Red blood cell alloimmunization and other transfusion‐related complications in patients with transfusion‐dependent thalassemia: A multi‐center study in Thailand

Abstract

Background Thalassemia is a common genetic disease in Southeast Asia. Red blood cell (RBC) transfusion is an essential treatment for severe forms of thalassemia. We performed a study to demonstrate RBC alloimmunization and other transfusion‐related complications in patients with transfusion‐dependent thalassemia (TDT). Study Design and Methods A multi‐center web‐based registry of TDT was conducted in eight medical centers across Thailand. Thalassemia information, transfusion therapy, and transfusion‐related complications were collected. Factors associated with each complication were demonstrated using the logistic regression analysis. Results Of 1000 patients recruited for the study, 449 were males (44.9%). The mean age was 23.9 ± 15.4 years. The majority of patients, 738 (73.8%) had hemoglobin E/beta‐thalassemia. In the study, 421 transfusion‐related complications were reported from 357 patients (35.7%). Alloimmunization was the most common complication which was found in 156 patients (15.6%) with 284 positive antibody tests. The most frequent antibodies against RBC were anti‐E (80/284, 28.2%) followed by anti‐Mia (45/284, 15.8%) and anti‐c (32/284, 11.3%). Age ≥3 years at initial blood transfusion, splenomegaly, higher frequencies, and volumes of transfusion were significant factors associated with alloimmunization. None of the patients had to terminate blood transfusion due to multiple alloantibodies. Other commonly seen complications were allergic reactions (130, 13.0%), autoimmune hemolytic anemia (70, 7.0%) and febrile non‐hemolytic transfusion reaction (54, 5.4%). Conclusions Transfusion‐related complications, especially alloimmunization, were common among Thai patients with TDT. Extended RBC antigen‐matching for the Rh system and Mia should be implemented to prevent the development of alloantibodies in multi‐transfused patients.

Characterization of pediatric transfusion‐dependent thalassemia patients in a large academic center

“…Unlike our study, Teawtrakul et al reported alloimmunization to be the most commonly documented transfusion‐related complication followed by allergic reactions among 421 transfusion‐dependent thalassemia patients in Thailand (15.6% and 13.0% for alloimmunization and allergic reactions, respectively) 24 . Seven patients included in their study had major transfusion‐related reactions ( n = 6 and 1 for anaphylaxis and TRALI, respectively) 24 . This difference observed in the frequency of major transfusion‐related reactions might be due to difference in the transfused RBC products.…”

“…Only one patient was reported to have anaphylaxis while none of the patients had TRALI. Unlike our study, Teawtrakul et al reported alloimmunization to be the most commonly documented transfusion‐related complication followed by allergic reactions among 421 transfusion‐dependent thalassemia patients in Thailand (15.6% and 13.0% for alloimmunization and allergic reactions, respectively) 24 . Seven patients included in their study had major transfusion‐related reactions ( n = 6 and 1 for anaphylaxis and TRALI, respectively) 24 .…”

“…22,23 In addition, receiving transfusion at less than 4-week interval was associated with increased risk of alloimmunization among transfusion-dependent thalassemia patients, having mean age ± SD, 23.9 ± 15.4 years, and treated in eight university hospitals in Thailand. 24 Conversely, receiving first transfusion before the age of 1 year was associated with lower risk of alloimmunization in a report from Center for Disease Control Thalassemia Blood Safety Network. 5 This reduced risk observed among children who began transfusion before 1 year of age might be explained by the immune tolerance developing in infants under 1 year of age.…”

“…24 Seven patients included in their study had major transfusion-related reactions (n = 6 and 1 for anaphylaxis and TRALI, respectively). 24 This difference observed in the frequency of major transfusion-related reactions might be due to difference in the transfused RBC products. In Canada, all RBC units provided by CBS are leukocyte-reduced by filtration at the time of collection.…”