The role of molecular immunohematology in sickle cell disease

Red blood cell transfusion therapy is a key component in the treatment of patients with sickle cell disease (SCD). There is no universal standard of care for the appropriate selection of RBC products for patients with SCD. A number of programs extend antigen matching to E and C in the Rh system, and to K, and some attempt to transfuse blood from African-American donors. Although these varied approaches reduce the rate of alloimmunization, patients continue to develop Rh antibodies. Molecular DNA-based analyses of patients alloimmunized to the Rh system, despite serologic Rh antigen matching, invariably reveal altered RH alleles. The prevalence of altered RH alleles in patients with SCD suggests an important emerging role for molecular methods in expanding matching of patients and donors in the Rh system for this patient population.