Unexpected red blood cell antibody distributions in Chinese people by a systematic literature review

Unexpected antibodies are frequently associated with hemolytic disease of the fetus and newborn (HDFN) and hemolytic transfusion reactions (HTRs), and screening for those unexpected antibodies is critical for the safety and effectiveness of transfusion. Different populations differ in the prevalence of significant antibodies and also the low-frequency red blood cell (RBC) antigens. In China, antibody screening has been a common practice for pretransfusion testing for more than 10 years. However, there has been no national guidelines regarding the minimum antigens on the screening cells, thus making the antibody screening tests unsatisfactory.

By a literature review, we systematically searched major databases from their inception to 2014, for publications regarding unexpected RBC antibodies, HTRs, and HDFNs in Chinese people, to explore the frequencies and clinical significance of unexpected RBC antibodies.

The overall prevalence of unexpected antibodies was approximately 0.2% (14,095/6,102,361). A total of 2241 patients suffered HTRs (693 patients) or HDFN (1548 patients). Among all the reported antibodies, antibodies of the Rh blood group system were the most, followed by MNS, Lewis, Kidd, Duffy, Diego, and Kell systems. Several rare but clinically significant unexpected antibodies were reported: four anti-Le(x) , three anti-Lu(a) , one anti-Tj(a) , and one anti-Hm .

All the commonly seen RBC antibodies are reported in Chinese people. However, anti-K is very rare. Besides, anti-Mur, anti-Di(a) are clinically significant. We propose that in China, the antigens on the antibody screening cells should include those recommended by the AABB and British Committee for Standards in Haematology, as well as Di(a) and Mur antigens.