Red Blood Cell Alloimmunization in Transfused Patients With Sickle Cell Disease in Sub-Saharan Africa; a Systematic Review and Meta-Analysis

Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions i...

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Bibliographic Details
Published in:Transfusion medicine reviews 2019-07, Vol.33 (3), p.162-169
Main Authors: Boateng, Lilian Antwi, Ngoma, Alain Mayindu, Bates, Imelda, Schonewille, Henk
Format: Article
Language:English
Subjects:
Alloimmunization
Sickle cell disease
Sub-Saharan Africa
Systematic review
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Summary:Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk. •The pooled proportion of alloimmunization in SCD in SSA is 7.4 (95% CI: 5.1-10.0).•Almost 50% of antibody specificities were against D, C, E, and K antigens.•Antibodies to low- and high-frequency antigens accounted for 29% of antibodies.•Studies did not consistently report factors that influence alloimmunization.•SCD patients in SSA should be screened for RBC antibodies and IAT cross-matched.
ISSN:0887-7963
1532-9496
DOI:10.1016/j.tmrv.2019.06.003