In search of red blood cells for alloimmunized patients with sickle cell disease

Patients with sickle cell disease (SCD) typically require transfusions with RBC components, which exposes them to numerous, possible foreign antigens and potentially causes them to produce an antibody or antibodies to the antigens they lack. As transfusion of these patients increases, the likelihood that they will produce an initial antibody or additional antibodies increases. Once a clinically significant antibody is produced, units of RBCs that lack the associated antigen should be transfused. Often patients with SCD present to transfusion service with numerous antibodies in their serum, making the search for compatible RBCs a challenge. The American Rare Donor Program (ARDP) has been used to search for RBCs to meet transfusion needs of this patient population. Between January 2005 and June 2006, approximately 33 percent of the requests to the ARDP for RBC components were alloimmunized patients with SCD. Of these requests, 94.9 percent were completely or partially filled; requests for r"r", Hy-, and E-, hrS- units of RBCs were among the most difficult to fill. This article will discuss the use and effectiveness of the ARDP and testing laboratories associated with the National Reference Laboratory for Blood Group Serology at the American Red Cross in obtaining compatible RBCs for alloimmunized patients with SCD.