Strategies to mitigate transfusion-associated red blood cell alloimmunization in sickle cell disease: A retrospective analysis.
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| Titel: | Strategies to mitigate transfusion-associated red blood cell alloimmunization in sickle cell disease: A retrospective analysis. |
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| Autoren: | Crowe EP; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Onyenekwu CP; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Ippolito J; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Feng X; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Smetana H; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Goel R; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.; Vitalant, Corporate Medical Affairs, Scottsdale, Arizona, USA., Jacobs JW; Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Ness PM; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Daniel D; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Rai H; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Tobian AAR; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Haddaway K; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA., Bloch EM; Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA. |
| Quelle: | Transfusion [Transfusion] 2025 Nov; Vol. 65 (11), pp. 2045-2054. Date of Electronic Publication: 2025 Oct 09. |
| Publikationsart: | Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: American Association Of Blood Banks Country of Publication: United States NLM ID: 0417360 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1537-2995 (Electronic) Linking ISSN: 00411132 NLM ISO Abbreviation: Transfusion Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Arlington, Va. : American Association Of Blood Banks |
| MeSH-Schlagworte: | Anemia, Sickle Cell*/therapy , Anemia, Sickle Cell*/immunology , Anemia, Sickle Cell*/blood , Isoantibodies*/blood , Isoantibodies*/immunology , Erythrocyte Transfusion*/adverse effects , Erythrocyte Transfusion*/economics , Blood Grouping and Crossmatching*/methods , Blood Grouping and Crossmatching*/economics , Blood Group Incompatibility*/prevention & control , Erythrocytes*/immunology , Transfusion Reaction*/prevention & control, Humans ; Retrospective Studies ; Female ; Male ; Adult ; Adolescent ; Child ; Blood Group Antigens/immunology ; Middle Aged ; Young Adult |
| Abstract: | Background: The American Society of Hematology (ASH) recommends prophylactic limited red blood cell (RBC) antigen matching for C, E, and K for patients with sickle cell disease (SCD). At our institution, reflexive extended antigen matching is employed: no antigen matching is undertaken initially; in the event of RBC alloimmunization, extended antigen matching (C/c, E/e, K, Fy a /Fy b , Jk a /Jk b , S/s) is performed prospectively. Study Design and Methods: We compared alloimmunization rates and costs of reflexive extended antigen matching with other RBC antigen-matching strategies. A 5-year retrospective review was conducted of all patients with SCD, who were transfused during the study period and lacked prior immunization. Age, sex, ABO/Rh type, number of transfused units of RBCs, antibody history, and transfusion reactions were assessed. The alloimmunization rate was defined as the number of new alloantibodies per 100 units of transfused RBCs. Costs were estimated for reflexive extended antigen matching, limited antigen matching, and extended antigen matching. Results: Of 805 patients, 325 (40.4%) met inclusion criteria. Fifty (50/325, 15.4%) patients developed a positive antibody-detection test after transfusing a median of 9 (interquartile range: 3-14) units (alloimmunization rate 0.29 per 100 RBCs); anti-C, E, and K were leading alloantibodies. Seven (7/50, 14.0%) responders developed additional antibodies. Two delayed hemolytic transfusion reactions (DHTRs) were reported. Reflexive extended antigen-matching cost $4,619,133 over the 5-year period; projected costs of prophylactic limited and extended antigen matching were $9,578,253 (+107%) and $14,537,373 (+215%), respectively. Discussion: Acknowledging the limitation of excluding some responders, the rates of alloimmunization and DHTRs, and comparatively low costs suggest that reflexive extended antigen matching is viable for selected settings. (© 2025 AABB.) |
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| Grant Information: | K23 HL151826 United States HL NHLBI NIH HHS; 1K23HL151826 EMB's effort is supported in part by the National Heart Lung and Blood Institute |
| Contributed Indexing: | Keywords: alloimmunization; anemia; cost–benefit analysis; erythrocyte transfusion; sickle cell |
| Substance Nomenclature: | 0 (Isoantibodies) 0 (Blood Group Antigens) |
| Entry Date(s): | Date Created: 20251009 Date Completed: 20251115 Latest Revision: 20251116 |
| Update Code: | 20251116 |
| PubMed Central ID: | PMC12614347 |
| DOI: | 10.1111/trf.18412 |
| PMID: | 41065546 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Background: The American Society of Hematology (ASH) recommends prophylactic limited red blood cell (RBC) antigen matching for C, E, and K for patients with sickle cell disease (SCD). At our institution, reflexive extended antigen matching is employed: no antigen matching is undertaken initially; in the event of RBC alloimmunization, extended antigen matching (C/c, E/e, K, Fy <sup>a</sup> /Fy <sup>b</sup> , Jk <sup>a</sup> /Jk <sup>b</sup> , S/s) is performed prospectively.<br />Study Design and Methods: We compared alloimmunization rates and costs of reflexive extended antigen matching with other RBC antigen-matching strategies. A 5-year retrospective review was conducted of all patients with SCD, who were transfused during the study period and lacked prior immunization. Age, sex, ABO/Rh type, number of transfused units of RBCs, antibody history, and transfusion reactions were assessed. The alloimmunization rate was defined as the number of new alloantibodies per 100 units of transfused RBCs. Costs were estimated for reflexive extended antigen matching, limited antigen matching, and extended antigen matching.<br />Results: Of 805 patients, 325 (40.4%) met inclusion criteria. Fifty (50/325, 15.4%) patients developed a positive antibody-detection test after transfusing a median of 9 (interquartile range: 3-14) units (alloimmunization rate 0.29 per 100 RBCs); anti-C, E, and K were leading alloantibodies. Seven (7/50, 14.0%) responders developed additional antibodies. Two delayed hemolytic transfusion reactions (DHTRs) were reported. Reflexive extended antigen-matching cost $4,619,133 over the 5-year period; projected costs of prophylactic limited and extended antigen matching were $9,578,253 (+107%) and $14,537,373 (+215%), respectively.<br />Discussion: Acknowledging the limitation of excluding some responders, the rates of alloimmunization and DHTRs, and comparatively low costs suggest that reflexive extended antigen matching is viable for selected settings.<br /> (© 2025 AABB.) |
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| ISSN: | 1537-2995 |
| DOI: | 10.1111/trf.18412 |