Frequency of Red Cell Alloimmunization in Multitransfused Thalassemia Patients
Nabila Aslam, Ayesha Imran, Arsala Rashid, Ambreen Kashir, Sundas Arshad, Aysha Khanum
1227
ABSTRACTBackground: Thalassemia major patients managed by regular transfusion regimen may develop alloimmunization against foreign red cell antigens. If the alloantibodies are hemolyzing, transfusion reaction can occur, and provision of blood thereafter requires phenotypically matched blood in addition to ‘ABO” and Rh ‘D’ typing.Aim: To determine the rate of occurrence of red cell alloimmunization in regularly transfused Thalassemia patient.Setting: Hematology department King Edward Medical University and affiliated hospitalsDuration of the study: Six months after the approval of synopsis From: 18th November 2016 to 18th May 2017Study design: Descriptive studyMethodology: This study was conducted in King Edward Medical University and its affiliated hospitals on patients with diagnosis of Thalassemia. After informed consent, a detailed transfusion history was taken using a set questionnaire which mentioned the name, age and sex, identification number, blood group, transfusions till date, diagnosis, transfusion history (date, frequency of transfusion and blood component types), total number and duration from last transfusion, any relevant drug history, and result of serological testing like DAT test and IAT was noted. If indirect coombs test is positive then antibody screening and identification is done (using panel of 11 cells).Results: Out of 138 cases, 42(30.30%) were between 2-10 years of age, 69(50.30%) were between 11-20 years of age and 27(19.39%) were between 21-30 years of age, mean±sd was calculated as 7.71±5.84 years, 84(61%) were male and 54(39%) were females. The occurrence of red cell alloantibodies in regularly transfused thalassemic patients was recorded in 29(21.01%). Frequency of specific types of most frequent alloantibodies in multi-transfused thalassemia patient shows that 22(76%) had Anti-Rh (Anti-D 8(27.5%), Anti-C 5(17%), Anti-c 1(3.4%), Anti-E 2(7%), Anti-e 4(14%), Anti-Cw 2(7%), 6(21%) had Anti-Kell (Anti-K 4(14%), Anti-kpa 2(7%), 1(3.4%) had Anti-MNS (Anti-N3. 1(4%) type of alloantibody.Conclusion: Rate of frequency of red cell alloantibodies occurrence is higher in frequently-transfused Thalassemic patients as compared to thalassemia patients with less no of transfusions while Anti-Rh was the commonest type of antibody detected. These findings are helpful for thalassemic patients receiving multiple transfusions,so these patients must receive cross-matched units and ideally their rbcs should be phenotyped to prevent alloimmunization.Keywords: Thalassemia, multi-transfusion, red blood cell alloantibodies
Background: Thalassemia major patients managed by regular transfusion regimen may develop alloimmunization against foreign red cell antigens. If the alloantibodies are hemolyzing, transfusion reaction can occur, and provision of blood thereafter requires phenotypically matched blood in addition to ‘ABO” and Rh ‘D’ typing.
Aim: To determine the rate of occurrence of red cell alloimmunization in regularly transfused Thalassemia patient.
Setting: Hematology department King Edward Medical University and affiliated hospitals
Duration of the study: Six months after the approval of synopsis From: 18th November 2016 to 18th May 2017
Study design: Descriptive study
Methodology: This study was conducted in King Edward Medical University and its affiliated hospitals on patients with diagnosis of Thalassemia. After informed consent, a detailed transfusion history was taken using a set questionnaire which mentioned the name, age and sex, identification number, blood group, transfusions till date, diagnosis, transfusion history (date, frequency of transfusion and blood component types), total number and duration from last transfusion, any relevant drug history, and result of serological testing like DAT test and IAT was noted. If indirect coombs test is positive then antibody screening and identification is done (using panel of 11 cells).
Results: Out of 138 cases, 42(30.30%) were between 2-10 years of age, 69(50.30%) were between 11-20 years of age and 27(19.39%) were between 21-30 years of age, mean±sd was calculated as 7.71±5.84 years, 84(61%) were male and 54(39%) were females. The occurrence of red cell alloantibodies in regularly transfused thalassemic patients was recorded in 29(21.01%). Frequency of specific types of most frequent alloantibodies in multi-transfused thalassemia patient shows that 22(76%) had Anti-Rh (Anti-D 8(27.5%), Anti-C 5(17%), Anti-c 1(3.4%), Anti-E 2(7%), Anti-e 4(14%), Anti-Cw 2(7%), 6(21%) had Anti-Kell (Anti-K 4(14%), Anti-kpa 2(7%), 1(3.4%) had Anti-MNS (Anti-N3. 1(4%) type of alloantibody.
Conclusion: Rate of frequency of red cell alloantibodies occurrence is higher in frequently-transfused Thalassemic patients as compared to thalassemia patients with less no of transfusions while Anti-Rh was the commonest type of antibody detected. These findings are helpful for thalassemic patients receiving multiple transfusions,so these patients must receive cross-matched units and ideally their rbcs should be phenotyped to prevent alloimmunization.
Keywords: Thalassemia, multi-transfusion, red blood cell alloantibodies