Blood Transfusion and Alloimmunization in Patients with Thalassemia: Multicenter Study

One of transfusion's side effects is alloimmunization against red blood cell (RBC) antigens. Early diagnosis by antibody screening is an important step in the detection of these alloantibodies. The authors studied the frequency of alloimmunization in thalassemic patients of 4 centers (2 adult and 2 pediatric centers) and compared the rates in children (up to 15 years) and adults. Antibody screening tests were performed by gel method according to its standard pattern and respective program. In positive cases, antibody identification test by gel method was performed. Eight hundred thirty-five patients were studied; 548 (65.6%) were adults (mean age = 24.5), and 287 (34.4%) cases were pediatrics (mean age = 10.05). Of these patients, 74.1% had no history of transfusion reaction, whereas 21 (2.5%) had hemolytic complications. Seventy-eight (9.3%) exhibited allergic symptoms, and 117 (14%) cases experienced febrile reactions during transfusion. Antibody screening showed positive results in 22 pediatric cases (7.7%) and 79 adults (14.4%); 72 (71.3%), 19 (18.8%), 3 (3%), and 1 (1%) cases exhibited single, double, triple, and autoantibodies, respectively. Anti-Kell antibody was seen in 34 (33.7%) cases, anti-D was seen in 11 (10.9%) cases, and anti-E in was seen in 10 (9.9%) cases. The authors observed 8 anti-D+C (7.9%) cases, 1 anti-D+E (1%), 3 anti-Kell+E, 3 anti-Kell+Kpa (3%), and 1 anti-Kell+D double antibodies. These antibodies were also a combination of Rh subgroups or Rh and Kell subgroups. The authors observed meaningful relations between history of transfusion reactions and age with antibody screening results (P = .005). Based on alloantibodies types, more than two thirds of them were Rh subgroups and Kell groups. Phenotype determination of RBCs before beginning chronic blood transfusion and careful cross-matching with Kell and Rh subgroups in addition to ABO may help reduce alloimmunization in chronic transfusion patients.

[1]  H. Rafatpanah,et al.  Alloimmunization among transfusion-dependent thalassemia patients , 2009, Asian journal of transfusion science.

[2]  M. Karimi,et al.  RBC alloimmunization in blood transfusion‐dependent β‐thalassemia patients in southern Iran , 2007, International journal of laboratory hematology.

[3]  D. Liang,et al.  Alloimmunization among patients with transfusion‐dependent thalassemia in Taiwan , 2006, Transfusion medicine.

[4]  S. Adil,et al.  Frequency of irregular red cell alloantibodies in patients with thalassemia major: a bicenter study. , 2005, JPMA. The Journal of the Pakistan Medical Association.

[5]  R. Davenport.  Pathophysiology of hemolytic transfusion reactions. , 2005, Seminars in hematology.

[6]  F. A. Bhatti,et al.  Red cell immunization in beta thalassaemia major. , 2004, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[7]  E. P. Dellinger,et al.  Infectious and immunologic consequences of blood transfusion , 2004, Critical care.

[8]  S. Al-Shemmari,et al.  RBC alloimmunization and autoimmunization among transfusion‐dependent Arab thalassemia patients , 2003, Transfusion.

[9]  V. Kiefel,et al.  Detection of Red Blood Cell Alloantibodies by Gel Centrifugation Test , 2003, Transfusion Medicine and Hemotherapy.

[10]  B. Wonke.  Clinical management of -Thalassemia major , 2001 .

[11]  E. Rachmilewitz,et al.  Pathophysiology of a- and -thalassemia: Therapeutic implications , 2001 .

[12]  B. Wonke.  Clinical management of beta-thalassemia major. , 2001, Seminars in hematology.

[13]  D. Prati.  Benefits and Complications of Regular Blood Transfusion in Patients with Beta-Thalassaemia major , 2000, Vox Sanguinis.

[14]  E. Vamvakas,et al.  Trends in the incidence of delayed hemolytic and delayed serologic transfusion reactions , 1999, Transfusion.

[15]  N. Olivieri.  5 Thalassaemia: clinical management , 1998 .

[16]  Y. Scott,et al.  Comparison of plasma and serum for antibody detection using DiaMed microtubes , 1996, Transfusion medicine.

[17]  Knight Rc,et al.  Detection of red cell antibodies: current and future techniques. , 1995 .

[18]  P. Rebulla.  Blood transfusion in beta thalassaemia major , 1995, Transfusion medicine.

[19]  G. Poole,et al.  Detection of red cell antibodies: current and future techniques. , 1995, British journal of biomedical science.

[20]  F. Galactéros,et al.  Transfusion et alloimmunisation chez les patients drépanocytaires , 1994 .

[21]  P. Bierling,et al.  [Transfusion and alloimmunization in sickle cell anemia patients]. , 1994, Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine.

[22]  P. Phillips,et al.  The use of the antiglobulin ‘gel‐test’ for antibody detection , 1992, Transfusion medicine.

[23]  D Josef,et al.  The gel test: a new way to detect red cell antigen‐antibody reactions , 1990, Transfusion.

[24]  J. Peristeri,et al.  Red Cell Alloantibodies in Patients with Thalassemia , 1990, Vox sanguinis.

[25]  M. Hartrick,et al.  Alloimmunization following blood transfusion. , 1989, Archives of pathology & laboratory medicine.

[26]  A. Karaklis,et al.  Alloimmunization to Red Cell Antigens in Thalassemia: Comparative Study of Usual versus Better‐Match Transfusion Programmes , 1987, Vox sanguinis.

[27]  F. Verdú,et al.  [Risks of blood transfusion]. , 1981, Actas urologicas espanolas.