Screening and identification of red blood cell alloantibodies among hemodialysis patients in National Institute of Urology and Nephrology

Abstract

Background It is well known that alloimmunization to red blood cell antigens resulting from the genetic disparities between the donor and the recipient is one of the risks of blood transfusion. Alloimmunization can result in clinical hemolysis and difficulty in cross-matching blood. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as renal failure patients on dialysis who receive blood transfusions. The antibody-screening test (2–3 cells panel) used to detect unexpected antibodies is not a mandatory pretransfusion testing in our blood bank of National Institute of Urology and Nephrology (NIUN), and is performed routinely in limited blood centers. Aim This study was conducted to screen and identify different types of red cell alloantibodies and the factors influencing the development of alloantibodies among patients on dialysis in NIUN. Patients and methods This study was conducted in the blood bank of NIUN, Egypt. A total of 192 patients (102 males and 90 women) who were diagnosed to have chronic renal failure, on regular hemodialysis for at least 1 year, their age more than 20 years, anemic (hemoglobin Results Red cell alloantibodies were detected in 10 (5.2%) patients (two men and eight women). The prevalence of alloantibodies detected in patients with positive results were anti-E (2.1%), anti-K (1.6%), antibodies of unknown specificity (1.6%), and antibody against high-incidence antigen (0.5%). There was a significant difference between sex and the number of blood units transfused with alloimmunization (P = 0.048 and 0.037, respectively). Conclusion The prevalence of alloimmunization among chronic renal failure patients on dialysis was 5.2%. The most common alloantibodies were anti-E (the Rhesus system) (2.1%) and anti-K (the Kell system) (1.6%) and the risk of alloimmunization is known to be influenced by the recipient sex (more in females) as well as the number of blood units transfused. So, antibody screening and identification tests are recommended as a routine pretransfusion testing protocol at least for the patients who are at higher risk of alloimmunization and require long-term transfusion dependence, which will definitely add significant value in blood safety.