Predicting the effect of transfusing only phenotype‐matched RBCs to patients with sickle cell disease: theoretical and practical implications

Castro, Oswaldo; Sandler, S. Gerald; Houston-Yu, Patricia; Rana, Sohail

doi:10.1046/j.1537-2995.2002.00126.x

Cited by 202 publications

(194 citation statements)

References 27 publications

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“…However, the immunological processes that occur during various SCD complications make it difficult to ascertain why ACS and VOC may be associated with significantly higher alloimmunization rates than other acute SCD-related complications. Consistent with previous reports (Rosse et al, 1990;Tahhan et al, 1994;Vichinsky et al, 2001;Aygun et al, 2002;Castro et al, 2002;Sakhalkar et al, 2005;Lasalle-Williams et al, 2011), we also observed that unmatched (CEK) transfusion was associated with an increased risk of alloimmunization in both univariate and multivariate analysis. In fact we observed the same alloimmunization rate (2Á6%) in CEK matched transfusions as reported by Sakhalkar et al (2005), and detected no antibodies following level 3 or higher matching despite the fact that our transfusions were strictly administered to a SCD population defined as 'responders.'…”

Section: Discussionsupporting

confidence: 92%

“…RBC transfusions also prove to be life saving for acute sickle-related complications, such as acute ischaemic stroke, acute chest syndrome (ACS), splenic sequestration and aplastic crisis. However, transfusion of RBCs is complicated by development of allo-and auto-antibodies, which occur much more frequently in patients with SCD than in any other heavily transfused patient population (alloimmunization rates 18-47% for SCD vs. 7-19% for thalassaemia major (Rosse et al, 1990;Heddle et al, 1995;Hoeltge et al, 1995;Aygun et al, 2002;Castro et al, 2002;Azarkeivan et al, 2011;Thompson et al, 2011;Vichinsky et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

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Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

et al. 2014

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SummarySickle cell disease (SCD) patients are at increased risk of red blood cell (RBC) alloimmunization. Recipient inflammatory state at time of transfusion has been shown to regulate alloimmunization in murine models, but evidence is lacking in SCD patients. We retrospectively studied a cohort of alloimmunized SCD patients to determine the influence of pro-inflammatory SCD-related complications at time of transfusion on alloimmunization. For each transfusion, the presence of pro-inflammatory state, degree of RBC antigen matching, unit age, storage solution and alloantibody detection date were ascertained. Transfusion-associated pro-inflammatory events were compared between transfusions resulting and not resulting in new alloantibodies. Univariate analysis and multivariate logistic regression were performed. Fifty-two patients received 3166 pre-storage leuco-reduced transfusions of which 128 resulted in alloantibodies. Transfusions during inflammatory events were associated with increased alloantibody risk on univariate and multivariate analysis; acute chest syndrome and vaso-occlusive crisis showed strongest associations with alloimmunization. Increased antigen matching demonstrated a protective effect on alloimmunization (univariate and multivariate analysis). Although an association was seen between citrate-phosphate-dextrose (adenine) stored units and alloimmunization on univariate analysis, no effect was found on multivariate analysis. Identifying recipient pro-inflammatory states at time of transfusion that promote alloimmunization can impact RBC unit selection decisions for SCD patients at risk for alloimmunization.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

et al. 2014

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“…From a medical perspective, minority underrepresentation can cause problems in the supply of matching blood and tissue products (Castro et al, 2002;Shaz et al, 2008). Various minority groups differ from a country's majority population because of genetic differences in blood group and tissue antigen expression.…”

Section: Introduction Why Recruiting Minority Blood Donors Is So Impomentioning

confidence: 99%

Missing Minorities – A survey based description of the current state of minority blood donor recruitment across 23 countries

Dongen¹,

Mews²,

Kort³

et al. 2016

Divers Equal Health Care

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What is known?1. Due to increasing migration, blood collection establishments are increasingly required to supply blood for patients from different ethnic backgrounds 2. People from minority groups are generally less actively involved in the blood supply than people from the indigenous population 3. Different ethnic groups can differ in blood group and tissue antigen expression, which can cause alloimmunisation if donor and patient are not from the same ethnic background What this paper adds1. Knowledge on the proportion of ethnic minority groups in the donor panels in 23 countries 2. Knowledge on current and expected shortages in blood supply in 42 blood supply establishments, with a focus on shortages due to ethnic diversity 3. A first inventory of methods used to recruit minority donors, including barriers and obstacles to recruitment ABSTrACT 1. Stable national blood supplies from donated human blood are essential to healthcare services worldwide. Migration has increased over the last years and so more and larger minority groups require blood products in their new countries, often with special characteristics that are not present in the majority population. In many countries however, minorities are less active in blood donations. The Missing Minorities (MIMI) project was initiated by the European Blood Alliance to investigate the problem of low donation rates among minorities. The MIMI project group surveyed 42 blood donation organisations worldwide. The results show a great awareness of the topic, but it is also evident that the applied management strategies are at a very early stage in many countries and that many blood donation organisations in Europe, Australia, Canada and the United States are not yet very successful in recruiting and retaining donors from minority groups. This paper also reports on the different methods of minority blood donor recruitment which have been used by the organisations. These methods require more systematic research in order to verify the findings of the most successful strategies identified in this paper. Overall, this paper can be seen as a first step towards better recruitment methods by showing the current situation, but it is also as a call for more research on the topic.

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“…The exact number of cumulative transfusions from birth to first antibody formation is often not reported and in many studies it is unclear if the transfusion history has been fully traced, including transfusions outside the reporting centers [9,10,12,[14][15][16]28]. Yet, the exposure to foreign RBC antigens is a prerequisite for alloimmunization and higher incidences of alloimmunization have been observed in patients with a higher number of transfusions [5,7,8,27,29].…”

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confidence: 99%

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

et al. 2016

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Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization.

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Predicting the effect of transfusing only phenotype‐matched RBCs to patients with sickle cell disease: theoretical and practical implications

Cited by 202 publications

References 27 publications

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease

Missing Minorities – A survey based description of the current state of minority blood donor recruitment across 23 countries

Early occurrence of red blood cell alloimmunization in patients with sickle cell disease

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