Red blood cell alloimmunization in sickle cell disease patients in Uganda

Natukunda, Bernard; Schonewille, Henk; Ndugwa, Christopher; Brand, Anneke

doi:10.1111/j.1537-2995.2009.02435.x

Cited by 100 publications

(125 citation statements)

References 32 publications

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“…In a study of Ugandan patients with SCD, 6.1% were alloimmunized despite low transfusion exposure and ethnic similarity between donors and recipients. 57 Our recent study evaluating the effect of C-, E-, and K- …”

Section: Strategies To Prevent Alloimmunization Rbc Antigen-matching mentioning

confidence: 99%

Transfusion therapy for sickle cell disease: a balancing act

Chou

2013

Hematology

109

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Transfusion therapy is a key intervention in decreasing morbidity and mortality in patients with sickle cell disease (SCD). Current indications for acute and chronic transfusion therapy have significantly increased the number of RBC units transfused to patients with SCD worldwide. This review summarizes transfusion management for the treatment or prevention of neurologic and perioperative complications, acute chest syndrome, and acute anemia associated with SCD. Despite the recognized benefits of transfusion therapy, it is not without the risks of iron overload, alloimmunization, and delayed hemolytic transfusion reactions. Transfusional iron overload management includes automated RBC exchange, noninvasive imaging to monitor iron burden, and iron chelation with parenteral or oral agents. Although limited and extended RBC antigen matching reduces antibody formation, the prevalence of RBC alloimmunization in patients with SCD remains high. Recent studies demonstrate that RH genetic diversity in patients with SCD contributes to Rh alloimmunization, suggesting that even more refined RBC matching strategies are needed. Advances in molecular blood group typing offer new opportunities to improve RBC matching of donors and recipients and can be of particular benefit to patients with SCD.

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Section: Strategies To Prevent Alloimmunization Rbc Antigen-matching mentioning

confidence: 99%

Transfusion therapy for sickle cell disease: a balancing act

Chou

2013

Hematology

109

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“…The authors explained that since blood cannot be collected locally, use of blood mostly from French Caucasian blood donors is causing alloimmunization in the Guianese population due to ethnic/geneticdifferences 13 . Natukunda et al 6 reported that the rate of RBC alloimmunization in Ugandan SCD patients was 6.1%. The homogeneity between donors and SCD patients plus the low transfusion load may explain this low immunization frequency 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Natukunda et al 6 reported that the rate of RBC alloimmunization in Ugandan SCD patients was 6.1%. The homogeneity between donors and SCD patients plus the low transfusion load may explain this low immunization frequency 6 . Chou et al 3 found alloimmunization prevalence as %58 among the patients who undergo chronic transfusion, 15% among the patients who undergo episodic transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Many factors should be considered to minimize alloimmunization prevalence in this group of patients who need more frequent transfusions. The main factors which increase alloimmunization risk include increased patient age 3,11 , female gender 2,14 , history of pregnancy 2,6 , not applying leukoreduction 15 , use of long term stored blood products 14,15 , the number of transfused RBC units 2,14 , transfusion for acute vasoocclusive indications and elevated inflammatory status of the patients 2 , ethnic/genetic differences 3,6,13 .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies identified alloantibodies of the Kidd and Duffy systems in addition to the Rh and Kell systems 5 . Factors implicated in RBC alloantibody formation include recipient sex and age, history of pregnancy, number and timing of blood transfusions, recipient clinical diagnosis and treatment, genetic factors related to antigenic response, and racial differences between donors and recipients 6 . Alloimmunization frequency varies among communities depending on various factors including ethnic, genetic differences and transfusion policies.…”

Section: Introductionmentioning

confidence: 99%

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Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

Solmaz

Karacaoğlu

Gereklioğlu

et al. 2016

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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AbstractÖz Purpose: We aimed to investigate erythrocyte alloimmunization frequency and related factors in our region where SCD is common. Material and Methods: This study was planned as a single center, cross-sectional and retrospective cohort study. A total of 216 patients who had been followed up due to SCD [Hemoglobin (Hb) SS, Hb S-β thalassemia, Hb S-α thalassemia] were included in this study. Patients were divided to two groups according to amount of transfusion. The patients who had received less than 6 transfusions per year and who did not have the history of erythropheresis were allocated to Group 1, and the patients who had received 6 or more simple transfusion per year or who had undergone erythrocyte exchange were allocated to Group 2. Results: Of 216 SCD patients included in the study. Alloimmunization was detected in 67 (31.0%) out of 216 patients who underwent transfusion, and in 17 (30.4%) out of 56 patients in Group 1 and in 50 (31.3%) out of 160 patients in Group 2. When the patients were analyzed according to alloimmunization development, our study revealed that neither SCD complications are a risk factor for alloimmunization nor alloimmunization increases mortality rates. Conclusion: High alloimmunization frequency found in our study suggests the insufficient adherence of alloimmunization-prevention policies in RBC transfusions performed except experienced institutions. Therefore alloimmunization may be reduced or prevented through performing extended red cell typing among SCD patients.Amaç: Orak hücre hastalığının sık görüldüğü bölgemizde eritrosit alloimmmünizasyon sıklığını ve ilişkili durumları araştırmayı amaçladık. Gereç ve Yöntem: bu çalışma tek merkezli, zamansal kesitli ve geriye dönük kohort çalşıması olarak planlanmıştır.Toplamda 216 orak hücre hastalığı [Hemoglobin (Hb) SS, Hb S-β talasemi, Hb S-α talasemi] tanısı olan hasta çalışmaya dahil edilmiştir. Hastalar transfüzyon miktarına gore iki gruba ayrılmıştır. Yılda 6'dan daha az transfüzyon alan ya da eritroferez öyküsü olmayan hastalar Grup 1'e, yılda 6 ve daha fazla basit transfüzyon alan ya da eritroferez işlemine alınan hastalar Grup 2'ye dahil edilmiştir. Bulgular: Çalışmamıza 216 hasta dahil edilmiştir. Transfüzyon tedavisi alan toplam 216 hastanın 67 (%31.0)'sinde, Grup 1'deki 56 hastanın 17'sinde (%30.4), Grup 2'deki 160 hastanın 50'sinde (%31.3) tespit edilmiştir. Hastalar alloimmünizasyon gelişimi açısından analiz edildiğinde, çalışmamız ne orak hücre komplikasyonlarının alloimmünizasyon gelişimi için ne de alloimmünizasyonun ölüm için bir risk faktörü olmadığını göstermiştir. Sonuç:Çalışmamamızda bulunan yüksek alloimmünizasyon sıklığı, tecrübeli merkezler dışında yapılan transfüzyonlarda alloimmünizasyonu önleyici politikalara yeteri kadar uyulmadığı konusunda fikir vermektedir. Bu nedenle orak hücre anemili hastalarda alloimmünizasyon, ayrıntılı eritrosit antijen tanımlama işlemi yapılarak azaltılabilir veya önlenebilir.

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Immunophenotypic parameters and RBC alloimmunization in children with sickle cell disease on chronic transfusion

et al. 2015

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Alloimmunization against red blood cell (RBC) antigens is a cause of morbidity and mortality in transfused patients with sickle cell disease (SCD). To investigate distinguishing characteristics of patients who develop RBC alloantibodies after transfusion (responders) versus those who do not (non-responders), a crosssectional study of 90 children with SCD on chronic RBC transfusion therapy at a single institution was conducted in which 18 immune parameters (including T and B cell subsets) were tested via flow cytometry, and medical records were reviewed. RBC alloimmunization was present in 26/90 (29%) patients, with anti-E, K, and C among the most commonly detected alloantibodies despite prophylactic matching for these antigens at the study institution. In addition, RBC autoantibodies had been detected in 18/26 (69%) of alloimmunized versus 7/64 (11%) of non-alloimmunized patients (P < 0.0001). Alloimmunized patients were significantly older (median 13.0 years vs. 10.7 years, P 5 0.010) and had more RBC unit exposures (median 148 U vs. 82 U, P 5 0.020) than non-alloimmunized patients. Sex, age at initiation of chronic transfusion, splenectomy, stroke, and transfusion outside of the study institution were not significantly associated with RBC alloimmunization. Alloimmunized patients had a significantly increased percentage of CD41 T memory cells compared to non-alloimmunized patients (57% vs. 49%, P 5 0.0047), with no other significant differences in immune cell subsets or laboratory values detected between these groups. Additional research of RBC alloimmunization is needed to optimize transfusion therapy and to develop strategies to prevent alloimmunization.

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Red blood cell alloimmunization in sickle cell disease patients in Uganda

Cited by 100 publications

References 32 publications

Transfusion therapy for sickle cell disease: a balancing act

Transfusion therapy for sickle cell disease: a balancing act

Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

Immunophenotypic parameters and RBC alloimmunization in children with sickle cell disease on chronic transfusion

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