Impact of blood donor, component and recipient variables on antigen-specific alloantibodies

A better understanding of factors influencing red blood cell (RBC) alloimmunization is desirable, given the dangers of this non-infectious serious hazard of transfusion. In a case-control retrospective study utilizing the Recipient Epidemiology and Donor Evaluation study (REDS)-III Biological Specimen and Data Repository Information Coordinating Center (BioLINCC) dataset, we investigated blood donor, component and recipient variables associated with RBC alloantibody specificities. 19 697 controls with no new alloantibody detected 2-16 weeks post-transfusion and 861 cases (with antibodies including anti-E, -K, -Jka, -C and -c) were studied. Univariate comparison revealed multiple factors are found more frequently in alloimmunized cases than controls, including use of ABO non-identical units, recipient female gender and shorter RBC unit storage duration. Multivariate donor/component odds ratio for each antibody specificity revealed myelodysplastic syndrome (MDS), sickle cell disease, rheumatoid arthritis and lupus as being associated with higher odds of antibody formation, with MDS being associated with the most antibody specificities. ABO non-identical recipient-donor pairs were associated with higher odds of alloimmunization for all antibody specificities evaluated. RBC storage duration showed significance only for anti-E after multivariable analysis, with units stored for a longer duration (>12 days) associated with reduced odds of alloimmunization. In sum, blood donor, recipient and component elements variably impacted alloantibody formation in transfusion recipients, with differences observed by antibody specificity.