Alloimmunization in patients with sickle cell disease and underrecognition of accompanying delayed hemolytic transfusion reactions.
Alloimmunization in patients with sickle cell disease and underrecognition of accompanying delayed hemolytic transfusion reactions.
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DOI：
10.1111/trf.15328
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发表时间：
2019-07
期刊：
影响因子：
2.9
通讯作者：
Chou ST
中科院分区：
文献类型：
--
作者：
Coleman S;Westhoff CM;Friedman DF;Chou ST
镰状细胞病（SCD）患者通常需要红细胞（RBC）输注，但同种免疫仍然是一个重要的并发症。同种抗体可在红细胞输注后数天至数周内导致迟发性溶血性输血反应 (DHTR)，但在慢性溶血患者中可能未被充分认识。这项回顾性研究旨在确定 DHTR 的发生率和严重程度，该研究由 624 名 SCD 患者组成，这些患者在 14 年的时间里接受了主要来自非洲裔美国捐赠者的 C、E 和 K 匹配红细胞的输注。我们通过基线、输血前以及输血后 30 天（在新抗体鉴定之前）血红蛋白 (Hb) 和 % HbS 的变化来识别潜在的 DHTR。 DHTR 的实验室证据与首次检测时 178 种可评估抗体中的 54 种（30%）相关，其中不到一半在事件发生时被患者或提供者识别。在接受血清学 Rh 匹配红细胞的患者中，DHTR 与 26% 的 Rh 抗体相关，38% 与非 Rh 抗体相关。 54 种 DHTR 中的 21 种 (39%) 与血红蛋白下降幅度相关，比输血前值低 1 g/dL 以上。在这 21 种严重 DHTR 中，长期输血患者的 12 种 DHTR 中的 10 种发现了 Rh 特异性，而间歇性输血患者中的 9 种 DHTR 中的 7 种发现了非 Rh 特异性。临床上高度怀疑和监测 DHTR 是有必要的，因为它们在 SCD 患者中可能比以前认为的更常见。
Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusions but alloimmunization remains a significant complication. Alloantibodies can lead to delayed hemolytic transfusion reactions (DHTRs) days to weeks after a RBC transfusion, but may be underrecognized in patients with chronic hemolysis. This retrospective study aimed to determine the incidence and severity of DHTRs associated with new antibody detection in a cohort of 624 patients with SCD who received transfusion with C-, E-, and K-matched RBCs from primarily African American donors over a 14-year period. We identified potential DHTRs by the change in hemoglobin (Hb) and % HbS at baseline, before transfusion, and up to 30 days after the transfusion that preceded new antibody identification. Laboratory evidence of a DHTR was associated with 54 of 178 evaluable antibodies at first detection (30%), among which less than half were recognized by the patient or provider at the time of the event. A DHTR was associated with 26% of Rh antibodies identified in patients receiving serologic Rh-matched RBCs, and 38% of non-Rh antibodies. Twenty-one of the 54 DHTRs (39%) were associated with a Hb decline greater than 1 g/dL lower than pretransfusion values. Among these 21 severe DHTRs, Rh specificities were identified in 10 of 12 DHTRs in chronically transfused patients, while non-Rh specificities were associated with seven of nine DHTRs in episodically transfused patients. High clinical suspicion and monitoring for DHTRs is warranted, as they may be more common in patients with SCD than previously appreciated.
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影响因子：
2.9
作者：
Nickel, Robert Sheppard;Hendrickson, Jeanne E.;Stowell, Sean R.
通讯作者：
Stowell, Sean R.
DOI：
10.3324/haematol.2010.038307
发表时间：
2011-06-01
期刊：
HAEMATOLOGICA-THE HEMATOLOGY JOURNAL
影响因子：
--
作者：
de Montalembert, Mariane;Dumont, Marie-Dominique;Noizat-Pirenne, France
通讯作者：
Noizat-Pirenne, France
影响因子：
20.3
作者：
Chou, Stella T.;Jackson, Tannoa;Westhoff, Connie M.
通讯作者：
Westhoff, Connie M.
影响因子：
24.7
作者：
Evers, Dorothea;Middelburg, Rutger A.;van der Bom, Johanna G.
通讯作者：
van der Bom, Johanna G.
影响因子：
20.3
作者：
Chou, Stella T.;Evans, Perry;Westhoff, Connie M.
通讯作者：
Westhoff, Connie M.