Antibody development in pediatric sickle cell patients undergoing erythrocytapheresis.
BACKGROUND
Erythrocytapheresis, or red blood cell exchange transfusion (RBCX), with donor red blood cell (RBC) units is now increasingly used in the treatment of acute and chronic complications of sickle cell disease (SCD). As in all transfusions, RCBX carries a risk of immunization against foreign antigen on transfused cells. However, by selecting donor units with RBC phenotypes similar to the patient, the risk of allo- and autoimmunization can be reduced.


METHODS
The formation of RBC alloantibodies and/or autoantibodies in 32 multitransfused pediatric SCD patients undergoing monthly RBCX over a 11-year period (12/1998 to 12/2009) was evaluated utilizing a retrospective patient chart review at Kosair Children's Hospital, Louisville, Kentucky.


RESULTS
After starting C, E, K antigen-matched RBCX, the rate of clinically significant allo-immunization decreased from 0.189/100 to 0.053/100 U, with a relative risk of 27.9%. Likewise, the rate of autoimmunization decreased from 0.063/100 to 0.035/100 U, with a relative risk of 55.9%.


CONCLUSIONS
After controlling for clinically insignificant antibodies, our auto- and alloimmunization rate was much less than previously reported values. In addition, the incidence of clinically significant allo- and autoimmunization decreased in our patient population after starting minor antigen-matched RBCX. These results suggest that by matching selected RBC phenotypes, there may be an association in the risk of allo- and autoimmunization of multi-transfused SCD patients.
Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Gwendolyn J
GJ
Godfrey
William
W
Lockwood
Maiying
M
Kong
Salvatore
S
Bertolone
Ashok
A
Raj
D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000276:immunology* / Q000628:therapy; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001789:Blood Group Antigens / Q000276:immunology*; D001788:Blood Grouping and Crossmatching / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology*; D007223:Infant; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007629:Kentucky; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
D001323:Autoantibodies; D001789:Blood Group Antigens; D007136:Immunoglobulins; D007518:Isoantibodies