Romphruk Amornrat V, Simtong Piyapong, Butryojantho Chalawan, Pimphumee Ratchadaporn, Junta Ninnate, Srichai Supawadee, Komvilaisak Patcharee, Puapairoj Chintana
Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
Transfusion. 2019 Jan;59(1):177-184. doi: 10.1111/trf.15002. Epub 2018 Nov 15.
Hemoglobin E-β thalassemia and homozygous β -thalassemia are the most common chronic transfusion-dependent thalassemias in Thailand. Patients with these conditions can experience clinical complications such as RBC alloimmunization. In this study we aimed to determine the prevalence, alloimmunization risk factors, antigenic exposure, and evaluation of antigen- (C, c, E, e, Mi ) matched RBC transfusion.
Thalassemia patients were recruited from a tertiary care hospital for 10 years from 2008 to 2017. The medical records of transfusion history were reviewed for red cell phenotype both of patients and donors, number of units transfused, and type of alloantibodies.
A total of 383 thalassemia patients were identified (178 males and 205 females). The frequency of RBC alloantibodies was 19.3%. Some patients tested positive for more than one antibody type. Autoantibodies were detected in nine individuals. Anti-E (49 [39.5%]), anti-Mi (24 [19.4%]), and anti-c (19 [15.3%]) were the most common antibodies detected. A high rate of alloimmunization was found in splenectomized patients. Risk of alloimmunization increased when more total units of blood had been transfused. A trend toward low alloimmunization rates was noted in the antigen-matched RBC group, where 3.5% (5/143) of patients were alloimmunized. Anti-E and anti-Mi , which may be naturally occurring, were identified in this group.
Thai patients are more prone to develop antibodies against the Rh and Mi than to the Kell blood group antigens. Provision of at least antigen-matched (C, c, E, e, Mi ) RBCs appears to improve the efficacy of transfusion in thalassemia patients.
血红蛋白E-β地中海贫血和纯合子β地中海贫血是泰国最常见的慢性依赖输血的地中海贫血。患有这些病症的患者可能会出现诸如红细胞同种免疫等临床并发症。在本研究中，我们旨在确定患病率、同种免疫风险因素、抗原暴露情况，并评估抗原（C、c、E、e、Mi）匹配的红细胞输血情况。
2008年至2017年期间，从一家三级护理医院招募地中海贫血患者，为期10年。回顾输血历史的病历，以了解患者和供者的红细胞表型、输注的单位数以及同种抗体类型。
共识别出383例地中海贫血患者（178例男性和205例女性）。红细胞同种抗体的发生率为19.3%。一些患者检测出不止一种抗体呈阳性。在9名个体中检测到自身抗体。检测到的最常见抗体为抗-E（49例[39.5%]）、抗-Mi（24例[19.4%]）和抗-c（19例[15.3%]）。脾切除患者中发现同种免疫发生率较高。输注的血液总量越多，同种免疫的风险就越高。在抗原匹配的红细胞组中，同种免疫发生率呈降低趋势，该组中有3.5%（5/143）的患者发生了同种免疫。在该组中鉴定出了可能天然存在的抗-E和抗-Mi。
泰国患者比针对凯尔血型抗原更容易产生针对Rh和Mi的抗体。提供至少抗原匹配（C、c、E、e、Mi）的红细胞似乎可提高地中海贫血患者的输血疗效。
