Antibody screening in multitransfused patients: a prerequisite before each transfusion

Area of Science:

• Transfusion Medicine
• Immunology
• Hematology

Background:

• Beta-thalassemia major necessitates lifelong red blood cell (RBC) transfusions.
• Alloimmunization is a significant complication in multi-transfused patients.
• Standard antibody screening is vital for safe transfusion practices.

Observation:

• A beta-thalassemia major patient on regular RBC transfusions presented with a positive antibody screen.
• Anti-S and anti-Lu(a) antibodies were identified despite compatible crossmatch.
• The compatible RBC unit was negative for S and Lu(a) antigens.

Findings:

• Antibodies identified were of IgG type with low titers (1:1).
• Donor tracing revealed S antigen positivity in two of three donors and Lu(a) positivity in one.
• The patient developed anti-S and anti-Lu(a) antibodies, necessitating antigen-negative blood.

Implications:

• This case underscores the importance of routine antibody screening at each transfusion visit.
• Strategies like single-center transfusion and dedicated donors may reduce alloimmunization.
• Further research is needed to validate methods for reducing alloimmunization rates in multi-transfused patients.