Red Blood Cell Alloimmunization and Autoimmunization in Blood Transfusion-Dependent Sickle Cell Disease and β-Thalassemia Patients in Al-Ahsa Region, Saudi Arabia

Abstract

Introduction. The risk of developing transfusion-related complications, especially alloimmunization, is an ongoing concern for transfusion-dependent patients. It is important to determine the rate of alloimmunization and autoimmunization in Al-Ahsa Region, Saudi Arabia, where sickle cell disease (SCD) and thalassemia incidence rates are the highest in Saudi Arabia. Methods. A cross-sectional study was conducted to review the transfusion history of patients with SCD and thalassemia at the King Fahad Hospital (KFH) in Al-Ahsa, Saudi Arabia. 364 transfusion-dependent patients were included in this study. Results. Alloimmunization rates in patients with SCD and thalassemia were 16.7% and 11.97%, respectively, while autoimmunization rates in patients with SCD and thalassemia were 5.3% and 0.7%, respectively. The most frequent alloantibodies among the study participants were against Kell, Rh blood group systems. Conclusion. Blood transfusion-related alloimmunization and autoimmunization compromise the proper management of chronically transfused patients. Ideally, extended matched phenotyping should be implemented to prevent alloimmunization and reduce the risk of developing blood transfusion-related alloantibodies.

Red Cell Alloimmunisation Among Sickle Cell Disease and Thalassemia Patients Following Rh- and K-Matched Red Cell Transfusion in Southwestern Saudi Arabia: A Multicenter Study

“…Another study in 2023 from Al-Hasa, eastern region of Saudi Arabia, reported 16.7% alloimmunization for SCD patients and 11.97% alloimmunization for thalassemia patients. 12 The rate of alloimmunisation reported from the latter two studies from the western region is significantly higher when compared to our study. 12 , 14 High alloimmunisation rates reported previously from Jazan region 21 might be due to the fact that the study was from single center and had lower sample size than the current study.…”

“… 12 The rate of alloimmunisation reported from the latter two studies from the western region is significantly higher when compared to our study. 12 , 14 High alloimmunisation rates reported previously from Jazan region 21 might be due to the fact that the study was from single center and had lower sample size than the current study. 21 In addition, the differences from the other in these studies in Saudi Arabia could be attributed to the diverse ethnic backgrounds of the donor and recipient populations and multiple transfusion of non-phenotypically matched blood units, which are both known to be associated with an increased risk of alloimmunisation in transfusion-dependent patients.…”

“…11 In Saudi Arabia, several reports from different regions reported the rate of alloimmunization in SCD patients is up to 39.4% while in thalassemia patients is up to 35.57%. [12][13][14][15][16][17] This variability in the alloimmunisation rate appears to be associated with disparities in race, age, underlying clinical conditions and transfusion protocols. 9,18 Jazan region, located on the coast of the Red Sea in the southwest corner of Saudi Arabia, is one of the regions with the highest prevalence of SCD and thalassaemia.…”

“… 11 In Saudi Arabia, several reports from different regions reported the rate of alloimmunization in SCD patients is up to 39.4% while in thalassemia patients is up to 35.57%. 12–17 This variability in the alloimmunisation rate appears to be associated with disparities in race, age, underlying clinical conditions and transfusion protocols. 9 , 18 …”

Hope on the Horizon: New and Future Therapies for Sickle Cell Disease

“…Transfusions help treat or prevent the perioperative complications, acute chest syndrome, and acute anemia associated with SCD; however, blood transfusions can also cause side effects such as alloimmunization and iron overload. Even though various strategies are employed to help mitigate these side effects, such as chelators for treating iron overload and antigen matching for preventing alloimmunization, these side effects persist [21,22].…”