Extended red blood cell antigen matching for transfusions in sickle cell disease: a review of a 14-year experience from a single center (CME)

BACKGROUND: Alloimmunization to red blood cell (RBC) blood group antigens is a major complication for patients with sickle cell disease (SCD), which limits the usefulness of RBC transfusion. Here, we report our experiences with extended RBC antigen matching for SCD patients. STUDY DESIGN AND METHODS...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2011-08, Vol.51 (8), p.1732-1739
Main Authors: LaSalle-Williams, Michele, Nuss, Rachelle, Le, Tuan, Cole, Laura, Hassell, Kathy, Murphy, James R., Ambruso, Daniel R.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anemia, Sickle Cell - blood
Anemia, Sickle Cell - immunology
Anemia, Sickle Cell - therapy
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood Grouping and Crossmatching - methods
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Bone marrow, stem cells transplantation. Graft versus host reaction
Child
Child, Preschool
Erythrocyte Transfusion - methods
Erythrocytes - immunology
Female
Histocompatibility Testing
Humans
Infant
Male
Medical sciences
Retrospective Studies
Time Factors
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Young Adult
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Summary:BACKGROUND: Alloimmunization to red blood cell (RBC) blood group antigens is a major complication for patients with sickle cell disease (SCD), which limits the usefulness of RBC transfusion. Here, we report our experiences with extended RBC antigen matching for SCD patients. STUDY DESIGN AND METHODS: Records for 99 SCD patients transfused only with the extended matching protocol between 1993 and 2006 were reviewed. Patients and donors were phenotyped for 20 blood group antigens and RBC units that were negative for antigens not expressed by the recipient were provided. When necessary, mismatches were allowed at Lea, Leb, Fyb, and MNSs to meet requirements for antigens regarded as the most clinically significant. Matched RBC units (6946) were provided to 99 patients (mean, 70 units/patient; range, 1‐519 units/patient). Eliminating mismatches, 90% of the transfusions matched all other negative antigens. RESULTS: Seven alloantibodies were detected in seven patients resulting in 7% alloimmunized at a rate of 0.1 antibodies per 100 units transfused. Three recipients who developed antibodies were D mosaic and would have been mistyped with serologic techniques. Alloimmunization was decreased compared to ABO and/or D matching at our institution and others. Twelve autoantibodies and no severe hemolytic transfusion reactions were reported. CONCLUSION: Exact matching for ABO, Rhesus, Kell, Kidd, and Fya and extending this match whenever possible is an effective strategy to reduce alloimmunization to RBC antigens. Consideration should be given to exploring this conclusion further with a controlled, multi‐institutional trial to determine efficacy, cost‐benefit analysis, and reproducibility of this approach.
ISSN:0041-1132
1537-2995
DOI:10.1111/j.1537-2995.2010.03045.x