State University of New York-Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY 11203, USA.
Transfusion. 2013 Apr;53(4):704-9. doi: 10.1111/j.1537-2995.2012.03796.x. Epub 2012 Jul 13.
Transfusion of red blood cells (RBCs) is frequently required for care of individuals with sickle cell disease (SCD). Alloimmunization rates are high and may be reduced by matching for RBC antigens that can cause alloimmunization.
During the PROACTIVE Feasibility Study, patients with SCD age 2 years or older admitted for pain without acute chest syndrome were enrolled for possible randomization to preventive blood transfusion or standard care. Transfusion and antibody histories were obtained at each site, and antibody screening was done, to assess transfusion burden and alloimmunization prevalence. Participating sites were surveyed regarding antigen matching practice.
A total of 237 patients (169 SS, 42 SC, 15 Sβ(0) -thalassemia, 11 Sβ(+) -thalassemia), 118 males and 119 females, were enrolled. Mean age was 19.3 years (range, 2.0-68.0); there were 122 children and 115 adults. A total of 75.8% had received at least a single transfusion of RBCs before the study. Thirty-four patients (14.4%) had a history of at least one alloantibody and 17 of these had more than one. When surveyed, 19 sites (83% of responders) reported antigen matching to at least include C, E, and K for transfusion of all patients with SCD.
Though antigen typing before transfusion of people with SCD and providing antigen-negative units is now widely employed by sickle cell centers, the alloimmunization rate remains quite high in contemporary sickle cell populations and may be due in large part to transfusions received at institutions not providing extended matching.
镰状细胞病（SCD）患者常需要输注红细胞（RBC）进行治疗。同种免疫发生率较高，通过匹配可能引起同种免疫的 RBC 抗原可降低同种免疫发生率。
在 PROACTIVE 可行性研究中，年龄≥2 岁且因疼痛而无急性胸部综合征的 SCD 患者入院后，可能会被随机分配到预防性输血或标准治疗组。在每个地点获取输血和抗体史，并进行抗体筛查，以评估输血负担和同种免疫发生率。对参与的地点进行了关于抗原匹配实践的调查。
共纳入 237 例患者（169 例 SS、42 例 SC、15 例 Sβ(0)-地中海贫血、11 例 Sβ(+) -地中海贫血，118 例男性和 119 例女性），平均年龄为 19.3 岁（范围 2.0-68.0）；其中 122 例为儿童，115 例为成人。75.8%的患者在研究前至少接受过一次 RBC 输血。34 例（14.4%）有至少一次同种异体抗体史，其中 17 例有不止一种同种异体抗体史。调查时，19 个地点（83%的应答者）报告称，为所有 SCD 患者输血时，抗原匹配至少包括 C、E 和 K。
虽然目前镰状细胞中心广泛采用在输血前对 SCD 患者进行抗原分型并提供抗原阴性单位，但在当代镰状细胞人群中同种免疫发生率仍然很高，这可能主要是由于在不提供扩展匹配的机构中接受的输血所致。
