Frequency Of Red Cell Alloimmunization Research Articles

Frequency of Red Cell Alloimmunization in Patients with Thalassemia Major: A Report from the Southwest of Iran

Background: The mainstay of managing severe β-thalassemia remains lifelong blood transfusion. Mismatched red blood cell phenotypes between donors and recipients in multiple blood transfusions can result in the development of alloimmunization in recipients. The aim of this study was to determine the frequency of major and subgroup antigens and their phenotypes in thalassemia major patients.
 Materials and Methods: This cross-sectional descriptive study was performed on 105 patients with thalassemia major who referred to Baghaei Hospital in Ahvaz in 2021. Their alloimmunization to erythrocyte antigens was determined with standard tubular antibody search kits.
 Results: Among the thalassemia major patients participating in the study, 51 were female (48.45%). The mean age of the participants was 21.10 ± 5.8 years. Out of the 105 patients studied, 26 had detectable alloantibodies in the serum (24.7%). The two groups of patients with positive and negative alloantibodies were significantly different in terms of Rh and C blood groups (P-values of 0.03 and 0.05, respectively). There was no significant association between the existence alloantibody and age, gender, spleen condition and the time of first transfusion (P > 0.05).
 Conclusion: It was concluded that red blood cell matching, at least for Rh and C groups, is necessary to prevent alloimmunization in thalassemia major patients.

Detection of red cell alloantibodies in thalassaemia patients

Background: β-thalassaemia patients receive regular blood transfusion to thrive. Due to antigen disparity between the blood donors and these patients they develop red cell alloantibodies due to alloimmunization. The objective of this study is to predict the frequency of red cell alloimmunization amongst β-thalassaemia major patients receiving regular blood transfusion.Methods: This study including 106 patients with β-thalassaemia was conducted in the department of Transfusion Medicine, S. C. B. Medical College, Cuttack for a period of 12 months. Alloantibodies to different red cell blood group antigens in multi-transfused thalassaemia patients were detected using the glass bead technology for blood group serology in the present study.Results: Out of 106 β-thalassaemia major patients included in the study, 7.5% of patients developed alloantibodies, all being clinically significant. The alloantibodies were anti-E, anti c, anti e and anti-D. The rate of incidence of these alloantibodies was 3.8%, 1.9%, 0.9% and 0.9% respectively. There was a significant association between alloantibody formation with number of transfused packed red cells (Mann-Whitney Test: p value = 0.035) and age at first transfusion (p value = 0.001). The factors having no association with alloimmunization to red cell antigens are age and gender.Conclusions: Alloimmunization to various erythrocyte blood group antigens is a common problem in multi-transfused β-thalassaemia patients. There is an association between number of transfused packed red cells and age at first transfusion with alloantibody formation in the study.

PS1596 AUTOIMMUNIZATION AND ALLOIMMUNIZATION IN TRANSFUSION DEPENDANT THALASSEMIA MAJOR PATIENTS:STUDY ON 300 PATIENTS

Background:Thalassemia is the most common genetic disorder worldwide and one of the major public health problems. Thalassemia patients are dependent on blood transfusions for their survival but they may be associated with many complications. Development of anti red blood cell antibodies(bot alloantibodies and autoantibodies) is one of them. There is a paucity of data on the incidence of alloimmunization and autoimmunization in thalassemic patients in Pakistan,as pre transfusion antibody screening is not routinely performed. Autoantibodies can result in clinical hemolysis and difficulty in cross matching blood. We studied the frequency of Red cell alloimmunization and autoimmunization among Thalassemia patients who received regular transfusions at Sundas Foundation and also to determine types of these antibodies among Thalassemia patients.Aims:To study the frequency of Red Cell alloimmunization and autoimmunization among multiple transfused Thalassemia patients and to determine the types of these antibodies.Methods:A total of 300 multiple transfused Thalassemia patients were included in this study. Clinical and serological records of all the patients were examined. Screening and identification of antibodies was performed on fresh serum of all patients using 3 cell and 11 cell panel respectively. Detection of autoantibodies was done using using polyspecific Coombs(IgG+C3d) gel cards. Approval of this study was taken from the institutional review board. Informed consent was provided.Results:We identified alloantibodies in 17 patients,the most common were Anti E followed by Anti D,Anti C,Anti K,Anti Fyb,Anti‐M.4 patients developed autoantibodies.Summary/Conclusion:Alloimmunization is an immune respone stimulated by the transfusion of blood products. Overall rate of alloimmunization was 5.66% in our study while it is 30%/190 in Kuwait,4.97%/161 in India,5%/1435 in Italy,3.7%/1200 in Greece,5%/711 in Iran,9.2%/97 and 22.7%/75 in Pakistan.

PB2449 RED CELL ALLOIMMUNIZATION IN MULTITRANSFUSED ONCOLOGY PATIENTS

Background:Blood transfusion is common nowadays in management of various diseases especially oncology patients. Blood grouping and cross matching is done in routine practice before transfusion against Major blood groups (i.e., ABO & Rh blood groups). Alloantibodies can be produced against Minor blood groups. These Alloantibodies can cause acute or delayed hemolytic transfusion reactions. These hemolytic reactions cause anemia as well as other related complications. Oncology patients can produce alloantibodies because of multiple transfusions from different donors. Pre transfusion antibody screening and identification in oncology patients can help them from unnecessary time required for identification of proper cross matched donor. Alloantibody identification can prevent the patients from complications related to allogenic blood transfusion. This study is designed to determine the frequency of alloantibodies in multitransfused oncology in Pakistani population.Aims:The objectives of the study is to determine the frequency and types of RBC alloimmunization in multitransfused oncology patients at a teaching hospital in Lahore, Pakistan.Methods:A total of 145 cases fulfilling the inclusion and exclusion were selected by non probability purposive sampling. Blood sample was taken and Plasma was separated with centrifugation. Routine blood testing for ABO and Rh grouping was done. The patient's plasma that was positive on initial screening for alloimmunization was further tested with Antibody Identification Panel.Results:The frequency of Red cell alloimmunization is 5.5% (8/145). The alloantibodies for Rh were 6 (4.13%) and one patient positive each for Kell and Duffy having frequency of 0.68 % each. Alloantibodies are found to be Anti‐D four (4) and each one (1) Anti‐ C, Anti‐E, Anti‐K and Anti FyaSummary/Conclusion:Allo‐antibodies are produced against Minor blood groups in multitransfused oncology patients. Alloantibodies against Rh system were most frequent.

Red blood cell alloimmunisation and autoimmunisation in transfusion dependent beta thalassemics from Southern India

AbstractThe development of red blood cell (RBC) isoimmunization with alloantibodies and autoantibodies complicate transfusion therapy in multiply transfused thalassemia patients. We conducted a study to analyse the frequency in our population. Clinical and antibody profile from 55 multiply transfused thalassemic patients who were receiving transfusions were collected and analyzed prospectively. A commercially available 3 cell antigen panel was used for the antibody screening procedure. If antibody screening with the 3-cell antigen panel was positive, an extended 11-cell antigen panel was used for antibody identification in LISS (Low Ionic Strength Solution). All patients received blood matched for only ABO and Rh (D) antigens. A total of 55 transfusion dependent â thalassemics were included in this study out of which 30 (54.55%) were males and 25(45.45%) females with a male to female ratio of 1.2: 1. Frequency of red cell alloimmunization in this study was found to be 1.8%. None of the patients developed red cell autoimmunization. The alloantibody identified in the the patient who developed alloimmunisation was was anti-K. In conclusion, the transfusion of matched blood is essential for chronically transfused beta thalassemia patients in order to avoid alloimmunization.

Red Blood Cell Alloimmunization in Sickle Cell Disease Patients in Jeddah, Saudi Arabia: A Pilot Study.

The treatment of patients with sickle cell disease frequently requires transfusion of red blood cells. Complications due to alloimmunization of red blood cells antigen remain a major risk as a post transfusion effect. The objective of this study is to determine the frequency of red cell alloimmunization in Jeddah, Saudi Arabia. A retrospective cross-section study of sickle cell disease patients at King Abdulaziz University Hospital between 2012 and 2013 was performed. Demographic characteristics and transfusion history was recorded. Blood samples were analyzed for alloimmunization using immunohematological technique. A total of 234 sickle cell patients were analyzed, of which 30 (12.8%) showed alloantibodies. A total of 43 alloantibodies were found out of which 28 belonged to Rh group, eight belonged to Kell while three belonged to MNS group. Demographic and transfusion characteristics were analyzed between alloimmunized and nonalloimmunized sickle cell disease patients. The rate of alloimmunization in Jeddah, Saudi Arabia was 12.8%. There was significant difference observed between alloantibodies detection between transfused patients compared to non-transfused patients. The consequences of red blood cell alloimmunization are highly significant and therefore immune hematological testing is highly recommended.

Frequency of Red Cell Alloimmunization and Autoimmunization in Thalassemia Patients: A Report from Eastern India.

Introduction. Red blood cell (RBC) alloimmunization and autoimmunization remain a major problem in transfusion dependent thalassemic patients. There is a paucity of data on the incidence of RBC alloimmunization and autoimmunization in thalassemic patients from eastern part of India, as pretransfusion antibody screening is not routinely performed. Aims. To assess the incidence of RBC alloimmunization and autoimmunization in transfusion dependent thalassemic patients in eastern India. Materials and Methods. Total 500 thalassemia cases were evaluated. The antibody screening and identification were performed with commercially available panel cells (Diapanel, Bio-rad, Switzerland) by column agglutination method. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG + C3d) gel cards in all patients. Results. A total of 28 patients developed RBC alloimmunization (5.6%) and 5 patients had autoantibodies (1%). Alloantibody against c had the highest incidence (28.57%) followed by E (21.42%). Five out of 28 (17.85%) patients had developed antibodies against both c and E. Conclusion. Data from this study demonstrate that the RBC alloantibody and autoantibody development rates are significant in our region. Thus, pretransfusion antibody screening needs to be initiated in eastern India in order to ensure safe transfusion practice.

Risk of maternal alloimmunization in Southern Pakistan – A study in a cohort of 1000 pregnant women

BackgroundHaemolytic disease of the fetus and the newborn [HDFN] is caused by incompatibility of maternal and fetal erythrocytes. Red blood cell alloimmunization is a well-known cause of HDFN. Due to heterogeneity of populations, the spectrum of alloimmunization varies around the world. This study aimed to determine the frequency of alloimmunization in pregnant women and to determine the risk of HDFN in our population. Study Design and MethodsThis was a descriptive study conducted at Aga Khan University Hospital Karachi. Blood type and red cell antibody screening was determined on every pregnant woman at her first antenatal visit. Red cell antibody identification was performed on positive screening results. ResultsA total of 1000 pregnant females including 633 (63.3%) multigravida were studied. Blood type B was predominant (n = 374 or 37.4%) and D negative was observed in 136 women (13.6%). No red cell antibody was detected in 982 females (98.2%). 20 red cell antibodies were detected in 18 women (1.8%). The incidence of non-anti-D was 16/1000 [1.6%] in all pregnant females. The non-anti-D alloantibodies included anti-M (n = 3; 15%), anti-Lewis(a) (n = 3; 15%), anti C ( n = 1; 5%), anti-E (n = 1; 5%), anti-e (n = 1; 5%), anti-Lewis(b) (n = 1; 5%) and nonspecific antibodies (n = 6; 30%). The incidence of anti-D was 4/136 or 2.9% in D negative blood type. After excluding prior sensitization due to blood transfusions, risk remained was 2.2%. Antibodies of clinical significance were identified in 9 (0.9%) females. ConclusionsIn our cohort, frequency of red cell alloimmunization during pregnancy was 1. 8% out of which 0.9% were clinically significant antibodies posing a risk for HDFN. Despite prenatal and post natal prophylaxis, risk of sensitization with D antigen in D negative women was high at 2.2%. We recommend that all pregnant women should be screened for irregular antibodies irrespective of the rhesus type.

Red blood cell antibodies in thalassemia patients in northern India: risk factors and literature review.

Study of the factors responsible for red cell alloimmunization can help in adopting appropriate strategy to minimize alloimmunization. However data for thalassemia patients from our region is limited. Therefore, a study was conducted to find out the frequency and the factors associated with red cell allo and autoimmunization in thalassemia patients at our center so as to enable us to take appropriate action to reduce alloimmunization. Clinical, demographic, allo and autoantibody and transfusion records of 280 thalassemia patients at our hospital were studied. Patients with and without alloantibodies were compared to find significant differences for age, gender, race, age at start of regular transfusions and splenectomy. Red cell antigen frequencies in thalassemia patients and published antigen frequencies in blood donors from the same center were compared to look antigen differences as a risk factor for alloimmunization. Twenty four thalassemia patients (8.6%) developed 28 clinically significant alloantibodies. 18 (65%) of the alloantibodies were of Rh system. The three most common antibodies detected was anti E (11, 39.3%) followed by anti K (6, 21.4%) and anti c (10.8%). Five (1.8%) of the 280 patients developed autoantibodies. Patient age was found to be significantly higher in alloimmunized patients than in non alloimmunized patients. Red cell antigen frequencies between blood donor and recipient populations were found to be homogenous for most of the relevant RBC antigens. The frequency of red cell alloimmunization in thalassemia patients from our center is moderate. In this setting of red cell phenotype concordant donor-recipient population requirement of extended phenotype matched transfusions may not be cost effective.

Sécurité transfusionnelle et drépanocytose à Bamako, Mali. Séroprévalence des infections à VIH, VHB, VHC et allo-immunisation anti-Rh et Kell chez les drépanocytaires

Red cell transfusion is one of the main treatments in sickle cell disease. However there are potential risks of blood transfusions. In order to propose strategies to improve blood safety in sickle cell disease in Mali, we conducted a prospective study of 133 patients with sickle cell anemia recruited at the sickle cell disease research and control center of Bamako, November 2010 to October 2011. The study aimed to determine the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections by serum screening and the frequency of red cell alloimmunization before and after blood transfusion. The diagnosis of sickle cell syndrome was made by HPLC, the detection of markers of viral infection was performed by ELISA, and the diagnosis of alloimmunization was conducted by the Indirect Coombs test. Prevalence of viral infections observed at the time of enrolment of patients in the study was 1%, 3% and 1% respectively for HIV, HBV and HCV. Three cases of seroconversion after blood transfusion were detected, including one for HIV, one for HBV and one another for HCV in sickle cell anemia patients. All these patients had received blood from occasional donors. The red cell alloimmunization was observed in 4.4% of patients. All antibodies belonged to Rh system only. Blood transfusion safety in sickle cell anemia patients in Mali should be improved by the introduction of at least the technique for detecting the viral genome in the panel of screening tests and a policy of transfusions of blood units only from regular blood donors.

Frequency of red cell alloimmunization in patients with sickle cell anemia in an Egyptian referral hospital

IntroductionSickle cell anemia (SCA) is an important public health issue in Tanta, Egypt. Erythrocyte transfusions may reduce the morbidity of SCA, however, they are associated with numerous risks. Among other risk categories, alloimmunization to red cell antigens may result from transfusions. The objective of this study was to explore the frequency of red cell alloantibodies among SCA patients who received regular transfusions. Materials and methodsA total of 42 patients with SCA were included in this study. This work planned to study the presence of alloantibodies to different red cell antigens in multi-transfused SCA patients using the ID card micro-typing system. Clinical and laboratory data were collected and analyzed to find out the frequency, pattern and factors influencing red cell alloimmunization secondary to multiple blood transfusion in these patients. ResultsOf a total of 42 SCA patients included in the study, 21.4% of patients developed alloantibodies. The most common alloantibodies were anti-K, anti-E and anti-C. The rate of incidence of these alloantibodies was 7.1%, 4.8% and 4.8%, respectively. There was significant association between alloantibody and the rate of transfused blood. The mean age of patients with and without alloimmunization was 12.0 and 6.2years. ConclusionsAlloimmunization to minor erythrocyte antigens of variable clinical significance is a frequent finding in transfused SCA patients. Regular screening for red cell alloantibodies would provide better management of these patients.

Frequency of Red Cell Alloimmunization Among Patients with Transfusion Dependent Beta Thalassemia in Pakistan

Development of red cell alloantibodies complicates transfusion therapy in multi transfused beta thalassemia patients. This study was designed to determine the frequency of red cell alloantibodies in patients with transfusion dependent beta thalassemia in Pakistani population. This is a cross-sectional descriptive study conducted at Baqai Institute of Hematology, Baqai Medical University and Husaini Institute of Hematology and oncology Karachi. A total of 800 transfusion dependent patients with beta thalassemia from different thalassemia centers in Karachi were included in this study to determine the frequency of red cell alloantibodies. Of 800 patients with transfusion dependent beta thalassemia, 30 (3.75%) patients developed red cell alloantibodies. These red cell alloantibodies were against Rh, Lewis, Duffy and Kell blood group systems. Results of this study indicate low frequency of red cell alloimmunization in Pakistani thalassemic population. This implies that there is homogeneity of red cell antigens in blood donors and recipients in Pakistani population. Red cell alloantibody formation was not influenced by age at the first transfusion, number of blood transfusions or splenectomy. Routine pre-transfusion phenotyping of blood, other than ABO and Rh “D” antigens is not recommended because of low rate of red cell alloimmunization and high cost of such testing.

Fréquence de l’allo-immunisation érythrocytaire chez les malades polytransfusés au centre hospitalo-universitaire du Point G, Bamako, Mali

This prospective study conducted within 9 months period aimed to determine the frequency of red cell alloimmunization among polytransfused patients of the medical Hematology and oncology ward, and the unit of hemodialysis of the Nephrology ward at the Point-G hospital. Irregular red blood cell antibody screening and identification were performed by gel-filtration method using indirect antiglobulin test and enzymatic treated cells. We did not use saline medium. A total of 78 patients were included in this study. The mean age of the patients was 36.78 ± 14.73 years (range: 11 and 77 years). The sex ratio was of 1.11 in favour of the women. The mean blood units transfused were 12.21 ± 9.99 units (range: 4 and 45 units). The Rhesus phenotypes Dccee, DccEe and DCcee were most predominant, with the respective frequencies of 67.9, 15.4 and 10.3%. Kell antigen was found at a frequency of 1.28%. The total rate of red cell alloimmunization was 10.3%. There was no significant difference between the two wards. All the screened agglutinins were warm antibodies belonging to the Rhesus system: anti-E (7.7%), anti-C (1.3%) and anti-D (1.3%). Only Anti-E was present among hematologic patients. We did not find a significant link between the sex, the age, the number of blood units transfused and the positivity of the antibody screening. We conclude that the frequency of post-transfusional alloimmunization is high among polytransfused patients in Mali. A systematic antibody screening among these patients and the selection of red cells with known Rhesus/Kell phenotypes would allow an optimal blood transfusion safety.