High B‐cell activating factor levels in multi‐transfused thalassemia patients

Abstract

Objectives To assess the associations between B‐cell activating factor (BAFF) and alloimmunisation in multi‐transfused thalassemia. Background Red blood cell (RBC) alloimmunisation is a complication of multi‐transfused thalassemia. BAFF is promoting B cells that produce alloantibodies. Methods/Materials Multi‐transfused thalassemia, 15 years or older, were recruited in the cohort study. Alloantibodies and BAFF levels were analysed. Results Of 114 patients, the overall prevalence of RBC alloimmunisation was 29.8%. The most common alloantibodies were anti‐E, anti‐Mia and anti‐c. BAFF levels were different among the three groups; the patients with baseline alloantibodies (median ± interquartile range 1251 ± 474 pg/ml), without alloantibodies (1098 ± 453) and healthy controls (719 ± 306), p < 0.001. The BAFF level was elevated in the >25 years old patients (vs. the <25, p = 0.011) and the buffy‐coat‐reduced blood recipients (vs. the pre‐storage leukocyte‐depletion, p = 0.005). Absolute lymphocyte count was higher in the patients without baseline alloantibodies (vs. with baseline alloantibodies, p = 0.049) and the splenectomised patients (vs. the non‐splenectomised patients, p < 0.001). Of the 72 patients without baseline antibodies, four who developed new antibodies showed no statistically different BAFF levels compared with those without new antibodies after 40‐month follow‐up (1296 ± 734 vs. 1062 ± 460, p = 0.491). In multivariate analysis, BAFF to absolute lymphocyte ratio was independently associated with RBC alloimmunisation (odds ratio 3.07, 95% confidence interval 1.124–8.369, p = 0.029). Conclusion B‐cell activating factor (BAFF) levels were elevated in multi‐transfused thalassemia and the BAFF to absolute lymphocyte ratio was associated with red blood cell (RBC) alloimmunisation.

How do we translate gaps and unmet needs of blood management for thalassemia into a collaborative implementation framework?

“…Overall, five major challenges were identified. First, while red cell phenotyping was crucial for thalassemic patients especially before the first transfusion so that antigen‐matched red blood cells could be provided to reduce alloimmunisation, not all patients were tested and thus 20%–30% experienced alloimmunisation 9 . Second, despite its proven effectiveness, 8 red cell genotyping could only be performed in limited selected patients due to its high cost.…”

“…First, while red cell phenotyping was crucial for thalassemic patients especially before the first transfusion so that antigen-matched red blood cells could be provided to reduce alloimmunisation, not all patients were tested and thus 20%-30% experienced alloimmunisation. 9 Second, despite its proven effectiveness, 8 red cell genotyping could only be performed in limited selected patients due to its high cost. Third, without an integrated information technology (IT) system that gathered thalassemic patient's blood requirements and blood donor's phenotypes, procuring required matching-blood in a timely manner was deemed difficult or even not possible on some occasions, leading to delayed transfusions.…”