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Characterization of pediatric transfusion-dependent thalassemia patients in a large academic center
Dorsa Zarrabian1, Mirette Hanna1,2,3
1Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Transfusion-dependent thalassemia patients receiving ABO, RhD, and K-matched blood had lower alloimmunization rates. Extending Rh antigen matching may further reduce alloimmunization in pediatric patients.
Area of Science:
- Hematology
- Immunology
- Pediatrics
Background:
- Transfusion-dependent thalassemia patients face high risks of transfusion complications.
- Limited data exists on alloimmunization frequency in pediatric patients.
- No consensus on prophylactic antigen matching for thalassemia patients.
Purpose of the Study:
- To assess alloimmunization frequency and specificity in pediatric transfusion-dependent thalassemia patients.
- To investigate associations between patient characteristics and alloimmunization.
- To evaluate the effectiveness of ABO, RhD, and K-matched red blood cell transfusions.
Main Methods:
- Retrospective study of transfusion-dependent thalassemia patients (July 2018 - June 2022).
- Reviewed clinical and transfusion records.
- Assessed alloimmunization against specific blood group antigens.
Main Results:
- Nine percent (8/92) of patients developed clinically significant alloantibodies.
- Six percent developed anti-E antibodies; 2% developed multiple antibodies.
- Transfusion outside Canada, beta-thalassemia diagnosis, and autoantibody development were associated with alloimmunization.
Conclusions:
- ABO, RhD, and K matching reduced but did not eliminate alloimmunization.
- Extending Rh antigen matching could further decrease alloimmunization rates.
- Further research into optimal antigen matching strategies is warranted.
Background:
Transfusion-dependent thalassemia patients are at high risk of transfusion-related complications. Yet, there is scanty data on the frequency of transfusion reactions, particularity alloimmunization among pediatric transfusion-dependent thalassemia patients. In addition, there is no consensus on the prophylactic antigen matching for prevention of alloimmunization or the extent of antigen matching for alloimmunized thalassemia patients.
Methods:
We conducted a retrospective study to assess the frequency and specificity of alloimmunization among pediatric transfusion-dependent thalassemia patients receiving ABO, RhD, and K-matched red blood cell units. In addition, we studied the association between patients' characteristics and alloimmunization. The clinical and transfusion records of transfusion-dependent thalassemia patients followed up at our institution between July 2018 and June 2022 were reviewed.
Results:
Ninety-two transfusion-dependent thalassemia patients having mean age of 13.37 years (SD, 5.56) were included in our study. Eight patients (9%) had developed clinically significant alloantibodies; six patients (6%) developed alloantibody against E antigen while two patients (2%) developed more than one alloantibody. Of alloimmunized patients, five patients had received transfusion outside Canada. Patients' sex, age, having a genotype variant, total number, and duration of transfusion received were not associated with the risk of alloimmunization. The transfusion-recipient's diagnosis of β-thalassemia, having developed autoantibody, and history of receiving transfusion outside Canada were associated with alloimmunization.
Conclusion:
Blood matching for ABO, RhD, and K antigens resulted in, although not eliminated, lower frequency of alloimmunization than that previously reported among pediatric thalassemia patients. Extending matching to include Rh antigens could further reduce the rate of alloimmunization.
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