Rostamian Hosein, Javandoost Ehsan, Mohammadian Mozhdeh, Alipour Abbas
Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Asian J Transfus Sci. 2022 Jan-Jun;16(1):111-120. doi: 10.4103/ajts.AJTS_39_20. Epub 2022 May 26.
Repeated allogeneic blood transfusions in thalassemia major patients stimulate the patient's immune system to generate antibodies against foreign erythrocyte antigens. This study was carried out to systematically review the findings of available studies about the prevalence of alloantibodies and autoantibodies, as well as the type of causative antigens among transfusion-dependent thalassemia patients in Iran.
Electronic search was conducted on Medline, PubMed, Cochrane, EMBASE, ScienceDirect, and Persians databases. All relevant articles published from January 1990 to July 2018 were included. Abstracts of conference booklets which that been published in the last 5 years were also included in the meta-analysis. The search language was restricted to English and Persian. The quality of studies was evaluated according to a checklist developed by authors, and Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias.
Twenty-three relevant articles met all the inclusion criteria. The prevalence of alloimmunization was 13%. Our study showed that anti-D (25%) and anti-K (25%) were most prevalent among Iranian β-thalassemia patients. Data analysis shows the autoantibody prevalence to be 1% among 3787 patients. Meta-regression revealed that the prevalence of alloantibodies increases with each year as the average age of the study population increases.
The prevalence of red blood cell (RBC) alloantibodies in transfused Iranian β-thalassemia patients was high. Appropriate preventive strategies such as RBC phenotyping for patients before beginning transfusion and using extended RBC donor-recipient matching, specifically for Rh and Kell system, could be implemented to avoid complications in thalassemia patients.
重型地中海贫血患者反复接受异体输血会刺激患者免疫系统产生针对外来红细胞抗原的抗体。本研究旨在系统回顾有关伊朗输血依赖型地中海贫血患者同种抗体和自身抗体的患病率以及致病抗原类型的现有研究结果。
在Medline、PubMed、Cochrane、EMBASE、ScienceDirect和波斯文数据库中进行电子检索。纳入1990年1月至2018年7月发表的所有相关文章。过去5年发表的会议手册摘要也纳入荟萃分析。检索语言限于英语和波斯语。根据作者制定的清单评估研究质量，并使用Cochrane偏倚风险评估工具评估偏倚风险。
23篇相关文章符合所有纳入标准。同种免疫的患病率为13%。我们的研究表明，抗-D（25%）和抗-K（25%）在伊朗β地中海贫血患者中最为普遍。数据分析显示，在3787名患者中自身抗体患病率为1%。荟萃回归显示，随着研究人群平均年龄的增加，同种抗体的患病率逐年上升。
在接受输血的伊朗β地中海贫血患者中，红细胞同种抗体的患病率较高。可以实施适当的预防策略，如在输血前对患者进行红细胞表型分析，并使用扩展的红细胞供受者匹配，特别是针对Rh和Kell系统，以避免地中海贫血患者出现并发症。
