Detection and Identification of Red Cell Alloantibodies in Multiply Transfused Thalassemia Major Patients: A Prospective Study

Abstract

Life long red blood transfusion remains the main treatment for b thalassemia major patients. The development of alloantibodies complicates transfusion therapy in thalassemia patients. Alloimmunization to red cell antigens is one of the most important immunological transfusion reaction and causes delayed type of transfusion reaction. A prospective study was conducted from January 2007 to January 2010. This was a cohorts of 115 patients were selected from regular transfusion group and they were followed for two and half year. They were followed up for the effect of transfusion during study period. There was a decline in patient number from 115 to 96 due to mortality and transfer of patient. A total of 96 multiply transfused thalassemia patients were prospectively included in this study and three consecutive samples collected after every 6 months and investigated for the development of alloantibody to red cell antigens. Tests for antibody screening and identification were performed on preserved sample to investigate prevalence and development of red cell alloimmunization by standardized laboratory techniques by same person at Prathama Blood Centre. A total of 96 patients were included in the study. 63 patients were males and 33 females. A total of five single alloantibodies were formed in five patients out of them four (80 %) belonged to Kell blood group system and one (20 %) from Rh system. It was observed that two (1.92 %) of new thalassemia patients developed red cell alloantibodies during study period. Red cell alloimmunization should be kept in mind in the patients receiving multiple transfusions. In present study, alloimmunization rate was 5.21 %. Mean transfusion duration in these patients was 23.90 days, probably due to presence of alloantibody. RBC alloantibody detection on regular interval and corresponding antigen negative blood transfusion is strongly recommended in transfusion dependent thalassemia patients.

Risks of red blood cell alloimmunization in transfusion‐dependent β‐thalassemia in Oman: a 25‐year experience of a university tertiary care reference center and a literature review

“… This is comparable to what has been described in Kuwait and Egypt . Moreover, it is comparable with what has been published in the Greek, Italian, Indian, Malaysian, Hong Kong, and Iranian thalassemia patients . This predominance is not unexpected given the immunogenicity of these particular antigens.…”

“…Female sex has also been identified as a risk factor for RBC alloimmunization in thalassemia patients as shown in data from Iran, Egypt, and India . However, there is no explanation that has been put forward for this finding.…”

Molecular genotyping of clinically important blood group antigens in patients with thalassaemia

“…In blood banks, only ABO and RhD grouping is performed as a part of pre-transfusion testing. Hence, the incidence of alloimmunization to other RBC antigens in multitransfused patients is particularly high (5-33%) and can cause problems in transfusion management1131415. The most important unexpected RBC alloantibodies are directed towards the Rh (D, C, E, c and e) and Kell (K) antigens, followed by antigens of the Duffy, Kidd and MNS blood group systems.…”

ABO, Rhesus, and Kell Antigens, Alleles, and Haplotypes in West Bengal, India

“…Patients can be heterozygous for the HbE and β-thalassemia alleles or homozygous for either the HbE or β-thalassemia allele [17]. Because the majority of these patients is transfusion-dependent and prone to alloimmunization [18,19], we detected red cell alloantibodies to blood group antigens in 5.6% of multiply transfused patients with β-thalassemia disease at our hospital in Kolkata [20]. Knowledge of the antigen prevalence allows us to predict the number of red cell units that need to be typed when searching for antigen-negative units.…”