Azarkeivan Azita, Ansari Shahla, Ahmadi Mohammad Hossein, Hajibeigy Bashir, Maghsudlu Mahtab, Nasizadeh Soheila, Shaigan Mojgan, Toolabi Abdolmajid, Salahmand Mitra
Department of Thalassemia Clinic, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Pediatr Hematol Oncol. 2011 Sep;28(6):479-85. doi: 10.3109/08880018.2011.568595.
One of transfusion's side effects is alloimmunization against red blood cell (RBC) antigens. Early diagnosis by antibody screening is an important step in the detection of these alloantibodies. The authors studied the frequency of alloimmunization in thalassemic patients of 4 centers (2 adult and 2 pediatric centers) and compared the rates in children (up to 15 years) and adults. Antibody screening tests were performed by gel method according to its standard pattern and respective program. In positive cases, antibody identification test by gel method was performed. Eight hundred thirty-five patients were studied; 548 (65.6%) were adults (mean age = 24.5), and 287 (34.4%) cases were pediatrics (mean age = 10.05). Of these patients, 74.1% had no history of transfusion reaction, whereas 21 (2.5%) had hemolytic complications. Seventy-eight (9.3%) exhibited allergic symptoms, and 117 (14%) cases experienced febrile reactions during transfusion. Antibody screening showed positive results in 22 pediatric cases (7.7%) and 79 adults (14.4%); 72 (71.3%), 19 (18.8%), 3 (3%), and 1 (1%) cases exhibited single, double, triple, and autoantibodies, respectively. Anti-Kell antibody was seen in 34 (33.7%) cases, anti-D was seen in 11 (10.9%) cases, and anti-E in was seen in 10 (9.9%) cases. The authors observed 8 anti-D+C (7.9%) cases, 1 anti-D+E (1%), 3 anti-Kell+E, 3 anti-Kell+Kpa (3%), and 1 anti-Kell+D double antibodies. These antibodies were also a combination of Rh subgroups or Rh and Kell subgroups. The authors observed meaningful relations between history of transfusion reactions and age with antibody screening results (P = .005). Based on alloantibodies types, more than two thirds of them were Rh subgroups and Kell groups. Phenotype determination of RBCs before beginning chronic blood transfusion and careful cross-matching with Kell and Rh subgroups in addition to ABO may help reduce alloimmunization in chronic transfusion patients.
输血的副作用之一是针对红细胞（RBC）抗原的同种免疫。通过抗体筛查进行早期诊断是检测这些同种抗体的重要步骤。作者研究了4个中心（2个成人中心和2个儿科中心）地中海贫血患者的同种免疫频率，并比较了儿童（15岁及以下）和成人的发生率。抗体筛查试验按照凝胶法的标准模式和各自的程序进行。在阳性病例中，采用凝胶法进行抗体鉴定试验。共研究了835例患者；其中548例（65.6%）为成人（平均年龄=24.5岁），287例（34.4%）为儿科患者（平均年龄=10.05岁）。这些患者中，74.1%无输血反应史，而21例（2.5%）有溶血并发症。78例（9.3%）出现过敏症状，117例（14%）在输血期间出现发热反应。抗体筛查显示，22例儿科病例（7.7%）和79例成人病例（14.4%）呈阳性；72例（71.3%）、19例（18.8%）、3例（3%）和1例（1%）病例分别出现单一、双重、三重和自身抗体。34例（33.7%）病例检测到抗Kell抗体，11例（10.9%）病例检测到抗-D，10例（9.9%）病例检测到抗-E。作者观察到8例抗-D+C（7.9%）病例、1例抗-D+E（1%）、3例抗-Kell+E、3例抗-Kell+Kpa（3%）和1例抗-Kell+D双重抗体。这些抗体也是Rh亚组或Rh与Kell亚组的组合。作者观察到输血反应史和年龄与抗体筛查结果之间存在有意义的关系（P = 0.005）。基于同种抗体类型，其中超过三分之二为Rh亚组和Kell组。在开始慢性输血前对红细胞进行表型测定，并除ABO血型外仔细与Kell和Rh亚组进行交叉配血，可能有助于减少慢性输血患者的同种免疫。
