Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
Department of Paediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
Blood Transfus. 2014 Jan;12 Suppl 1(Suppl 1):s100-4. doi: 10.2450/2012.0154-12. Epub 2013 Feb 6.
There is an ongoing controversy regarding provision of usually matched blood (i.e. matched for ABO-D antigens) or phenotypically matched blood (also matched for Rh and Kell antigens) for multiply transfused thalassaemics, especially in developing countries. A pilot study conducted at our centre revealed an alloimmunisation rate of 3.79% with Rh and Kell alloantibodies accounting for 90% of all antibodies. The present cross-sectional study was conducted to assess the impact of a policy of partial better matching (for Rh cDE and Kell antigens) of blood on alloimmunisation in thalassaemics.
In this cross-sectional study three groups of patients were considered. Group 1 comprised 211 thalassaemics who received usually matched (UM) blood until April 2009. Their rates of alloimmunisation have already been published in a prior study. Group 2 consisted of 46 thalassaemics who were enrolled after April 2009 and have received partially better matched (PBM) blood (matched for ABO, Rh cDE and Kell antigens) since the initiation of transfusion therapy. Group 3 (UM→PBM) comprised the patients from group 1 who, from April 2009, were given partial better matched blood. Antibody screening (using a 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibodies.
None of the thalassaemic patients in group 2 (PBM) developed alloantibodies. Eight thalassaemics in group 3 (UM→PBM) developed new alloantibodies (after April 2009).
According to the results of the present study, providing at least partially better matched blood appears to improve the efficacy of transfusion for chronically transfused thalassaemics. Large-scale, comprehensive, multicentre studies need to be carried out to formulate realistic, evidence-based, economically feasible transfusion policies for thalassaemic children based on the red blood cell antigen profile of the population.
对于多次输血的地中海贫血患者，尤其是在发展中国家，提供通常匹配的血液（即匹配 ABO-D 抗原）或表型匹配的血液（也匹配 Rh 和 Kell 抗原）一直存在争议。我们中心进行的一项试点研究显示，Rh 和 Kell 同种抗体的免疫率为 3.79%，占所有抗体的 90%。本横断面研究旨在评估部分更好匹配（针对 Rh cDE 和 Kell 抗原）血液对地中海贫血患者同种免疫的影响。
在这项横断面研究中，考虑了三组患者。第 1 组包括 211 名接受通常匹配（UM）血液的地中海贫血患者，直到 2009 年 4 月。他们的同种免疫率已在之前的一项研究中发表。第 2 组由 46 名地中海贫血患者组成，他们于 2009 年 4 月后入组，自输血治疗开始以来一直接受部分更好匹配（PBM）血液（匹配 ABO、Rh cDE 和 Kell 抗原）。第 3 组（UM→PBM）由第 1 组的患者组成，他们从 2009 年 4 月起开始接受部分更好匹配的血液。进行抗体筛查（使用 3 细胞面板）和抗体鉴定（11 细胞面板）以检测同种抗体的存在。
第 2 组（PBM）的地中海贫血患者均未发生同种抗体。第 3 组（UM→PBM）的 8 名地中海贫血患者在 2009 年 4 月后发生新的同种抗体。
根据本研究结果，至少部分更好地匹配血液似乎可以提高慢性输血地中海贫血患者的输血效果。需要进行大规模、全面、多中心的研究，根据人群的红细胞抗原谱，为地中海贫血儿童制定基于现实、基于证据、经济可行的输血政策。
