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ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 171-177

Alloimmunization to erythrocyte antigens in patients receiving multiple blood transfusions: Clinico-immunohematological and demographic risk factors and impact of extended red cell phenotyping


Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India

Correspondence Address:
Dr. Sudipta Sekhar Das
Department of Transfusion Medicine, Apollo Gleneagles Hospitals, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_68_21

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Background and Objectives: The risk of red blood cell (RBC) alloimmunization is always a concern for multi-transfused patients. Various factors have been found to be associated with alloimmunization. Alloimmunization rates were reported from 4% to 50%, 1.9% to 13% and 1.27% to 13.1% in thalassemic, onco-hematology and renal patients respectively. Transfusion of extended phenotype-matched blood was found to reduce rate of alloimmunization. This study investigated the various risk factors associated with RBC alloimmunization and the impact of transfusing phenotype-matched PRBC to multi-transfused patients. Methods: The retrospective observational study included 4350 multi-transfused patients of hemoglobinopathies, onco-hematological diseases and chronic renal failure (CRF). Pre-transfusion testing that included ABO and Rh(D) typing, antibody screening and crossmatching were performed following departmental standard operating procedure (SOP). Rh (C, c, E, e) and Kell (K) antigen phenotyping of blood donors as well as patients were performed by recommended techniques. Statistical analysis was done using the SPSS statistical package. Results: The mean age of multi-transfused patients was 41.4 years with a female preponderance. A total of 122 alloantibodies with various specificities were found in the 4350 patients (2.8%). Anti-E was the most frequent alloantibody (27.87%) followed by anti-c (11.48%). Frequency of alloimmunization in patients with hemoglobinopathies receiving phenotype-matched blood was 1.89% which was significantly lower than those receiving phenotype-unmatched blood (p=0.0019). Gender, age, splenomegaly status, number of PRBC unit transfused, phenotype-matched status, and transfusion duration in years were independent risk factors of alloimmunization. Conclusion: Alloimmunization to red blood antigens challenge the proper management of multi-transfused patients. Based on the present results we suggest considering antibody screening as an important tool of pre-transfusion testing to ensure safe blood transfusion. It will be prudent to adopt a transfusion policy that provides at least the Rh-Kell phenotype-matched blood to minimize red cell alloimmunization among multi-transfused patients.


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