Detection of red cell alloantibodies in thalassaemia patients

Authors

  • Ansuman Sahu Department of Blood Bank- Transfusion Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  • Pankaj Parida Department of Transfusion Medicine, SCB Medical College & Hospital, Cuttack, Odisha, India
  • Smita Mahapatra Department of Transfusion Medicine, SCB Medical College & Hospital, Cuttack, Odisha, India
  • Binay Bhusan Sahoo Department of Transfusion Medicine, SCB Medical College & Hospital, Cuttack, Odisha, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20200121

Keywords:

Alloantibodies, Alloimmunization, β-thalassaemia, Blood group antigens, Multiple transfusion

Abstract

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.

References

Disorders of Haemoglobin Structure and Synthesis. F Frank, C Colin, P David, R Brayan, eds. In: de Gruchy’s Clinical Haematology in Medical Practise. 5th ed. Blackwell Science; 2005:154-162.

Prati D. Benefits and complications of regular blood transfusion in patients with beta-thalassaemia major. Vox sanguinis. 2000;79(3):129-37.

Lo SC, Chang JS, Lin SW, Lin DT. Platelet alloimmunization after long‐term red cell transfusion in transfusion‐dependent thalassemia patients. Transfusion. 2005 May;45(5):761-5.

Bhatti FA, Salamat N, Nadeem A, Shabbir N. Red cell immunization in beta thalassaemia major. Journal of the College of Physicians and Surgeons-Pakistan: JCPSP. 2004 Nov;14(11):657-60.

Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly Asian descent. Blood. 2000 Nov 15;96(10):3369-73.

Sadeghian MH, Keramati MR, Badiei Z, Ravarian M, Ayatollahi H, Rafatpanah H, et al. Alloimmunization among transfusion-dependent thalassemia patients. Asian J Trans Sci. 2009 Jul;3(2):95.

Wang LY, Liang DC, Liu HC, Chang FC, Wang CL, Chan YS, et al. Alloimmunization among patients with transfusion‐dependent thalassemia in Taiwan. Trans Med. 2006 Jun;16(3):200-3.

Ameen R, Al‐Shemmari S, Al‐Humood S, Chowdhury RI, Al‐Eyaadi O, Al‐Bashir A. RBC alloimmunization and autoimmunization among transfusion‐dependent Arab thalassemia patients. Transfusion. 2003 Nov;43(11):1604-10.

Karimi M, Nikrooz P, Kashef S, Jamalian N, Davatolhagh ZR. RBC alloimmunization in blood transfusion‐dependent β‐thalassemia patients in southern Iran. Inter J Lab Hematol. 2007 Oct;29(5):321-6.

Sirchia G, Zanella A, Parravicini A, Rebulla P, Morelati F, Masera G. Red cell alloantibodies in thalassemia major: results of an Italian cooperative study. Transfusion. 1985 Mar 4;25(2):110-2.

Pradhan V, Badakere S, Vasantha K, Korgaonkar S, Panjwani S, Jajoo N. Antibodies to red cells in beta thalassemia major patients receiving multiple transfusions: a short report. Indian J Hematol Blood Transfus. 2001;19:100.

Gupta R, Singh DK, Singh B, Rusia U. Alloimmunization to red cells in thalassemics: emerging problem and future strategies. Trans Apher Sci. 2011 Oct 1;45(2):167-70.

BhaskarShenoy MM, Shivaram C, Nijaguna S. Red Cell AlloimmunizationIn Multi Transfused Patients with Beta Thalassemia Major-A Study from South India. Int J Med Pharm Sci. 2013 Jun;3(10):31-40.

Chaudhari CN. Red cell alloantibodies in multiple transfused thalassaemia patients. Med J Armed Forces Ind. 2011 Jan 1;67(1):34-7.

Dhawan HK, Kumawat V, Marwaha N, Sharma RR, Sachdev S, Bansal D, et al. Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients. Asian J Trans Sci. 2014 Jul;8(2):84.

Charache S. Problems in transfusion therapy. N Engl J Med. 1990;322:1666-8.

Spanos TH, Karageorga M, Ladis V, Peristeri J, Hatziliami A, Kattamis C. Red cell alloantibodies in patients with thalassemia. Vox sanguinis. 1990 Jan;58(1):50-5.

Rosse WF, Gallagher D, Kinney TR, Castro O, Dosik H, Moohr J, et al. Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease. Blood. 1990 Oct 1;76(7):1431-7.

Poole J, Daniels G. Blood group antibodies and their significance in transfusion medicine. Trans Med Rev. 2007 Jan 1;21(1):58-71.

El Danasoury AS, Eissa DG, Abdo RM, Elalfy MS. Red blood cell alloimmunization in transfusion‐dependent Egyptian patients with thalassemia in a limited donor exposure program. Transfusion. 2012 Jan;52(1):43-7.

Hendrickson JE, Desmarets M, Deshpande SS, Chadwick TE, Hillyer CD, Roback JD, et al. Recipient inflammation affects the frequency and magnitude of immunization to transfused red blood cells. Transfusion. 2006 Sep;46(9):1526-36.

Reisner EG, Kostyu DD, Phillips G, Walker C, Dawson DV. Alloantibody responses in multiply transfused sickle cell patients. Tissue Anti. 1987 Oct;30(4):161-6.

Saied DA, Kaddah AM, Eldin RM, Mohaseb SS. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent Egyptian thalassemic patients. J Pediatr hematol/oncol. 2011 Aug 1;33(6):409-14.

Shamsian BS, Arzanian MT, Shamshiri AR, Alavi S, Khojasteh O. Frequency of red cell alloimmunization in patients with β-major thalassemia in an Iranian referral hospital. Iranian J Pediatr. 2008;18(2):149-53.

Schonewille H, Van De Watering LM, Loomans DS, Brand A. Red blood cell alloantibodies after transfusion: factors influencing incidence and specificity. Transfusion. 2006 Feb;46(2):250-6.

Ahmed AM, Hasan NS, Ragab SH, Habib SA, Emara NA, Aly AA. Red cell alloimmunization and autoantibodies in Egyptian transfusion-dependent thalassaemia patients. Archiv Med Sci: AMS. 2010 Aug 30;6(4):592.

Fluit CR, Kunst VA, Drenthe‐Schonk AM. Incidence of red cell antibodies after multiple blood transfusion. Transfusion. 1990 Jul 8;30(6):532-5.

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2020-01-23

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