Dhawan Hari Krishan, Kumawat Vijay, Marwaha Neelam, Sharma Ratti Ram, Sachdev Suchet, Bansal Deepak, Marwaha Ram Kumar, Arora Satyam
Department of Transfusion Medicine, PGIMER, Chandigarh, India.
Department of Pathology, Shaheed Hasan Khan Mewati, Government Medical College, Nalhar (Mewat), Haryana, India.
Asian J Transfus Sci. 2014 Jul;8(2):84-8. doi: 10.4103/0973-6247.137438.
The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies.
The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards.
Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C(w) = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system.
Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.
抗红细胞抗体（同种抗体和自身抗体）的产生仍然是重型地中海贫血患者面临的一个主要问题。我们研究了在本中心接受定期输血的地中海贫血患者中红细胞同种免疫和自身免疫的发生率，并分析了可能导致这些抗体产生的因素。
本研究对在我院地中海贫血门诊登记的319例多次输血的重型β地中海贫血患者进行。检查所有患者的临床和输血记录，包括患者年龄、输血治疗开始年龄、输血总量、输血间隔、脾切除或其他干预措施的情况。分别使用三细胞和11细胞板（DiaPanel，伯乐，瑞士）进行同种抗体筛查和鉴定。为检测自身抗体，使用多特异性抗人球蛋白（IgG + C3d）凝胶卡进行自身对照检测。
319例患者中，18例（5.64%）产生了同种抗体，90例（28.2%）产生了自身抗体。18例同种抗体患者中有9例也有自身抗体。首次输血时，同种免疫患者的年龄显著高于未免疫患者（P = 0.042）。在23种同种抗体中，52.17%属于Rh血型系统（抗-E = 17%，抗-D = 13%，抗-C = 13%，抗-C（w）= 9%），35%属于Kell血型系统，9%属于Kidd血型系统，4%属于Xg血型系统。
在多次输血的地中海贫血患者中，5.64%检测到同种免疫。Rh和Kell血型系统抗体占同种抗体的80%以上。本研究再次强调首次输血前进行红细胞抗原分型并输注抗原匹配血液（至少针对Rh和Kell抗原）的必要性。诊断后尽早开始输血治疗是减少同种免疫的另一种方法。
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