Alloimmunization to Red Cells and the Association of Alloantibodies Formation with Splenectomy Among Transfusion-Dependent β-Thalassemia Major/HbE Patients

Overview

Journal Indian J Clin Biochem

Specialty Biochemistry

Date 2015 Apr 18

PMID 25883429

Citations 5

Authors

Suteenee Jansuwan

Orathai Tangvarasittichai

Surapon Tangvarasittichai

Affiliations

Soon will be listed here.

Abstract

Severe hemolytic anemia in β-thalassemia major and β-thalassemias/HbE (β-TM) patients requires giving blood transfusions. Chronic blood transfusions lead to iron overload consequence with organs damage and risk of alloantibody-formation. This study evaluates the prevalence of red cell alloimmunization and estimates the risk of alloantibody-formation in chronic transfusion-dependent β-TM patients. This cross sectional study was conducted on 143 β-TM patients receiving regular transfusions. We tried to determine the frequency, types and factors influencing red cell alloimmunization in these transfusion-dependent β-TM patients. Median age of 25 (17.5 %) alloantibody-formation β-TM patients was 19.0 years (inter quartile 15.5-24.0 years). The alloantibodies were Anti-Rh (E) (13.1 %), Anti-Rh (D) (0.7 %). Thirty-four patients (23.8 %) of the sample had splenectomies of which 10 (29.4 %) had alloantibody-formation. The interval from first transfusion to antibody development varied from 1.5 to 14 years. Alloantibody-formation correlated with splenectomy and splenectomy correlated with number of transfusion (p < 0.005). In multiple logistic regression used to estimate the risk of alloantibodies formation with splenectomy; OR and 95 % CI were 2.88 (1.07-7.80), p = 0.037 after adjusting for other co-variates. The rate of red cell alloimmunization was 17.5 % and splenectomy associated with increased alloantibody-formation in these transfusion-dependent β-TM patients.

Citing Articles

Red blood cell alloimmunization among transfusion-dependent thalassemia major patients in Northeastern Iran.

Mobasheri L, Chahkandi T, Talebpour A, Sarab G Asian J Transfus Sci. 2025; 18(2):214-218.

PMID: 39822688 PMC: 11734775. DOI: 10.4103/ajts.ajts_107_21.

Alloantibody among Thalassemia patients receiving multiple blood transfusions at a tertiary care hospital in India.

Thakur S, Sinha A, Jahan A, Mathur A, Negi D, Singh S Bioinformation. 2023; 19(4):362-368.

PMID: 37822830 PMC: 10563553. DOI: 10.6026/97320630019362.

People with blood disorders can be more vulnerable during COVID-19 pandemic: A hypothesis paper.

Aydemir D, Ulusu N Transfus Apher Sci. 2021; 60(3):103080.

PMID: 33608217 PMC: 7874911. DOI: 10.1016/j.transci.2021.103080.

Alloimmunization in Thalassemia Patients.

Joob B, Wiwanitkit V Int J Prev Med. 2019; 10:90.

PMID: 31360337 PMC: 6592109. DOI: 10.4103/ijpvm.IJPVM_10_18.

Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review.

Franchini M, Forni G, Marano G, Cruciani M, Mengoli C, Pinto V Blood Transfus. 2019; 17(1):4-15.

PMID: 30653458 PMC: 6343597. DOI: 10.2450/2019.0229-18.

References

Schonewille H, Haak H, van Zijl A . Alloimmunization after blood transfusion in patients with hematologic and oncologic diseases. Transfusion. 1999; 39(7):763-71. DOI: 10.1046/j.1537-2995.1999.39070763.x. View

Ameen R, Al-Shemmari S, Al-Humood S, Chowdhury R, Al-Eyaadi O, Al-Bashir A . RBC alloimmunization and autoimmunization among transfusion-dependent Arab thalassemia patients. Transfusion. 2003; 43(11):1604-10. DOI: 10.1046/j.1537-2995.2003.00549.x. View

Wasi C, Wasi P, Thongcharoen P . Serum-immunoglobulin levels in thalassaemia and the effects of splenectomy. Lancet. 1971; 2(7718):237-9. DOI: 10.1016/s0140-6736(71)92573-6. View

Singer S, Kuypers F, Styles L, Vichinsky E, Foote D, Rosenfeld H . Pulmonary hypertension in thalassemia: association with platelet activation and hypercoagulable state. Am J Hematol. 2006; 81(9):670-5. DOI: 10.1002/ajh.20640. View

Matzner Y, Hershko C, Polliack A, Konijn A, IZAK G . Suppressive effect of ferritin on in vitro lymphocyte function. Br J Haematol. 1979; 42(3):345-53. DOI: 10.1111/j.1365-2141.1979.tb01142.x. View

de Sousa M, Smithyman A, Tan C . Suggested models of ecotaxopathy in lymphoreticular malignancy. A role for iron-binding proteins in the control of lymphoid cell migration. Am J Pathol. 1978; 90(2):497-520. PMC: 2018158. View

Schonewille H, van de Watering L, Brand A . Additional red blood cell alloantibodies after blood transfusions in a nonhematologic alloimmunized patient cohort: is it time to take precautionary measures?. Transfusion. 2006; 46(4):630-5. DOI: 10.1111/j.1537-2995.2006.00764.x. View

Thompson A, Cunningham M, Singer S, Neufeld E, Vichinsky E, Yamashita R . Red cell alloimmunization in a diverse population of transfused patients with thalassaemia. Br J Haematol. 2011; 153(1):121-8. PMC: 5728106. DOI: 10.1111/j.1365-2141.2011.08576.x. View

Kapadia A, de Sousa M, Markenson A, Miller D, GOOD R, Gupta S . Lymphoid cell sets and serum immunoglobulins in patients with thalassaemia intermedia: relationship to serum iron and splenectomy. Br J Haematol. 1980; 45(3):405-16. DOI: 10.1111/j.1365-2141.1980.tb07161.x. View

10.

Wang L, Liang D, Liu H, Chang F, Wang C, Chan Y . Alloimmunization among patients with transfusion-dependent thalassemia in Taiwan. Transfus Med. 2006; 16(3):200-3. DOI: 10.1111/j.1365-3148.2006.00656.x. View

11.

Gascon P, Zoumbos N, Young N . Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med. 1984; 100(2):173-7. DOI: 10.7326/0003-4819-100-2-173. View

12.

Sengsuk C, Tangvarasittichai O, Chantanaskulwong P, Pimanprom A, Wantaneeyawong S, Choowet A . Association of Iron Overload with Oxidative Stress, Hepatic Damage and Dyslipidemia in Transfusion-Dependent β-Thalassemia/HbE Patients. Indian J Clin Biochem. 2014; 29(3):298-305. PMC: 4062663. DOI: 10.1007/s12291-013-0376-2. View

13.

Bryan C, Nishiya K, Pollack M, DuPont B, de Sousa M . Differential inhibition of the MLR by iron: association with HLA phenotype. Immunogenetics. 1981; 12(1-2):129-40. DOI: 10.1007/BF01561656. View

14.

BUFFE D, Rimbaut C . Immunosuppresive effect of a human hepatic glycoferroprotein, alpha2H globulin. A study on the transformation of normal human lymphocytes. Immunology. 1975; 29(1):175-84. PMC: 1445880. View

15.

CONSTANTOULAKIS M, Trichopoulos D, Avgoustaki O, Economidou J . Serum immunoglobulin concentrations before and after splenectomy in patients with homozygous beta-thalassaemia. J Clin Pathol. 1978; 31(6):546-50. PMC: 1145343. DOI: 10.1136/jcp.31.6.546. View

16.

Eder A, Chambers L . Noninfectious complications of blood transfusion. Arch Pathol Lab Med. 2007; 131(5):708-18. DOI: 10.5858/2007-131-708-NCOBT. View

17.

Andersen V, Cohn J, Sorensen S . Immunological studies in children before and after splenectomy. Acta Paediatr Scand. 1976; 65(4):409-15. DOI: 10.1111/j.1651-2227.1976.tb04907.x. View

18.

Sirchia G, Zanella A, Parravicini A, Morelati F, Rebulla P, Masera G . Red cell alloantibodies in thalassemia major. Results of an Italian cooperative study. Transfusion. 1985; 25(2):110-2. DOI: 10.1046/j.1537-2995.1985.25285169198.x. View

19.

Schumacher M . Serum immunoglobulin and transferrin levels after childhood splenectomy. Arch Dis Child. 1970; 45(239):114-7. PMC: 2020394. DOI: 10.1136/adc.45.239.114. View

20.

Pahuja S, Pujani M, Gupta S, Chandra J, Jain M . Alloimmunization and red cell autoimmunization in multitransfused thalassemics of Indian origin. Hematology. 2010; 15(3):174-7. DOI: 10.1179/102453309X12583347114013. View