High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors
High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors
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DOI：
10.1182/blood-2013-03-490623
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发表时间：
2013-08-08
期刊：
影响因子：
20.3
通讯作者：
Westhoff, Connie M.
中科院分区：
文献类型：
--
作者：
Chou, Stella T.;Jackson, Tannoa;Westhoff, Connie M.
红细胞（RBC）输注是镰状细胞病（SCD）患者的关键治疗方法，但RBC免疫接种仍然很复杂。在本研究中，我们评估了182例SCD患者的Rh D，C，E和K抗原匹配和非裔美国人供体输血的效果。总体而言，71例（58%）慢性和9例（15%）间歇性输血患者进行同种免疫。55例（45%）慢性和7例（12%）间歇性输血患者进行Rh免疫。在确定的146种抗体中，91种是无法解释的Rh抗体，其中三分之一与迟发性输血反应的实验室证据有关。五十六例抗体发生在红细胞表型阳性的患者相应的Rh抗原和35例患者的红细胞缺乏抗原和Rh匹配的红细胞输注。高分辨率RH基因分型显示87%的个体存在变异等位基因。这些数据描述了与表型Rh匹配的非洲裔美国人红细胞输注SCD患者的Rh同种免疫的患病率。我们的研究结果表明，改变RH等位基因的患者和捐助者在这项研究中的Rh同种异体免疫。是否RH基因分型的患者和少数捐助者将减少Rh同种异体免疫SCD需要检查。
Red blood cell (RBC) transfusion is a key treatment of patients with sickle cell disease (SCD) but remains complicated by RBC immunization. In the present study, we evaluated the effects of antigen matching for Rh D, C, and E, and K and transfusion from African American donors in 182 patients with SCD. Overall, 71 (58%) chronic and 9 (15%) episodically transfused patients were alloimmunized. Fifty-five (45%) chronic and 7 (12%) episodically transfused patients were Rh immunized. Of 146 antibodies identified, 91 were unexplained Rh antibodies, one-third of which were associated with laboratory evidence of delayed transfusion reactions. Fifty-six antibodies occurred in patients whose RBCs were phenotypically positive for the corresponding Rh antigen and 35 in patients whose RBCs lacked the antigen and were transfused with Rh-matched RBCs. High-resolution RH genotyping revealed variant alleles in 87% of individuals. These data describe the prevalence of Rh alloimmunization in patients with SCD transfused with phenotypic Rh-matched African American RBCs. Our results suggest that altered RH alleles in both the patients and in the donors contributed to Rh alloimmunization in this study. Whether RH genotyping of patients and minority donors will reduce Rh alloimmunization in SCD needs to be examined.