Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Blood Transfusion Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Transfusion. 2020 Feb;60 Suppl 1:S15-S21. doi: 10.1111/trf.15682.
Blood transfusion is the first-line treatment for patients with thalassemia and many sickle cell patients. However, cases of unregulated blood transfusion are shown to carry a high risk of alloimmunization to red blood cells (RBCs), which can lead to a hemolytic transfusion reaction and be fatal to patients. Screening and identification of alloantibodies are, therefore, essential practice in blood transfusion services. Transfusion of phenotyped blood can minimize these risks to patients.
A prospective study was carried out on 1015 donors, and a prospective and retrospective study was carried out on 208 multiple transfused patients with β-thalassemia and sickle cell anemia. Donor and patient samples were subjected to Rh & K typing, and patient samples were also subjected to screening & identification of RBC antibodies. We aimed to determine the prevalence of RBC antigens in thalassemia and sickle cell patients, as well as blood donors, at King Abdulaziz University Hospital and the frequency of alloimmunization in the selected patients.
The most commonly detected Rh-phenotype in donors was R1r (32.02%), followed by R1R1 (23.25%). Only 9.16% of donors were positive for the K antigen. The prevalence of Rh and K blood group antigens was also reported: the highest detected Rh-phenotype was R1r (40.86%) followed by R1R2 (24.04%) with only (6.25%) positive patients for K antigen. The rate of alloimmunization among sickle cell anemia and thalassemia patients was 39.42% and 35.57%, respectively. The highest specificity rates of the alloantibodies were recorded for anti-E and anti-K in both patient groups.
The rate of alloimmunization in transfused patients was high and particularly observed against the Rh and K antigens. This study emphasizes the clinical need for typing patient RBCs prior to transfusion so as to provide phenotyped matched blood units and minimize the risks and associated morbidities of alloimmunization. Keeping a database of phenotyped blood donors is essential for the clinically effective and safe management of transfusion patients.
输血是治疗地中海贫血和许多镰状细胞病患者的首选方法。然而，不规范的输血可能会导致红细胞（RBC）的同种免疫反应，从而导致溶血性输血反应，对患者有致命危险。因此，筛选和鉴定同种抗体是输血服务的重要实践。输注表型匹配的血液可以最大限度地降低患者的这些风险。
对 1015 名献血者进行了前瞻性研究，对 208 名接受多次输血的β-地中海贫血和镰状细胞贫血患者进行了前瞻性和回顾性研究。对献血者和患者样本进行 Rh 和 K 定型，对患者样本还进行了 RBC 抗体的筛选和鉴定。我们旨在确定在阿卜杜勒阿齐兹国王大学医院的地中海贫血和镰状细胞病患者以及献血者中 RBC 抗原的流行率，以及在选定患者中的同种免疫频率。
献血者中最常见的 Rh 表型为 R1r（32.02%），其次为 R1R1（23.25%）。只有 9.16%的献血者对 K 抗原呈阳性。还报告了 Rh 和 K 血型抗原的流行率：检测到的最高 Rh 表型为 R1r（40.86%），其次为 R1R2（24.04%），仅有（6.25%）阳性患者对 K 抗原呈阳性。镰状细胞贫血和地中海贫血患者的同种免疫率分别为 39.42%和 35.57%。在两组患者中，同种抗体的特异性最高分别为抗-E 和抗-K。
接受输血的患者的同种免疫率很高，特别是针对 Rh 和 K 抗原。本研究强调了在输血前对患者 RBC 进行定型的临床必要性，以便提供表型匹配的血液单位，最大限度地降低同种免疫的风险和相关的发病率。保存表型献血者数据库对于输血患者的临床有效和安全管理至关重要。
