Red cell alloimmunization in multi-transfused, oncology patients: Risks and management

Abstract

Introduction: Repeated blood transfusion can result in the development of alloantibodies against one or more red cell antigens. Risk of alloimmunization is high in patients receiving multiple transfusions in hemoglobinopathies, hematologic malignancies, and cancer patients receiving chemotherapy. Materials and Methods: A study was undertaken to know risk of alloimmunization in multi-transfused, oncology patients and its management in a tertiary care oncology hospital over 3 years' period receiving multiple transfusions and subjected to antibody screening by 3-cell panel and antibody identification by 11 or 14 cell panels, wherever required, using solid phase red cell adherence technology. Results: 8115 units of leukodepleted, packed red blood cells (RBCs) were given to 5886 admissions. Of these, 18 patients (0.30%) developed red cell alloimmunization. Of these, 17 (94.5%) were female and only 1 (5.5%) was male patient, with 78% (14) solid organ malignancies and 22% (4) hematological malignancies. Three patients (16.6%) had concurrent warm autoantibodies with alloantibodies while 5 patients (28%) had multiple alloantibodies. About 68% of alloantibodies belonged to Rh blood group system followed by Duffy, Kidd, Kell, and MNS systems. Maximum alloantibodies (36%) were anti-E alloantibody. Conclusion: It is vital to detect the appearance of new alloantibodies or disappearance of old alloantibodies to prevent hemolytic transfusion reaction during or after allogeneic transfusion. Regular screening for the development of alloantibodies in multi-transfused patients and providing leukoreduced, Rh phenotyped and antigen-matched blood is recommended for better management of these patients. The prevention of RBC alloantibody formation in multi-transfused patients extends life expectancy and reduces the requirement of blood transfusion.