Hematology 2019: Red cell autoimmunization in multiply transfused thalassemia patients- Rajendra Chaudhary- Sanjay Gandhi Postgraduate Institute of Medical Sciences
Hematology 2019: Red cell autoimmunization in multiply transfused thalassemia patients- Rajendra Chaudhary- Sanjay Gandhi Postgraduate Institute of Medical Sciences
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血液学 2019：多次输血地中海贫血患者的红细胞自身免疫 - Rajendra Chaudhary - Sanjay Gandhi 医学科学研究所
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发表时间：
2020
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R. Chaudhary
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作者：
R. Chaudhary
地中海贫血是印度的一个主要健康问题。输血支持仍然是治疗的主要手段。红细胞同种异体免疫是输血依赖患者的重要并发症。该研究旨在确定同种异体免疫的流行率，并评估可能影响同种异体免疫的风险因素，以制定策略，最大限度地减少这些患者的输血相关风险。对我院400例地中海贫血患者的临床、人口学、同种抗体和自身抗体状况及输血记录进行了研究。比较有和没有同种抗体的患者，发现年龄、性别、种族、开始定期输血和脾切除术时的年龄有显著差异。36例（9%）产生了42种有临床意义的同种抗体，其中27例（65%）为Rh系统的同种抗体. 400例患者中有22例（5.5%）出现自身抗体。患者年龄被发现是显着较高的同种免疫患者比非同种免疫患者。同种异体免疫率随输血单位数的增加而增加。接受未过滤血液的患者比接受白细胞减少血液的患者具有更高的同种免疫率。脾切除患者的同种异体免疫率高于非脾切除患者。本中心地中海贫血患者的红细胞同种异体免疫频率适中。实施普遍的白细胞减少政策可能有助于减少同种免疫。然而，在我们的环境中，提供扩展表型匹配血液的政策可能不具有成本效益，因为输血依赖患者和献血者之间的抗原一致性。
红细胞同种免疫和自身免疫仍然是输血依赖性地中海贫血患者的主要问题。有一个从印度东部地中海贫血患者的红细胞同种异体免疫和自身免疫的发病率的数据缺乏，输血前抗体筛查不定期进行。目标。评估印度东部输血依赖性地中海贫血患者红细胞同种异体免疫和自身免疫的发生率。材料和方法。共评估了500例地中海贫血患者。使用市售平板细胞（Diapanel，Bio-rad，瑞士）通过柱凝集法进行抗体筛选和鉴定。为了检测自身抗体，在所有患者中使用多特异性Coombs（IgG + C3 d）凝胶卡进行自身对照和直接抗球蛋白试验。结果共有28例患者发生RBC同种免疫（5.6%），5例患者发生自身抗体（1%）。抗c抗体发生率最高（28.57%），其次为抗E抗体（21.42%）。28例患者中有5例（17.85%）同时产生抗c和E抗体。结论这项研究的数据表明，红细胞同种抗体和自身抗体的发展率是显着的，在我们的地区。因此，输血前抗体筛查需要在印度东部启动，以确保安全的输血实践。
共500例地中海贫血患者，年龄2 ~ 40岁。入选标准为依赖输血且每月至少有一次输血史的患者。排除标准为输血依赖但有Rh同种免疫或母胎出血史的女性患者。分析所有患者的临床和输血记录，以确定不同年龄组和不同类型的地中海贫血（重型β地中海贫血和E-β地中海贫血）患者是否存在抗体特异性的同种免疫/自身免疫。所有地中海贫血患者均根据机构输血政策进行输血，以保持目标Hb水平9-11.5 g/dL，输血间隔为2-4周（中位间隔为3周）。根据我院的输血策略，所有地中海贫血患者在AHG阶段通过凝胶卡技术进行相容性检测后均给予ABO和Rh（D）匹配的浓缩红细胞（分型和交叉配型政策）。如果检测到患者具有同种抗体，则这些患者接受ABO & Rh（D）匹配的特定抗原阴性（针对其具有同种抗体）相容单位进行输血。产生自身抗体的患者接受了“最佳匹配”单位的输血。
Thalassemia is a major health problem in India. Transfusion support remains the mainstay of treatment. Red blood cell alloimmunization is an important complication in transfusion-dependent patients. The study was conducted to determine alloimmunization prevalence and to evaluate risk factors that could influence alloimmunization to make strategies to minimize transfusion-associated risks in those patients. Clinical, demographic, allo and autoantibody status and transfusion records of 400 thalassemia patients at our hospital were studied. Patients with and without alloantibodies were compared to find significant differences for age, gender, race, age at start of regular transfusions and splenectomy. Thirty six (9 %) developed 42 clinically significant alloantibodies. Majority, 27 (65 %) of the alloantibodies were of Rh system. Twenty two (5.5 %) of the 400 patients developed autoantibodies. Patient age was found to be significantly higher in alloimmunized patients than in non alloimmunized patients. Rate of alloimmunization increased with the number of units transfused. Patients who received unfiltered blood had a higher alloimmunization rate compared to those who always received leukoreduced blood. Patients who underwent Splenectomy had a higher alloimmunization rate compated to those without splenectomy. The frequency of red cell alloimmunization in thalassemia patients from our center is moderate. Implementation of policy of universal leukoreduction may help in minimizing alloimmunization. However, policy of providing extended phenotype matched blood may not be cost effective in our setting because of antigenic concordance between transfusion dependent patients and blood donors in general.
Red blood cell (RBC) alloimmunization and autoimmunization remain a major problem in transfusion dependent thalassemic patients. There is a paucity of data on the incidence of RBC alloimmunization and autoimmunization in thalassemic patients from eastern part of India, as pretransfusion antibody screening is not routinely performed. Aims. To assess the incidence of RBC alloimmunization and autoimmunization in transfusion dependent thalassemic patients in eastern India. Materials and Methods. Total 500 thalassemia cases were evaluated. The antibody screening and identification were performed with commercially available panel cells (Diapanel, Bio-rad, Switzerland) by column agglutination method. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG + C3d) gel cards in all patients. Results. A total of 28 patients developed RBC alloimmunization (5.6%) and 5 patients had autoantibodies (1%). Alloantibody against c had the highest incidence (28.57%) followed by E (21.42%). Five out of 28 (17.85%) patients had developed antibodies against both c and E. Conclusion. Data from this study demonstrate that the RBC alloantibody and autoantibody development rates are significant in our region. Thus, pretransfusion antibody screening needs to be initiated in eastern India in order to ensure safe transfusion practice.
Total 500 thalassemic patients were evaluated in the age ranging from 2 to 40 years. The inclusion criteria were patients who were dependent on transfusion and had a history of blood transfusion at least once in every month. The exclusion criteria were female patients who were transfusion dependent but had a history of Rh isoimmunization or fetomaternal haemorrhage. Clinical and transfusion records were analyzed in all patients for presence of alloimmunization/autoimmunization with antibody specificity among different age groups and different types of thalassemic (beta thalassemia major and E-beta thalassemia) patients. All thalassemia patients were transfused according to institutional transfusion policy to keep target Hb level 9–11.5 g/dL with a transfusion interval of 2–4 weeks (median interval of 3 weeks). As per transfusion strategy of our institute, all thalassemia patients were given ABO and Rh(D) matched packed red cells after compatibility testing by gel card technique in the AHG phase (type and crossmatch policy). In case patients were detected to have alloantibodies, those patients received ABO & Rh(D) matched particular antigen negative (against which they had alloantibody) compatible units for transfusion. Patients who had developed autoantibodies received transfusion with “best matched” units.