标准红细胞抗原匹配与扩展红细胞抗原匹配预防胎儿及新生儿溶血病的比较：一项系统评价
Standard Compared With Extended Red Blood Cell Antigen Matching for Prevention of Subsequent Hemolytic Disease of the Fetus and Newborn: A Systematic Review.
作者信息
Sugrue Ronan P, Olsen Jaxon, Abi Antoun Marie Elise, Skalla Lesley A, Cate Jennifer, James Andra H, Stonehill Alexandra, Watkins Virginia, Telen Marilyn J, Federspiel Jerome J
机构信息
Department of Obstetrics and Gynecology, the Duke University Medical Center Library, the Department of Medicine, the Department of Pathology, and the Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; and the Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts.
出版信息
Obstet Gynecol. 2024 Oct 1;144(4):444-453. doi: 10.1097/AOG.0000000000005701. Epub 2024 Aug 8.
OBJECTIVE
To systematically review and meta-analyze alloimmunization among recipients of red blood cells (RBCs) matched for ABO blood type and Rhesus D (ABO+D) antigen compared with those also matched for c, E, and Kell (cEK).
DATA SOURCES
Four online databases (Medline, Scopus, EMBASE, ClinicalTrials.gov ) were searched from March 28, 2023, to April 1, 2024. The search protocol was peer reviewed and published on PROSPERO ( CRD42023411620 ).
METHODS OF STUDY SELECTION
Studies reporting alloimmunization as the primary outcome among recipients of RBCs matched for ABO+D or additional cEK matching were included. Patients transfused with unmatched RBCs or a mixture of matching regimens were excluded. Risk of bias was assessed with Cochrane Tool to Assess Risk of Bias in Cohort Studies and Tool for Risk of Bias. Random-effects meta-analysis was used to combine effect estimates.
TABULATION, INTEGRATION, AND RESULTS: Ten studies met criteria. Risk of bias was low. Overall, 91,221 patients were transfused, of whom 40,220 (44.1%) received additional cEK-matched RBCs. The overall rate of alloimmunization was 6.2% (95% CI, 2.5-14.9%) for ABO+D-only matching and 1.9% (95% CI, 0.7-5.1%) when cEK was added. Time of follow-up antibody testing ranged from 6 to 18 months after transfusion. Additional cEK match was associated with significantly less alloimmunization compared with standard ABO+D match (odds ratio [OR] 0.37, 95% CI, 0.20-0.69). This association remained when chronically transfused patients were excluded (OR 0.65, 95% CI, 0.54-0.79) and for alloimmunization to c, E, or K antigens only (OR 0.29, 95% CI, 0.18-0.47).
CONCLUSION
Additional cEK RBC matching protocols were associated with lower odds of recipient alloimmunization. Given severe sequelae of alloimmunization in pregnancy, routine cEK matching for transfusion in people with pregnancy potential younger than age 50 years in the United States merits consideration.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42023411620 .
目的
系统评价并荟萃分析与仅进行ABO血型和恒河猴D（ABO+D）抗原匹配的红细胞（RBC）接受者相比，同时进行c、E和Kell（cEK）匹配的RBC接受者中的同种免疫情况。
数据来源
于2023年3月28日至2024年4月1日检索了四个在线数据库（Medline、Scopus、EMBASE、ClinicalTrials.gov）。检索方案经过同行评审并发表在PROSPERO（CRD42023411620）上。
研究选择方法
纳入报告将同种免疫作为ABO+D匹配或额外cEK匹配的RBC接受者主要结局的研究。排除输注不匹配RBC或匹配方案混合的患者。使用Cochrane队列研究偏倚风险评估工具和偏倚风险工具评估偏倚风险。采用随机效应荟萃分析合并效应估计值。
列表、整合与结果：十项研究符合标准。偏倚风险较低。总体而言，91221例患者接受了输血，其中40220例（44.1%）接受了额外的cEK匹配RBC。仅ABO+D匹配时同种免疫的总体发生率为6.2%（95%CI，2.5-14.9%），添加cEK时为1.9%（95%CI，0.7-5.1%）。随访抗体检测时间为输血后6至18个月。与标准ABO+D匹配相比，额外的cEK匹配与显著更低的同种免疫相关（优势比[OR]0.37，95%CI，0.20-0.69）。排除长期输血患者后该关联仍然存在（OR 0.65，95%CI，0.54-0.79），且仅针对c、E或K抗原的同种免疫时也存在该关联（OR 0.29，95%CI，0.18-0.47）。
结论
额外的cEK RBC匹配方案与接受者同种免疫的较低几率相关。鉴于妊娠同种免疫的严重后果，在美国，对于年龄小于50岁有妊娠可能的人群，考虑在输血时常规进行cEK匹配是有必要的。
系统评价注册
PROSPERO，CRD42023411620。
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