Transfusion Modalities in Thalassemia Patients: Prophylactic Antigen Matched Versus Usual Matched approach-...

Alloimmunisation is a significant problem that can considerably complicate the management of transfusion dependent β-thalassemia patients. Extended prophylactic red cell matching/Better match approach has been proposed to reduce the risk of alloimmunisation. There is limited literature on efficacy of Better Match Approach in preventing alloimmunisation. This cross-sectional analytical study was performed to evaluate the efficacy of prophylactic antigen matching (for c, E and K antigens) versus Usual match approach (matching only for ABO and D antigens) for issuing blood to transfusion dependent thalassemia patients, over 14 years follow up period. 329 transfusion dependent thalassemia patients were included and were divided into three categories: Category I (Usual match to better match approach), Category II (patients who received ≤5 transfusions at ≤18 months as UM before BM), Category III (Better match approach). Presence and rate of alloimmunisation in each category was evaluated. Alloantibodies were seen in 28 out of total 329 (8.51%) patients. 35 antibodies were detected in 28 patients. Majority antibodies belonged to Rh (62.85%) followed by Kell (20%) blood group systems. Alloimmunization in patients who received blood according to better matched approach was 1.98% which is much lower than the national average of 4.8%. In usual match approach, alloimmunisation rates of 11.97% were observed. However, this figure is not an actual reflection of the alloimmunisation prevalence rate as many patients included in this category were referred from other centres due to complications. Extended red cell antigen matching is beneficial in reducing alloimmunisation rates among thalassemia patients, however, feasibility and logistics of extended red cell matching need to be considered.