Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors

Analysis of CTLA-4 -318C/T Polymorphism in Thalassemia Patients Transfused at the Casablanca Children's Hospital (Morocco)

“…In addition, the differences in the design and selection criteria of the study, such as the different age and the treatments to which the patients are subjected. however taking into account on the one hand, the strong association between autoimmunizations and alloimmunizations which has been clinically proven by Ryder et al [24] , and also by our study done in 2019 [3]; and on the other hand the effect of variants of the CTLA-4 gene on susceptibility to autoimmune diseases, further studies with a higher number of patients and investigation of others variants of CTLA-4 gene are commended. In fact, autoimmunity markers could be adapted to the transfusion strategy and used to predict the development of alloantibodies.…”

“…The transfusion therapy remains the conventional and essential treatment for thalassemia patients to this day [1], [2]. However It is confronted to RBC alloimmunizations challenge by erythrocyte phenotypic missmatched between donors and recipients [3]- [6] leading to delayed transfusion hemolysis and difficulties to finding compatible units leading to a transfusion deadlock [7]. On the other hand, the alloimmunization can affect the outcomes after allogeneic hematopoietic stem cell transplants (HSCT) and increase the transplant rejection risk [8].…”

“…Although extensive phenotyping of RBCs have minimized the sensibilisation against erythrocytes [3], [9] genetic or immunological markers that differentiate a "responder" from "non-responder" to erythrocyte antigens remains undefined, although tolerance to erythrocyte antigens has been reported in a murine alloimmunization model [10].…”

Beta Thalassemia Major: Overview of Molecular Etiology, Pathophysiology, Current and Novel Therapeutic Approaches

“…The recommended treatment for betathalassemia major involves regular red blood cell transfusions throughout life, usually administered every two to five weeks depending on the transfusion needs of each individual in order to maintain the pre-transfusion level of hemoglobin between 9 and 10.5 g/dL [3] or higher (11-12 g/dL) for patients with cardiac complications and keep post-transfusion hemoglobin levels below 15 g/dL. The need for transfusions can start as early as six months old [30], to avoid the risk of developing red blood cell alloantibody and subsequent difficulty in finding compatible units for transfusion [30][31][32]. Patients starting regular transfusion regimens should be vaccinated against hepatitis A and B (depending on the age) [30] and their cytomegalovirus status should be assessed.…”

“…Patients starting regular transfusion regimens should be vaccinated against hepatitis A and B (depending on the age) [30] and their cytomegalovirus status should be assessed. The development of one or more specific anti-red blood cell antibodies (alloimmunization) is an important complication of regular transfusion therapy [16,32]. Before starting transfusion therapy, the patient's blood type must be determined as well as red blood cell phenotyping for at least the C, c, D, E, e and Kell antigens in order to help identify and characterize antibodies in the case of subsequent immunization.…”