RBC alloimmunization and autoimmunization among transfusion-dependent Arab thalassemia patients

Area of Science:

• Hematology
• Transfusion Medicine
• Genetics

Background:

• Thalassemia major is a prevalent hemoglobinopathy in the Arabian Gulf.
• Data on red blood cell (RBC) alloimmunization and autoimmunization in transfusion-dependent Arab thalassemia patients are limited.

Purpose of the Study:

• To determine the frequency of RBC alloimmunization and autoimmunization in transfusion-dependent Arab thalassemia patients in Kuwait.
• To identify the types of RBC alloantibodies developed and the age of onset.

Main Methods:

• Retrospective review of pretransfusion investigation records for 190 thalassemia major patients in Kuwait.
• Classification of patients into Kuwaiti Arab and non-Kuwaiti Arab groups.
• Analysis of RBC alloantibody and autoantibody presence and age of development.

Main Results:

• 30% of patients developed RBC alloantibodies, primarily against Kell and Rh systems (anti-K in 72%, anti-E in 45.6%).
• 11% of patients developed RBC autoantibodies, with or without co-existing alloantibodies.
• 49.6% of RBC alloantibodies developed between ages 2 and 10 years.

Conclusions:

• High alloimmunization and autoimmunization rates may be linked to population heterogeneity, donor matching challenges, and poststorage leukodepleted blood use.
• Recommendations include Rh and Kell antigen-matched blood transfusions.
• Prestorage leukodepleted red blood cells are advised for thalassemia patients to mitigate alloimmunization.