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Erythrocyte Alloimmunization and Autoimmunization in the Pediatric Population: A Multicenter, Cross-Sectional Study
Yongjun Wang1, Yuanqing Yang1, Zhengfeng Li2
1Department of Blood Transfusion, The Second Xiangya Hospital, Central South University, Changsha, China.
Insights
The prevalence of erythrocyte alloimmunization was 0.55% and autoimmunization was 0.14% in Chinese children. Anti-M antibodies were most common, and repeat pre-transfusion testing can be omitted for infants under 4 months.
Area of Science:
- Hematology
- Immunology
- Pediatrics
Background:
- Erythrocyte alloantibodies and autoantibodies pose transfusion challenges.
- Prevalence data for these antibodies in Chinese children were previously lacking.
Purpose of the Study:
- To determine the prevalence of erythrocyte alloimmunization and autoimmunization in Chinese pediatric patients.
- To inform transfusion management policies for children in China.
Main Methods:
- Analyzed data from 30,603 pediatric inpatients across three tertiary hospitals in central China.
- Utilized column agglutination technology for antibody screening and identification panels.
- Collected clinical details to identify risk factors for antibody formation.
Main Results:
- Alloimmunization rate was 0.55% and autoimmunization rate was 0.14%.
- Anti-M (58.77%) was the most frequent alloantibody; autoantibodies comprised 19.91%.
- Age, sex, geography, ABO blood group, and diagnosis were significant risk factors for antibody formation.
Conclusions:
- Repeat pre-transfusion testing can be omitted for infants <4 months due to zero risk of antibody formation.
- MNS system antibodies (especially anti-M) are prevalent in younger children.
- Extended Rh system antigen-matched transfusions are needed; shared transfusion records are crucial to prevent hemolytic reactions.
Background:
Erythrocyte alloantibodies and autoantibodies complicate transfusion. However, the prevalence of erythrocyte alloimmunization and autoimmunization has not been estimated in the Chinese pediatric population. Therefore, we investigated the prevalence of erythrocyte alloimmunization and autoimmunization in the Chinese pediatric population with the aim of developing a reasonable transfusion management policy in children from China.
Methods:
This study included 30,603 pediatric inpatients who were admitted to three tertiary hospitals in central China from May 2020 to October 2022. Antibody screening was carried out with a three-cell panel by column agglutination technology, and samples with positive screening were analyzed for antibody specificity with a 16-cell identification panel. Clinical details of the patients were collected to identify associations with antibody formation.
Results:
The alloimmunization rate was 0.55% (169/30,603), and the autoimmunization rate was 0.14% (43/30,603). Alloantibodies comprised 80.09% of the antibodies. The most frequent alloantibodies were anti-M (58.77%), anti-E (9.48%), and anti-P1 (4.27%). Autoantibodies comprised 19.91% of antibodies. Age (p = 0.000), sex (p = 0.016), geographical area (p = 0.000), ABO blood group (p = 0.008), and diagnosis (p = 0.000) were independent risk factors for antibody formation. The risk of antibody formation at the ages of 0-28 days and 1-3 months was zero (odds ratio = 0.000). The antibody distribution was significantly different by age (p = 0.000) and diagnosis (p = 0.000).
Conclusion:
Repeat pre-transfusion testing for infants less than 4 months of age can be omitted for no risk of antibody formation. MNS system antibodies, especially anti-M, are prominent in younger children, and this decreases with age. Provision of extended phenotype-matched transfusion for Rh system antigens, especially antigen E, is necessary in children to control erythrocyte alloimmunization. The presence of antibodies with high evanescence rates in the pediatric population suggests the pressing need for nationwide shared transfusion records to avoid hemolytic transfusion reactions in children.
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