Original article

Blood Transfusion - 4 2021 (July-August)

Complete RH and Kell matching related to low alloimmunisation risk in sickle cell disease: prevalence and risk factors of alloimmunisation in a Spanish tertiary care national reference centre

Authors

Key words: sickle cell disease, erythrocyte transfusion, alloimmunisation, immunohaematology
Publication Date: 2020-09-18

Abstract

Background - Red blood cell (RBC) transfusion remains an essential part of sickle cell disease (SCD) management but it can lead to alloimmunisation, with an increased incidence in this population. Prevention is based on RBC antigen phenotype matching, with complete RH and Kell matching being a standard of care.
Materials and methods - We performed a retrospective, single-centre study analysing alloimmunisation prevalence and risk factors in a cohort of transfused SCD patients.
Results - Eighty-seven patients (96.5% of paediatric age) received 1,781 RBC units (RBCu). Complete RH and Kell matched RBCu represented a median of 100% among total transfusions per patient. Of the 87 patients, 52 (59.8%) underwent chronic transfusion therapy, whereas 35 (40.2%) were only episodically transfused. Seven patients were alloimmunised (8.4%) and eleven antibodies were detected (alloimmunisation rate: 0.62/100 units transfused). 54.6% of these antibodies corresponded to RH-Kell despite the high accomplishment of the RH-Kell matching transfusion protocol. Alloimmunised patients had a median of 90.9% RH-Kell matched transfusions vs 100% in non-alloimmunised patients, but no statistical differences were observed (p=0.127). Number of transfused RBCu (19 vs 7; p=0.023), number of episodic RBCu (8 vs 2; p=0.006), episodic to chronic RBCu ratio (0.57 vs 0.09; p=0.045), number of vaso-occlusive crises (VOC) (4 vs 2; p=0.011), and autoantibody presence (57.1 vs 0%; p<0.001) were all statistically related to alloimmunisation.
Discussion - We report a low alloimmunisation prevalence (8.4%) related to a high grade of RH-Kell matching. However, deviation from 100% translates into alloimmunisation, with >50% of alloantibodies corresponding to RH-Kell. Alloimmunisation risk increases with transfusion burden, particularly during acute complications, and in patients with a higher number of VOC, probably reflecting underlying inflammation and disease severity. Further studies will be needed to elucidate additional risk factors and help prevent alloimmunisation in these patients.

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Authors

Isabel Regalado-Artamendi - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid

Ana M. Pérez-Corra - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid

Marina García-Morín - Paediatric Oncology/Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Elena Cela - Paediatric Oncology/Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Cristina Beléndez - Paediatric Oncology/Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Eduardo J. Bardón-Cancho - Paediatric Oncology/Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Gloria Pérez-Rus - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Isabel Pérez-Sánchez - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid

Cristina Pascual - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid

Silvia Monsalvo - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid

Carmen Falero - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid

Jose L. Díez-Martín - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid;Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; Universidad Complutense de Madrid, Madrid, Spain

Javier Anguita - Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Paediatric Oncology/Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid

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