Risk Stratification for Autoimmune Hemolytic Anemia in Children With Pediatric Transfusion-Dependent Thalassemia
Arooj Khan1, Faizan Sadiq1, Shaista Azeem Khan1
1Department of Paediatrics, Khyber Medical College and Teaching Hospital, Peshawar, PAK.
Insights
Younger age, earlier diagnosis, and frequent blood transfusions increase the risk of autoimmune hemolytic anemia (AIHA) in children with transfusion-dependent thalassemia (TDT). These factors are crucial for managing AIHA development.
Area of Science:
- Pediatrics
- Hematology
- Immunology
Background:
- Transfusion-dependent thalassemia (TDT) requires lifelong blood transfusions.
- Autoimmune hemolytic anemia (AIHA) is a significant complication in TDT patients.
- Identifying AIHA risk factors in pediatric TDT is crucial for management.
Purpose of the Study:
- To determine the risk factors for developing autoimmune hemolytic anemia (AIHA) in children with transfusion-dependent thalassemia (TDT).
- To analyze demographic, clinical, and laboratory parameters associated with AIHA in this population.
Main Methods:
- Cross-sectional study involving 300 pediatric TDT patients under 18 years old.
- AIHA diagnosis confirmed by Coombs test.
- Statistical analysis using chi-square and independent t-tests to identify significant risk factors (p < 0.05).
Main Results:
- 48.66% of TDT children developed AIHA.
- Significant risk factors included younger patient age, earlier age at diagnosis, earlier age at first transfusion, shorter transfusion intervals (< 3 weeks), and longer transfusion duration.
- Age at diagnosis and first transfusion showed strong statistical significance (p = 0.00).
Conclusions:
- Patient age, age at diagnosis, age at first transfusion, transfusion interval, and transfusion duration are key risk factors for AIHA in pediatric TDT.
- These findings highlight the importance of monitoring transfusion practices and early diagnosis to mitigate AIHA risk.
Abstract:
Objective This study aimed to identify the risk factors for autoimmune hemolytic anemia (AIHA) in children with transfusion-dependent thalassemia (TDT). Methodology This cross-sectional study was conducted at the Department of Child Health, Khyber Teaching Hospital, Peshawar, Pakistan, from March 25, 2024, to September 25, 2024. A total of 300 patients under 18 years of age, diagnosed with TDT, were included in the study. Relevant demographic, clinical, and laboratory investigations were conducted for each patient, with AIHA diagnosed based on the Coombs test. Risk factors, including demographic data, disease characteristics, transfusion history, clinical factors, and laboratory parameters, were recorded and analyzed. The significance of these risk factors was assessed by using the chi-square test for categorical variables and the independent t-test for continuous variables, comparing Coombs test-compatible and incompatible patients. A p-value of less than 0.05 was considered statistically significant. Results The mean±SD age of participants in this study was 6.82±4.2 years with an age range of one to 16 years. The male gender was 56.33%. The results of the Coombs test showed that 48.66% of these children had developed AIHA. The comparison between incompatible and compatible patients at Coombs test showed that age of patients (5.87±3.93 vs. 7.68±4.28 years, p = 0.00), age at the time of diagnosis (2.21±0.99 vs. 4.64±3.03 years, p = 0.00), age at the time of first infusion (3.05±1.28 vs. 5.49±3.2 years, p = 0.00), transfusion interval < 3 weeks (48.6% vs. 37%, p = 0.04) and duration of transfusion (2.87±3.2 vs. 2.21±1.93 years, p = 0.03) were the significant risk factors in the development of AIHA. Conclusion The patient's age, age at diagnosis, age at the time of first transfusion, the transfusion interval, and the duration of blood transfusion are the significant risk factors influencing the development of AIHA.
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