthy blood donors, the Ror, ccD.ee and R2r, ccD.Ee phenotypes accounted for 82% of the Rhesus phenotypes and all were Kell negative.ConclusionThe numbers of transfusions and the rates of RBC alloantibodies are low and the most important RBC alloantibody-inducing blood group antigens are relatively homogeneously distributed in this population. A general change in the Kenyatta National Hospital pre-transfusion test regimen is thus not necessary. The current transfusion practice should be reconsidered if transfusion frequencies increase in the future.
Highlights
Blood transfusion constitutes an important supportive modality in the management of patients with sickle cell disease (SCD) and cancer, because of longer periods of treatment and increased survival rates
Of the samples from 300 patients who met the inclusion criteria, 72 samples could not be evaluated for the following reasons: insufficient sample because of leakage during shipment (n = 40); samples breaking in the centrifuge whilst processing (n = 20); and lack of proper labeling (n = 12)
We observed a low rate of Red blood cell (RBC) alloimmunisation amongst both SCD and cancer patients
Summary
Blood transfusion constitutes an important supportive modality in the management of patients with sickle cell disease (SCD) and cancer, because of longer periods of treatment and increased survival rates. RBC alloAb against incompatible RBC in an allogeneic bone marrow transplant may require procedures for RBC reduction.[6,7] The development of alloAb has been associated with that of autoantibodies (autoAb),[8,9] which can shorten the lifespan of recipients’ own RBCs and/or transfused RBCs and potentially cause haemolysis Because of this, these patients may require several transfusions and may need interventions, such as drugs to suppress the immune system and/or splenectomy.[9] These challenges need to be considered when handling patients who are likely to be transfusiondependent, as well as those who could benefit from haematopoietic stem cell transplantations. No data are available on the prevalence of red blood cell (RBC) antibody formation amongst Kenyan patients with multiple transfusion needs, such as patients with sickle cell disease (SCD) or haematological malignancies (HM) and solid (SM) malignancies
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