Red Cell Alloimmunization and Autoimmunization in Multi-Transfused Thalassemia Patients in Sulaymaniyah Province-Iraq

Abstract

Thalassemias are considered important health issues throughout Iraq, involving its Kurdistan region. This disorder, particularly its major form, needs lifelong regular transfusions. But this form of medical care is associated with various complications including red cell alloimmunization and autoimmunization. This study determined the frequency and associations of alloimmunization among multi-transfused patients with -thalassemia major. The subjects were 204 patients who were registered at a thalassemia care center in Sulaymaniyah-Iraqi Kurdistan. The patients' records were analyzed, their red cells were phenotyped for ABO/RhD antigens using the gel card method, and irregular antibody screening/identification was performed using the standard tube method. Alloantibodies were detected in 5.8% of the patients, while DAT was positive in 4% of the patients, which indicated autoantibodies. The identified alloantibodies were anti-E (2.4%), anti-C (1.4%), anti-e (1%), and anti-K (1%). A patient's age at the start of transfusion (＞2 years) (P=0.042) and a positive history of transfusion reactions (P=0.003) were correlated with a significantly higher rate of alloantibody formation. From the results of our study, we conclude that measures to decrease the development of alloantibodies may incorporate matching for Rhesus and Kell systems and early induction of blood transfusions.

Red Blood Cell Alloimmunization in Pediatric group with Beta Thalassemia: A Five-Year Experience

“…The current study’s findings also reported no significant median difference in age at the time of diagnosis of thalassemia, age at the time of the first transfusion, the total number of transfusions, and the number of hospitalizations in patients with and without alloimmunization. Abdulqader et al 22 also reported somewhat similar findings in their study.…”

“…The median age at the time of diagnosis, age at the time of the first transfusion, the total number of transfusions, and the number of hospitalization due to thalassemia was found to be 8 (4-16) months, 20 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months, 64 (26-127), and 4 (3-4) respectively (Table 2). There were 10 (11.9%) patients in whom splenectomy was observed.…”

“… 19 In addition, it appears that delaying a regular transfusion schedule increases the occurrence of RBC alloimmunization. 19 - 23 …”

“…However, in a few studies, a lower prevalence of alloimmunization with splenectomy was also reported. 22 , 28 - 30 …”

Is it reasonable for the use of Rh‐ee blood? A hospital‐based survey from a southern medical center in Taiwan

“…Anti‐Mia, anti‐E, and cold antibodies were the most frequent alloantibodies in our population, which is similar in the Eastern area 13,19–22 . However, anti‐K, one of the common alloantibodies in other areas, is not common in our population 7,12,23 …”