Al-Mousawi Muqdad M N, Al-Allawi Nasir A S, Alnaqshabandi Rubad
a Department of Haematology , Azadi Teaching Hospital , Duhok , Iraq.
b Scientific Research Centre, Faculty of Medical Sciences, University of Duhok , Duhok , Iraq.
Hemoglobin. 2015;39(6):423-6. doi: 10.3109/03630269.2015.1077460. Epub 2015 Aug 31.
Hemoglobinopathies are significant health problems in Iraq, including its Northern Kurdistan region. One of the essential components of management of these disorders is regular lifelong blood transfusions. The latter is associated with several complications including red cell alloimmunization. No study has looked at the frequency of alloimmunization and its associations in the country. To address the latter issue, 401 multi transfused patients [311 with β-thalassemia (β-thal) syndrome and 90 with sickle cell disease], registered at a large thalassemia care center in Iraqi Kurdistan had their records reviewed, and their sera tested for atypical antibodies using screening and extended red cell panels. Red cell alloimmunization was detected in 18 patients (4.5%) with a total of 20 alloantibodies, while no autoantibodies were detected. The most frequent alloantibody was anti-E, followed by anti-D, anti-K, anti-C(w), anti-C, anti-c and anti-Le(a). Ethnicity was an important predictor of alloimmunization, while age at start of transfusion (>2 vs. ≤2 years) (p = 0.005), Rhesus D (RhD) negative status (p = 0.0017) and history of previous transfusion reactions (p = 0.007) showed a statistically significant higher rate of alloimmunization. However, patients' age, gender, number of units transfused, underlying diagnosis and splenectomy were not significantly associated with alloimmunization. Based on our observations, measures to reduce alloimmunization rates may include extended matching for Rhesus and Kell antigens and early initiation of blood transfusions.
血红蛋白病在伊拉克，包括其北部库尔德斯坦地区，是严重的健康问题。对这些疾病进行管理的一个重要组成部分是终身定期输血。后者会引发包括红细胞同种免疫在内的多种并发症。该国尚未有研究关注同种免疫的发生率及其相关因素。为解决后一个问题，对在伊拉克库尔德斯坦一家大型地中海贫血治疗中心登记的401例多次输血患者[311例β地中海贫血（β-地贫）综合征患者和90例镰状细胞病患者]的记录进行了回顾，并使用筛查和扩展红细胞面板检测了他们血清中的非典型抗体。在18例患者（4.5%）中检测到红细胞同种免疫，共发现20种同种抗体，未检测到自身抗体。最常见的同种抗体是抗-E，其次是抗-D、抗-K、抗-C(w)、抗-C、抗-c和抗-Le(a)。种族是同种免疫的一个重要预测因素，而输血开始时的年龄（>2岁与≤2岁）（p = 0.005）、恒河猴D（RhD）阴性状态（p = 0.0017）和既往输血反应史（p = 0.007）显示同种免疫发生率在统计学上显著更高。然而，患者的年龄、性别、输血量、潜在诊断和脾切除术与同种免疫无显著相关性。基于我们的观察，降低同种免疫发生率的措施可能包括对Rh和Kell抗原进行扩展配型以及尽早开始输血。
