DOI: http://dx.doi.org/10.18203/2349-3933.ijam20180004

Red cell alloimmunization in multitransfused chronic renal patients on haemodialysis in a tertiary care centre of Jammu region

Vijay Sawhney, Neeti Dutt, Sushil Sharma, Kajal Khajuria

Abstract


Background: There is a high incidence of alloimunization in many patients with diseases that require repetitive blood transfusions. One such group is chronic renal failure patients as majority of them have severe anemia due to deficiency of erythropoietin. As many such patients are unable to afford erythropoietin, they are treated with blood transfusions. This study was thus undertaken to study alloimunization in such patients at our center.

Methods: A total of 96 patients found eligible were enrolled in this cross-sectional study that was carried out from June 2016 to august 2016. After detailed history, antibody screening was done by using Immucor Panoscreen three vial set and if screening came out to be positive antibody identification was then done by using Immucor Panocell-10.

Results: 96 patients including 76 male and 20 female patients recieved a total of 912 transfusions. Alloantibodies were detected in a total of 12 patients (12.5%). Of these 12 patients 8 patients had a single antibody whereas 4 patients developed two antibodies. The antibodies developed at a rate of 1.8% per transfusion (16/912). On alloantibody type identification, the most common type found was anti E (4/16) followed by both anti D and anti C in 3 patients each.

Conclusions: Alloimmunization to minor erythrocyte antigens occurs in many patients of chronic renal failure. This results in frequent pre-and post-transfusion complications. Inclusion of antibody screening test in routine pretransfusion testing protocol for the patients who are at higher risk of alloimmunization and require long-term transfusion dependence is desirable.


Keywords


Alloimunization, Anemia, Renal failure

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References


Melnikova I. Anaemia therapies. Nature Reviews Drug Discovery. 2006;5(8):627-8.

Ratcliffe PJ. Molecular biology of erythropoietin. Kidney Int. 1993;44:887-904.

Bhatti FA, Salamat N, Nadeem A, Shabbir N. Red cell immunization in beta thalassaemia major. J Coll Physicians Surg Pak. 2004;14:657-60.

Lo SC, Chang JS, Lin SW, Lin DT. Platelet alloimmunization after long-term red cell transfusion in transfusion-dependent thalassemia patients. Transfusion. 2005;45:761-5.

Prati D. Benefits and complications of regular blood transfusion in patients with beta-thalassaemia major. Vox Sang. 2000;79:129-37.

Walker RH, Lin DT, Hatrick MB. Alloimmunizaton following blood transfusion. Arch Pathol Lab Med. 1989;113:254-61.

Patel J, Shukla R, Gupte S. Red cell alloimmunization in multitransfused patients and multiparous women. Ind J Hematol Blood Transfus. 2009;25(2):49-52.

Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent. Thalassemia patients of predominantly Asian descent. Blood. 2000;96:3368-73.

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;55:563-5.

Schonewille H, van de Watering LM, Loomans DS, Brand A. Red blood cell alloantibodies after transfusion: factors influencing incidence and specificity. Transfusion. 2006;46:250-6.

Blumberg N, Peth K, Ross K, Avila E. Immune response to chronic red blood cell transfusion. Vox Sang. 1983:44:212-7.

Wang L-Y, Liang D-C, Liu H-C, Chang F-C, Wang C-L, Chan Y-S, et al. Alloimmunization among patients with transfusion-dependent thalassemia in Taiwan. Transfus Med. 2006;16:200-3.

Spanos T, Karageorga M, Ladis V, Peristeri J, Hatziliami A, Kattamis C. Red cel alloantibodies in patients with thalassemia. Vox Sang. 1990;58:50-5.

Rosse WF, Gallagher D, Kinney TR, Castro O, Dosik H, Moohr J, et al. Transfusion and alloimmunization in sickle cell disease. Blood. 1990;76:1431-7.

Mahmood IH, Al-badrani EI, Saadi N. Human recombinant erythropoietin in the treatment of anemia of patients with chronic renal failure. Hemoglobin. 2009;51(12.96):2.

Shukla JS, Chaudhary RK. Red cell alloimmunization in multitransfused chronic renal failure patients undergoing hemodialysis. Indian J Pathol Microbiol. 1999;42:299-302

Babiker H, Elsayed T. Frequency of Alloantibodies Among Chronic Renal Failure Patients in Red Sea State.Indian J Hematol Blood Transfus. 2014;30(3):187-90.

Agrawal A, Mathur A, Dontula S, Jagannathan L. Red Blood Cell Alloimmunization in Multi-transfused Patients: A Bicentric Study in India. Glob J Transfus Med. 2016;1:12-5.