Bonfils Blood Center, Denver, CO 80230, USA.
Transfusion. 2011 Aug;51(8):1732-9. doi: 10.1111/j.1537-2995.2010.03045.x. Epub 2011 Feb 18.
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.
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 Le(a) , Le(b) , Fy(b) , 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.
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.
Exact matching for ABO, Rhesus, Kell, Kidd, and Fy(a) 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.
红细胞（RBC）血型抗原同种免疫是镰状细胞病（SCD）患者的主要并发症，限制了 RBC 输血的用途。在这里，我们报告了我们在 SCD 患者中进行扩展 RBC 抗原匹配的经验。
回顾了 1993 年至 2006 年间仅根据扩展匹配方案接受输血的 99 例 SCD 患者的记录。对患者和供体进行了 20 种血型抗原表型检测，并提供了与受者不表达的抗原阴性的 RBC 单位。必要时，允许在 Le(a)、Le(b)、Fy(b)和 MNSs 上存在不匹配，以满足被认为最具临床意义的抗原的要求。为 99 名患者（平均每位患者 70 单位；范围为 1-519 单位/患者）提供了匹配的 RBC 单位（6946 个）。消除不匹配后，90%的输血与其他所有阴性抗原相匹配。
在 7 名患者中检测到 7 种同种抗体，导致 7%的患者发生同种免疫，每 100 单位输血发生 0.1 种抗体。3 名发生抗体的受者为 D 镶嵌型，用血清学技术可能会被误分型。与我们机构和其他机构的 ABO 和/或 D 匹配相比，同种免疫减少。未报告 12 种自身抗体和严重溶血性输血反应。
对 ABO、Rh、Kell、Kidd 和 Fy(a) 进行精确匹配，并尽可能扩展这种匹配，是减少 RBC 抗原同种免疫的有效策略。应考虑进一步通过对照、多机构试验来探索这一结论，以确定这种方法的疗效、成本效益分析和可重复性。
