Managing the patient with haemoglobinopathy and multiple red cell antibodies

The main supportive treatment for haemoglobinopathies is repetitive red blood cell (RBC) transfusions, but this may lead to development of RBC alloimmunization which represents a critical and clinically relevant barrier. One of the greatest risk factors for alloimmunization is the antigen disparity between donor and recipient. This is prevalent with European donors and African recipients because of different blood group phenotypes. Various authors have reported that from 5·2 to 30% of thalassaemia patients and from 18% to as much as 47% of sickle cell anaemia (SCA) patients are affected. The presence of single or multiple allo and autoantibodies increases the complexity of the serological work‐up to find compatible products and demands highly skilled investigation by different panels, elutions, adsorptions, etc., and this delays transfusion therapy. RBC alloantibody evanescence, for example anti‐Jka, and the lack of serological identification, carries a risk of severe and life‐threatening haemolytic transfusion reactions after the re‐exposure to the immunizing antigen. Prophylactic matching should be extended to blood group systems such as Duffy, Kidd and MNS. RBC genotyping may also improve a precise matching of RH alleles and be a valuable support in the event of multiple antibodies. The greater the level of matching, the closer one comes to the ‘perfect match’ which is an innovative strategy adopted to ensure the effectiveness and safety of transfusion therapy...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Invited Review Source Type: research