Pereira Bueno M L, Mitestainer M B, Da Silva J A R, Benites B D, Roversi F M
Hematology and Transfusion Medicine Center -University of Campinas/Hemocentro-Unicamp, Campinas, São Paulo, Brazil; Universidade São Francisco, Bragança Paulista, São Paulo, Brazil.
Universidade São Francisco, Bragança Paulista, São Paulo, Brazil.
Transfus Clin Biol. 2021 Aug;28(3):258-263. doi: 10.1016/j.tracli.2021.04.006. Epub 2021 Apr 24.
Blood transfusion is a key intervention for decreasing morbidity and mortality in many cases and, besides its importance, potentially fatal consequences of incompatible transfusion are a great risk to patients. This study evaluated the incidence and specificity of erythrocyte alloantibodies in multi-transfused patients enrolled at an important Regional Blood Center.
MATERIALS/METHODS: This was a single-center retrospective cohort study that eveluated patients enrolled at a Regional Blood Center in a period of four years. A total of 29,128 patient samples were screened, out of which 79 (0.27%) were multiple-transfused patients with alloantibodies identified.
The most common alloantibody found was anti-E (22.55%) followed by anti-D (14.71%), anti-C (5.88%), anti-c (5.88%), anti-e (1.96%) and anti-C (0.98%). We also identified combinations of alloantibodies (25.32%), 5.88% of which showed an IgG autoantibody isolated or combined with alloantibodies. The most frequent reason for the need of blood transfusion included cases of surgery, emergency and urgency (36.71%).
A low rate of development of alloantibodies in multi-transfused patients was found, which could be a consequence of the implementation of red blood cell phenotyping for patients who may receive frequent transfusions, as in the case of some hematological neoplasms and hemoglobinopathies. However, the most common alloantibodies identified were against the Rh and/or Kell systems, with high clinical significance since both can cause delayed hemolytic transfusion reactions. Thus, the implementation of reliable antibody screening tests and the transfusion of phenotyped units for selected patients in all transfusion services represent important measures to increase transfusion safety.
输血是降低许多病例发病率和死亡率的关键干预措施，除其重要性外，不相容输血的潜在致命后果对患者构成巨大风险。本研究评估了在一家重要的地区血液中心登记的多次输血患者中红细胞同种抗体的发生率和特异性。
材料/方法：这是一项单中心回顾性队列研究，评估了在四年期间在一家地区血液中心登记的患者。共筛查了29128份患者样本，其中79份（0.27%）为多次输血且鉴定出同种抗体的患者。
发现最常见的同种抗体是抗-E（22.55%），其次是抗-D（14.71%）、抗-C（5.88%）、抗-c（5.88%）、抗-e（1.96%）和抗-C（0.98%）。我们还鉴定出同种抗体组合（25.32%），其中5.88%表现为分离的IgG自身抗体或与同种抗体结合。输血需求最常见的原因包括手术、急诊和紧急情况（36.71%）。
发现多次输血患者中同种抗体的产生率较低，这可能是对可能频繁输血的患者（如某些血液系统肿瘤和血红蛋白病患者）实施红细胞表型分析的结果。然而，鉴定出的最常见同种抗体是针对Rh和/或Kell系统的，具有很高的临床意义，因为两者都可引起迟发性溶血性输血反应。因此，在所有输血服务中对选定患者实施可靠的抗体筛查试验和输注表型匹配的血制品是提高输血安全性的重要措施。
