Risk factors for red blood cell alloimmunization in the Recipient Epidemiology and Donor Evaluation Study (REDS‐III) database

Abstract

Despite the significance of red blood cell (RBC) alloimmunization, the lack of standardized registries in the US has prevented the completion of large studies. Data from 3·5 years of the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) recipient database, containing information from 12 hospitals, were studied. A RBC alloantibody responder had an antibody identified at any point during the study, and a non-responder had a negative antibody screen at least 15 days post-RBC transfusion. Demographics, blood type, ICD9/10 codes, and other potential correlates were evaluated. Of 319 177 (2·07%) screened patients, 6597 had a total of 8892 clinically significant RBC alloantibodies identified, with 75% being in the Rh or Kell families. Alloimmunization was more common in females (2·38%) than males (1·68%), and in RhD negative (2·82%) than RhD positive (1·94%) patients. Age, sex, RhD status and race were associated with being a responder, and certain diagnoses (including sickle cell disease or trait, systemic lupus erythematosus, rheumatoid arthritis and myelodysplastic syndrome) were more common among responders than non-responders. Data collected in this multi-centre recipient database provide the largest RBC alloimmunized patient cohort studied in the US, with previously known demographic and disease associations of responder status confirmed, and new associations identified.

The evanescence and persistence of RBC alloantibodies in blood donors

“…High‐titer, low‐avidity and low‐incidence antibodies were also grouped into “other,” with no further data availability to subspecify these alloantibodies. As in previous studies, warm autoantibodies, cold autoantibodies, cold reactive immunoglobulin M class alloantibodies, and nonspecific antibodies were excluded . Methodologies for antibody screening and determination of antibody specificity varied by blood center.…”

“…As in previous studies, warm autoantibodies, cold autoantibodies, cold reactive immunoglobulin M class alloantibodies, and nonspecific antibodies were excluded. 12,13 Methodologies for antibody screening and determination of antibody specificity varied by blood center. For example, blood centers used solid phase (two centers), gel card (one center), and enhanced tube (one center) antibody screening platforms.…”

Accuracy of Blood Group Typing in the Management and Prevention of Alloimmunization

“…Reported RBC alloimmunization rates have considerable variations depending on the population and disease studied [9]. The rates are estimated between 1 and 3% in patients that receive episodic transfusions, while for patients who receive chronic blood transfusions like patients with SCD and MDS, rates vary between 8 and 76% [9][10][11][12].…”

“…Reported RBC alloimmunization rates have considerable variations depending on the population and disease studied [9]. The rates are estimated between 1 and 3% in patients that receive episodic transfusions, while for patients who receive chronic blood transfusions like patients with SCD and MDS, rates vary between 8 and 76% [9][10][11][12]. Although the most commonly observed alloantibodies of clinical relevance are against antigens belonging to RH (D, C, c, E, e), KEL (K, k, Js a , Kp a ), JK (Jk a , Jk b ), FY (Fy a , Fy b ), and MNS (M, S, s) blood group systems [9], alloantibodies against Rh variants [13][14][15] and other rare blood group phenotypes have also been implicated in shortened survival of transfused RBCs by causing DHTR [13,16] or HDFN [17].…”

“…The rates are estimated between 1 and 3% in patients that receive episodic transfusions, while for patients who receive chronic blood transfusions like patients with SCD and MDS, rates vary between 8 and 76% [9][10][11][12]. Although the most commonly observed alloantibodies of clinical relevance are against antigens belonging to RH (D, C, c, E, e), KEL (K, k, Js a , Kp a ), JK (Jk a , Jk b ), FY (Fy a , Fy b ), and MNS (M, S, s) blood group systems [9], alloantibodies against Rh variants [13][14][15] and other rare blood group phenotypes have also been implicated in shortened survival of transfused RBCs by causing DHTR [13,16] or HDFN [17]. In addition, some antibodies only have occasional reports of being clinically significant, that is, anti-Yt a , -Ge, and -N or have no clinical significance unless reactive at 37°C, that is, anti-Le a , -Le b , -M, -N, -P1, -Lu b , -A1, and -Bg [18].…”