Functional lymphocyte immunophenotypes observed in thalassaemia and haemophilia patients receiving current blood product preparations

Hodge, Greg; Lloyd, John Uri; Hodge, Sandra; Story, Colin; Han, Ping

doi:10.1046/j.1365-2141.1999.01385.x

Cited by 31 publications

(28 citation statements)

References 30 publications

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“…[631] In our study, out of 90 auto positive patients 43 (53.1%) had undergone splenectomy ( P = 0.001). Possible explanation for this is that lymphocytosis associated with blood transfusion is also associated with elevated levels of serum immunoglobulins, immune complexes and cells expressing surface immunoglobulins,[313233] suggesting the possible role of absence of spleen and autoantibody formation. In our study, these antibodies were not interfering with compatibility testing in most cases and were not associated with increased destruction of RBCs in these patients.…”

Section: Discussionmentioning

confidence: 79%

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients

Dhawan¹,

Kumawat²,

Marwaha³

et al. 2014

Asian J Transfus Sci

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Background:The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies.Materials and Methods:The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards.Results:Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-Cw = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system.Conclusion:Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.

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Section: Discussionmentioning

confidence: 79%

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients

Dhawan¹,

Kumawat²,

Marwaha³

et al. 2014

Asian J Transfus Sci

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“…A study on multitransfused patients found that patients with thalassemia major showed a significant lymphocytosis, with mainly B-cell changes consistent with ongoing B-cell stimulation associated with chronic exposure to red cell antigens. [11] This B-cell stimulation is accompanied by an increase in serum immunoglobulin, immune complexes, and cells expressing surface immunoglobulin. These immune system alterations in thalassemia patients might explain the increased chances of autoantibodies and alloantibodies being present together.…”

Section: Discussionmentioning

confidence: 99%

Direct antiglobulin test positivity in multi-transfused thalassemics

Jain¹,

Agnihotri²,

Marwaha³

et al. 2016

Asian J Transfus Sci

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Introduction:Red cell allo- and auto-immunization is a well recognized problem in multi-transfused thalassemic patients. We conducted this study on 301 multi-transfused thalassemic patients under the Thalassemia Transfusion Programme of Advanced Pediatric Centre of PGIMER.Aims and Objectives:The study was designed to determine the frequency of alloimmunization and autoimmunization in multi-transfused thalassemic patients and to establish the specificity of alloantibody to red cell antigens, if alloimmunization is detected.Materials and Methods:The antibody screening was performed by the conventional tube technique using commercially available three cell screening panel (Diamed Switzerland) by saline, low ionic strength solution (LISS) and albumin indirect antiglobulin test (IAT). Samples with alloantibodies were then tested with red cell identification panel to determine the alloantibody specificity. Autoantibody screening was performed by direct antiglobulin test (DAT) during pre-transfusion testing.Results:Of the 301 patients, 52 (17.28%) were found to have antibodies (-allo and –autoantibodies). A total of 11 red cell alloantibodies were detected in 10 patients and the specificities were anti-Kell in 6(54.5%), anti-D in 2(18.2%), anti-c in 1(9.1%) and a combination of anti-E (9.1%) and anti-Jkb in 1 (9.1%) patients. DAT was positive in 48 (15.9%) patients. The frequency of autoantibody was significantly higher in alloimmunized group as compared to non-alloimmunized group (60% V/s 14.4%). Also, the pre-transfusion hemoglobin was significantly lower in the immunized group (8.5 gm/dl V/s 9.0 gm/dl; p=0.03) than the non-immunized group.Conclusion:Based on these observations, we suggest antigen typing of all thalassemia major patients for ABO, Rh and Kell antigens before initiating transfusion therapy. Also, screening for allo- and auto-antibodies at regular intervals should be done prior to each transfusion.

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“…An overall normal CD 4 : CD 8 ratio was shown in thalassaemia patients transfused with post-storage leukocyte-depleted blood [17]. However, a marked absolute lymphocytosis mostly due to an increase in B lymphocytes predominantly in splenectomized patients was reported with the use of both non-leukoreduced and leukoreduced blood [18]. The lymphocytosis is accompanied by an increase in serum immunoglobulins, immune complexes, and cells bearing surface immunoglobulins which are the result of the immunomodulatory effect of blood elements, absence of spleen and recipient immune status [19, 20].…”

Section: Discussionmentioning

confidence: 99%

Red cell alloimmunization and autoantibodies in Egyptian transfusion-dependent thalassaemia patients

Ahmed¹,

Hasan²,

Ragab³

et al. 2010

aoms

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IntroductionThe objective of this study was to explore the frequency of red cell alloantibodies and autoantibodies among β-thalassaemia patients who received regular transfusions.Material and methodsThis study included 501 patients with β-thalassaemia. This work planned to study the presence of alloantibodies and autoantibodies to different red cell antigens in multitransfused thalassaemia patients using the ID. Card micro typing system.ResultsOf a total of 501 β-thalassaemia patients included in the study, 11.3% of patients developed alloantibodies; 9.7% of these alloantibodies were clinically significant. The most common alloantibodies were anti-K, anti-E and anti-C. The rate of incidence of these alloantibodies was 3.9%, 3.3% and 1.7% respectively. Autoantibodies occurred in 28.8% of the patients and 22.1% of these antibodies were typed IgG. There was a significant association between splenectomy with alloimmunization and autoantibody formation (p = 0.03, p = 0.001 respectively). There was no significant association between alloantibody, autoantibody formation and number of transfused packed red cells.ConclusionsAlloimmunization to minor erythrocyte antigens and erythrocyte autoantibodies of variable clinical significance are frequent findings in transfused β-thalassaemia patients. There is an association between absence of the spleen and the presence of alloimmunization and autoantibody formation.

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Functional lymphocyte immunophenotypes observed in thalassaemia and haemophilia patients receiving current blood product preparations

Cited by 31 publications

References 30 publications

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients

Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients

Direct antiglobulin test positivity in multi-transfused thalassemics

Red cell alloimmunization and autoantibodies in Egyptian transfusion-dependent thalassaemia patients

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