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Red cell alloimmunization in sickle cell disease.

S C Davies, A C McWilliam, P E Hewitt

    British Journal of Haematology
    |June 1, 1986
    PubMed
    Summary
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    Sickle cell patients receiving transfusions developed red cell antibodies, primarily Rhesus and Kell. Extended antigen matching, beyond ABO and Rh(D), is recommended to reduce alloimmunization and improve patient outcomes.

    Area of Science:

    • Immunology
    • Hematology
    • Transfusion Medicine

    Background:

    • Alloimmunization to red blood cell antigens can cause complications in transfused patients.
    • Current recommendations suggest limited antigen matching for sickle cell disease (SCD) patients, focusing only on ABO and Rh(D).
    • This approach is based on the premise that SCD patients do not have a higher incidence of antibody production compared to other multitransfused populations.

    Purpose of the Study:

    • To investigate the incidence of post-transfusion alloimmunization in sickle cell disease patients.
    • To identify specific red cell antigens responsible for alloimmunization in this patient group.
    • To evaluate the effectiveness of current transfusion guidelines and propose improvements.

    Main Methods:

    • A cohort of 34 sickle cell disease patients from a UK haemoglobinopathy clinic were studied.

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  • Post-transfusion alloimmunization was monitored.
  • Red cell antibody formation was assessed, with specific attention to Rhesus and Kell antigens.

    • Main Results:

    • Red cell antibodies were identified in 17.6% of the transfused sickle cell patients.
    • Rhesus and Kell antibodies constituted 66% of the total antibodies detected.
    • This indicates a significant rate of alloimmunization, particularly against these antigens.

    Conclusions:

    • The findings challenge the existing recommendations for limited antigen matching in sickle cell patients.
    • Extended red cell phenotyping and matching for Kell and certain Rhesus antigens (beyond Rh(D)) are recommended.
    • Implementing these strategies may reduce alloimmunization and associated morbidity in transfused sickle cell patients.