International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Medical Laboratory Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada.
Transfus Med Rev. 2019 Jul;33(3):162-169. doi: 10.1016/j.tmrv.2019.06.003. Epub 2019 Jun 20.
Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk.
镰状细胞病 (SCD) 是撒哈拉以南非洲 (SSA) 最常见的单基因疾病。增加血液携氧能力的输血对于许多 SCD 患者的治疗至关重要。然而，红细胞 (RBC) 同种免疫是这些患者输血的主要挑战。通常在 SSA，输血前检测仅涉及 ABO D 分组和相容性，而不检测 RBC 抗体。关于 SSA 中 SCD 患者 RBC 同种免疫频率的数据有限。我们对已发表的关于 SCD 输血患者同种免疫的数据进行了系统评价和荟萃分析，以确定 SSA 中 SCD 患者 RBC 同种免疫的发表患病率。系统地搜索了六个数据库以确定相关研究，没有时间或语言限制。总共确定了 249 篇文章，其中 15 篇符合我们的选择标准。每 100 名接受输血的患者中同种免疫的总体比例为 7.4（95%置信区间：5.1-10.0）。针对 E、D、C 和 K 抗原的抗体占抗体特异性的近一半，针对低频率和高频率抗原的抗体也很常见，占特异性的近 30%（20%为低频率抗原，9%为高频率抗原）。研究之间的异质性为中度，荟萃分析发现非洲地区是异质性的主要贡献者。我们还观察到，在报告可能影响同种免疫的因素方面，研究之间存在不一致。本综述概述了 SSA 同种免疫问题的严重程度，并提供了一个基线，可用于比较任何减少同种免疫风险的干预措施的效果。
