Red cell alloimunization and autoantibodies in transfusion dependent thalassemia patients of Jammu region
DOI:
https://doi.org/10.18203/2349-3933.ijam20220115Keywords:
Alloantibodies, Thalassemia, SplenectomyAbstract
Background: Thalassemia is one of the most common genetic disorder of hemoglobin synthesis in Jammu region. Although RBC transfusion is life saving for these patients, it may be associated with some complications like RBC alloimmunization. Thus, alloimmunization against red blood cell antigens increases the need for transfusion and can significantly complicate transfusion therapy. Therefore, screening for unexpected antibodies should be a part of all pretransfusion testing, with antibody identification in the event of a positive result. The aim of the study was to determine the frequency of alloimmunization and autoimmunization and the most common alloantibodies involved.
Methods:This was a descriptive study involving a total of 146 thalassemic patients in the age range of 2-32 years receiving regular blood transfusions, registered at SMGS blood bank, Jammu. Antibodies screening, antibody identification, and cross matching was done on all patient samples included in the study, during the period between November 2014 and October 2015.
Results: At the start of the study, 8 patients who tested positive for alloantibodies 3 patients had more than one antibody subtype. Anti-E was the commonest antibody found in 4 (50%) patients. Similarly, at the end of study, antibody screening and then identification revealed presence of antibodies in 10 patients. Only 1 patient had more than one antibody subtype. Anti E was again the commonest antibody found in 5 (50%) patients.
Conclusions:The most common alloantibodies identified were anti Rh system antibodies (anti-E and anti-D) followed by Kell antibodies. In order to reduce alloimmunization, a policy for performing extended red cell phenotyping of these patients is essential and at least antigen E and Kell negative blood should be provided for transfusion to these patients.
References
Shah D, Choudhury P, Dubey AP. Current trends in management of the beta thalassemias. Indian Pediatr. 1999;36(12):1229-42.
Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Pennsylvania: Elsevier Saunders; 2007: 528-529.
Eliezer AR, Patricia JG. How I treat thalassemia. Blood J Hematol Library Org. 2011;118:3479-88.
Prati D. Benefits and complications of regular blood transfusion in patients with beta-thalassaemia major. Vox Sang. 2000;79(3):129-37.
Bhatti FA, Salamat N, Nadeem A, Shabbir N. Red cell immunization in beta thalassaemia major. J Coll Physicians Surg Pak. 2004;14(11):657-60.
Wang LY, Liang DC, Liu HC, Chang FC, Wang CL, Chan YS, et al. Alloimmunization among patients with transfusion-dependent thalassemia in Taiwan. Transfus Med. 2006;16(3):200-3.
Sirchia G, Zanella A, Parravicini A, Morelati F, Rebulla P, Masera G. Red cell alloantibodies in thalassemia major. Results of an Italian cooperative study. Transfusion. 1985;25(2):110-2.
Gupta R, Singh B, Rusia U, Goyal S. Red cell alloimunization in routinely transfused patients of Beta thalassemia major. IJBTI. 2010;1(1):1-4.
Sadeghian MH, Keramati MR, Badiei Z, Ravarian M, Ayatollahi H, Rafatpanah H, et al. Alloimmunization among transfusion-dependent thalassemia patients. Asian J Transfus Sci. 2009;3(2):95-8.
Bilwani F, Kakepoto GN, Adil SN, Usman M, Hassan F, Khurshid M. Frequency of irregular red cell alloantibodies in patients with thalassemia major: a bicenter study. J Pak Med Assoc. 2005;55(12):563-5.
Mansour AK, Aly RM, Abdelrazek SY, Elghannam DM, Abdelaziz SM, Shahine DA, et al. Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients. Hematol Oncol Stem Cell Ther. 2012;5(1):54-9.
Belhoul KM, Bakir ML, Kadhim AM, Dewedar HE, Eldin MS, Alkhaja FA. Prevalence of iron overload complications among patients with b-thalassemia major treated at Dubai Thalassemia Centre. Ann Saudi Med. 2013;33(1):18-21.
Haslina MN, Ariffin N, Hayati I, Rosline H. Red cell immunization in multiply transfused Malay thalassemic patients. Southeast Asian J Trop Med Public Health. 2006;37(5):1015-20.
Vichinsky E, Neumayr L, Trimble S, Giardina PJ, Cohen AR, Coates T, et al. Transfusion complications in thalassemia patients: a report from the Centers for Disease Control and Prevention (CME). Transfusion. 2014;54(4):972-81.
Ahmed AM, Hasan NS, Ragab SH, Habib SA, Emara NA, Aly AA. Red cell alloimmunization and autoantibodies in Egyptian transfusion-dependent thalassaemia patients. Arch Med Sci. 2010;6(4):592-8.
Pahuja S, Pujani M, Gupta SK, Chandra J, Jain M. Alloimmunization and red cell autoimmunization in multitransfused thalassemics of Indian origin. Hematology. 2010;15(3):174-7.
Dhawan HK, Kumawat V, Marwaha N, Sharma RR, Sachdev S, Bansal D, et al. Alloimmunization and autoimmunization in transfusion dependent thalassemia major patients: Study on 319 patients. Asian J Transfus Sci. 2014;8(2):84-8.
Spanos T, Karageorga M, Ladis V, Peristeri J, Hatziliami A, Kattamis C. Red cell alloantibodies in patients with thalassemia. Vox Sang. 1990;58(1):50-5.
Rosse WF, Gallagher D, Kinney TR, Castro O, Dosik H, Moohr J, et al. Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease. Blood. 1990;76(7):1431-7.
Calderone Z, Minniti CP, Kratovil T, Stojakovic M, Vollmer A, Barjaktarevic I, et al. rs660 polymorphism in Ro52 (SSA1; TRIM21) is a marker for age-dependent tolerance induction and efficiency of alloimmunization in sickle cell disease. Mol Immunol. 2009;47(1):64-70.
Thompson AA, Cunningham MJ, Singer ST, Neufeld EJ, Vichinsky E, Yamashita R, et al. Red cell alloimmunization in a diverse population of transfused patients with thalassaemia. Br J Haematol. 2011;153(1):121-8.
Pattanapanyasat K, Gonwong S, Chaichompoo P, Noulsri E, Lerdwana S, Sukapirom K, et al. Activated platelet-derived microparticles in thalassaemia. Br J Haematol. 2007;136(3):462-71.
Westerman M, Pizzey A, Hirschman J, Cerino M, Weiner Y, Ramotar P, et al. Microvesicles in haemoglobinopathies offer insights into mechanisms of hypercoagulability, haemolysis and the effects of therapy. Br J Haematol. 2008;142(1):126-35.
Danasoury AS, Eissa DG, Abdo RM, Elalfy MS. Red blood cell alloimmunization in transfusion-dependent Egyptian patients with thalassemia in a limited donor exposure program. Transfusion. 2012;52(1):43-7.
Williams M, Nuss R, Le T, Cole L, Hassell K, Murphy JR, et al. Extended red blood cell antigen matching for transfusions in sickle cell disease: a review of a 14-year experience from a single center (CME). Transfusion. 2011;51(8):1732-9.
Leiby DA. Babesiosis and blood transfusion: flying under the radar. Vox Sang. 2006;90(3):157-65.
Mali S, Kachur SP, Arguin PM, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (CDC). Malaria surveillance--United States, 2010. MMWR Surveill Summ. 2012;61(2):1-17.
Tonnetti L, Eder AF, Dy B, Kennedy J, Pisciotto P, Benjamin RJ, et al. Transfusion-transmitted Babesia microti identified through hemovigilance. Transfusion. 2009;49(12):2557-63.
