RH genotype matching for transfusion support in sickle cell disease
RH genotype matching for transfusion support in sickle cell disease
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DOI：
10.1182/blood-2018-05-851360
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发表时间：
2018-09-13
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.;Evans, Perry;Westhoff, Connie M.
Rh异体免疫仍然是镰状细胞病（SCD）患者的挑战，尽管输血血清学Rh C， E和K抗原匹配的红细胞。RH等位基因改变的遗传有助于SCD患者输血后RH抗体的流行，并解释了大约三分之一的病例。其余的似乎是受到非裔美国人供体红细胞上Rh蛋白改变的刺激。根据RH基因型将患者与供体匹配可能会减轻RH同种异体免疫，但其可行性和所需资源尚不清楚。我们比较了SCD患者（n = 857）和非裔美国捐赠者（n = 587）的RH等位基因频率，发现RH等位基因频率相似。总体而言，29%的RHD和53%的RHCE等位基因在患者和非裔美国捐赠者中发生改变。我们将RH基因型匹配与血清学RH D、C和E以及K抗原匹配进行了建模，发现在我们的机构中，RH基因型与RH血清学匹配所需的非裔美国人供体数量约为两倍。我们证明，非裔美国人的供体招募对于维持C、E和k阴性供体单位的充足供应是必要的，以避免耗尽rh阴性（RhD2）的血液供应。我们的研究结果表明，在主要由非裔美国人组成的供体池中，SCD患者的预防性RH基因匹配是可行的，并将优化我们现有的少数族裔供体库存的使用。目前对所有少数民族献血者进行RH基因分型的成本和数据管理仍然是限制因素。
Rh alloimmunization remains a challenge for patients with sickle cell disease (SCD) despite transfusion of serologic Rh C, E, and K antigen-matched red cells. Inheritance of altered RH alleles contributes to the prevalence of Rh antibodies after blood transfusion in patients with SCD and explains approximately one-third of cases. The remainder seem to be stimulated by altered Rh proteins on African American donor red cells. Matching patients with donors on the basis of RH genotype may mitigate Rh alloimmunization, but the feasibility and resources required are not known. We compared RH allele frequencies between patients with SCD (n = 857) and African American donors (n = 587) and showed that RH allele frequencies are similar. Overall, 29% of RHD and 53% of RHCE alleles are altered in patients and African American donors. We modeled RH genotype matching compared with serologic Rh D, C, and E, along with K antigen matching, and found that approximately twice the number of African American donors would be required for RH genotype vs Rh serologic matching at our institution. We demonstrated that African American donor recruitment is necessary to maintain an adequate supply of C-, E-, and K-negative donor units to avoid depleting the Rh-negative (RhD2) blood supply. Our results suggest that prophylactic RH genetic matching for patients with SCD is feasible with a donor pool comprised primarily of AfricanAmericans and would optimize the use of our existing minority donor inventory. The current cost of RH genotyping all minority donors and management of the data remain limiting factors.