The Immunohematologic and Clinical Evaluation of Increased Risk for Red Blood Cell Alloimmunization among Multi-Transfused Pediatric Patients in a Tertiary Medical Institution in Central Luzon, Philippines

Abstract

Abstract Introduction/Objective Multiple blood transfusion is a therapeutic treatment for patients with hematologic disorders. However, patients who undergo repeated blood transfusions are at higher risk of developing red blood cell alloimmunization. This may further delay the availability of compatible blood and pose a higher risk for hemolytic transfusion reactions. Methods/Case Report A total of 55 patients, with an age range of 2-19 years, were included in the study. All patients had hematologic disorders and underwent chronic blood transfusion. In this retrospective study, Student’s t-test and Fisher’s exact tests were used to compare the means and percentages, respectively, under 5% level of significance. R ver 4.0.3 was utilized in the analyses. Results (if a Case Study enter NA) Out of the 55 pediatric patients, 10 (18.2%; CI95%: 9.1 to 30.9%) were found to be alloimmunized. Two patients had multiple antibodies whereas the others had one specificity, having a total of 12 detected alloantibodies. The most prevalent alloantibody was anti-E (60%), followed by anti-Jka (20%), anti-Mia (20%), anti-S (10%), and anti-K (10%). All obtained alloantibodies showed no correlation (p>0.05) with the age group of the patients. Subsequently, it was not evident that average blood transfusion (p=0.949) and packed red blood cells transfused per year (p=0.782) significantly differ between alloimmunized and non-alloimmunized patients. Similarly, there was no sufficient evidence that the age group (p=0.723), sex (p=1.000), blood group (p=1.000) and hematologic disorder (p=0.949) were associated with their alloimmunization status. Conclusion The alloimmunization incidence rate of 18.2% in this study was higher compared to related literatures, and most of the detected alloantibodies were of IgG type which are commonly clinically significant. The study showed no significant correlation between the specific risk factors and the development of alloimmunization. For patient care, it is imperative to include precautions such as extended RBC phenotyping and provision of antigen matched RBCs to prevent unnecessary transfusion reactions caused by alloimmunization.