Investigation of alloimmunization in beta-thalassemia major patients: a cross-sectional study

Patients with beta-thalassemia major (BTM) require frequent blood transfusion due to the nature of the disease. However, frequent blood transfusion may cause alloimmunization and produce unexpected or irregular antibodies, mainly an immunoglobulin G (IgG) that induce hemolysis in these patients and make subsequent blood transfusion difficult.

In this cross-sectional study, 135 BTM patients (56 female and 79 male) with age range 5-59 y (28.3 ± 3.9) from southwest of Iran in 2022 were selected. Antibody screening was performed with standard method for the patients, if the patient had a positive screening test, antibody identification was performed. Direct Coomb's test was used for detection the presence of autoantibodies. Laboratory and demographic analysis were performed by Graph Pad Prism software (Version 8.3).

Among the 135 examined patients, 8 (5.8%) patients were positive for the antibody screening test; 39.6% anti-K, 24.1% anti-D, and the prevalence of each anti-E, anti-Jkb, and anti-C was 12.1%. None of the patients had autoantibody. No statistically significant difference was observed in the parameters including age, gender, age in the first transfusion, and splenectomy status between immunized and nonimmunized patients (P < 0.05).

The most prevalent unexpected antibodies were anti-K and anti-D, respectively, and anti-C, anti-E, and anti-jkb had the same frequencies. Fortunately, the frequency of unexpected antibodies in the BTM patients was lower compared to some other regions of Iran. One of the reasons for the relatively low amount of alloimmunization in the present study compared to the previous studies from Iran may be due to using regular leukoreduced packed cell unit consumption for the BTM patients. However, the continuation of antibody screening programs and the use of blood negative for the relevant antigen can increase the lifespan of the transfused cells in the patients.