Red blood cell alloimmunization in sickle cell disease: prevalence in 2010

• Type of Material: Article
• Authors: Scott T. Miller, SUNY Downstate Medical Center; Hae-Young Kim, New England Research Institutes; Debra L. Weiner, Children’s Hospital Boston; Carrie G. Wager, New England Research Institutes; Dianne Gallagher, New England Research Institutes; Lori A. Styles, Children’s Hospital & Research Center at Oakland; Carlton Dampier, Emory University; Susan D. Roseff, Virginia Commonwealth University
• Language: English
• Date: 2013-04-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 American Association of Blood Banks.
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1537-2995.2012.03796.x
• Title of Journal or Parent Work: Transfusion
• ISSN: 0041-1132
• Volume: 53
• Issue: 4
• Start Page: 704
• End Page: 709
• Grant/Funding Information: This publication was made possible by Grant Number U10HL083721 from the National Heart, Lung, and Blood Institute, National Institutes of Health.
• Keywords: TRANSFUSION MANAGEMENT; INTERLEUKIN-8; Life Sciences & Biomedicine; Transfusion; Duffy blood group; EXPRESSION; Cooperative Study of Sickle Cell Disease; ANEMIA; RISK-FACTORS; STROKE-PREVENTION TRIAL; Hematology; ACUTE CHEST SYNDROME; Science & Technology; CHILDREN; PROACTIVE
• Research Categories: Health Sciences, Immunology; Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Transfusion of red blood cells is frequently required for care of individuals with sickle cell disease. Alloimmunization rates are high, and may be reduced by matching for red cell antigens that can cause alloimmunization. STUDY DESIGN AND METHODS: During the PROACTIVE Feasibility Study, patients with sickle cell disease age two years or older admitted for pain without acute chest syndrome were enrolled for possible randomization to preventive blood transfusion or standard care. Transfusion and antibody histories were obtained at each site, and antibody screening was done, to assess transfusion burden and alloimmunization prevalence. Participating sites were surveyed regarding antigen matching practice. RESULTS: 237 patients (169 SS, 42 SC, 15 Sβ0-thalassemia, 11 Sβ+-thalassemia), 118 males and 119 females, were enrolled. Mean age was 19.3 years (range 2.0–68.0); there were 122 children and 115 adults. 75.8% had received at least a single transfusion of red blood cells prior to the study. Thirty-four patients (14.4%) had a history of at least one alloantibody and 17 of these had more than one. When surveyed, 19 sites (83% of responders) reported antigen matching to at least include C, E and K for transfusion of all patients with sickle cell disease. CONCLUSION: Though antigen typing prior to transfusion of people with sickle cell disease and providing antigen negative units is now widely employed by sickle cell centers, the alloimmunization rate remains quite high in contemporary sickle cell populations and may be due in large part to transfusions received at institutions not providing extended matching.