Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Vox Sang. 2022 Sep;117(9):1057-1069. doi: 10.1111/vox.13296. Epub 2022 May 24.
There is a varied prevalence of red cell alloimmunization being reported from different parts of India. This study aimed to estimate the overall prevalence of alloimmunization in India by performing a systematic review of the literature and to establish the most suitable antigen-matching strategy to reduce the red blood cell (RBC) alloimmunization rate among transfusion recipients.
A systematic search of all the original articles published in English on RBC alloimmunization among transfusion recipients from India in MEDLINE, SCOPUS, CINAHL and Google Scholar bibliographic databases was conducted. After screening the articles as per inclusion/exclusion criteria, data extraction was done independently by two sets of investigators. Meta-analysis was performed by the binary random-effects model using the restricted maximum likelihood method.
A total of 44 studies on RBC alloimmunization, with a cumulative sample size of 309,986 patients, were grouped into hospital-based and multiply-transfused patients, which yielded a prevalence of 0.5 (95% confidence interval; 0.3-0.8) and 4.8 (95% confidence interval; 3.9-5.7) per 100 patients, respectively. As many as 1992 alloantibodies were identified among the 1846 alloimmunized patients. The most common antibody identified was anti-E (127; 31.99%), followed by anti-c (75; 18.89%) in multiply-transfused patients.
The rate of alloimmunization was 0.5 per 100 patients tested for antibodies and 4.8 per 100 patients receiving transfusion. Considering E- and c-antigen-matched red cells along with ABO and RhD matching may significantly reduce the overall occurrence of alloimmunization among Indian population who are transfusion-dependent.
印度不同地区报道的红细胞同种免疫发生率存在差异。本研究旨在通过系统评价文献来评估印度同种免疫的总体发生率，并确定最合适的抗原匹配策略，以降低输血受者的红细胞（RBC）同种免疫率。
对 MEDLINE、SCOPUS、CINAHL 和 Google Scholar 文献数据库中发表的关于印度输血受者 RBC 同种免疫的所有英文原始文章进行系统检索。根据纳入/排除标准筛选文章后，由两组调查人员独立进行数据提取。采用受限极大似然法的二项随机效应模型进行荟萃分析。
共纳入 44 项 RBC 同种免疫研究，累积样本量为 309986 例患者，分为医院患者和多次输血患者，其发生率分别为 0.5（95%置信区间；0.3-0.8）和 4.8（95%置信区间；3.9-5.7）/100 例。在 1846 例同种免疫患者中鉴定出 1992 种同种抗体。在多次输血患者中最常见的抗体是抗-E（127；31.99%），其次是抗-c（75；18.89%）。
抗体检测的同种免疫发生率为 0.5/100 例，输血患者的同种免疫发生率为 4.8/100 例。考虑到 E 抗原和 c 抗原匹配的红细胞与 ABO 和 RhD 匹配相结合，可能会显著降低印度依赖输血人群的总体同种免疫发生率。
