title: Alloimmunisation in thalassaemics: a comparison between recipients of usual matched and partial better matched blood. An evaluation at a tertiary care centre in India.
abstract: BACKGROUND
  There is an ongoing controversy regarding provision of usually matched blood (i.e. matched for ABO-D antigens) or phenotypically matched blood (also matched for Rh and Kell antigens) for multiply transfused thalassaemics, especially in developing countries. A pilot study conducted at our centre revealed an alloimmunisation rate of 3.79% with Rh and Kell alloantibodies accounting for 90% of all antibodies. The present cross-sectional study was conducted to assess the impact of a policy of partial better matching (for Rh cDE and Kell antigens) of blood on alloimmunisation in thalassaemics.
  
  
  METHODS
  In this cross-sectional study three groups of patients were considered. Group 1 comprised 211 thalassaemics who received usually matched (UM) blood until April 2009. Their rates of alloimmunisation have already been published in a prior study. Group 2 consisted of 46 thalassaemics who were enrolled after April 2009 and have received partially better matched (PBM) blood (matched for ABO, Rh cDE and Kell antigens) since the initiation of transfusion therapy. Group 3 (UM→PBM) comprised the patients from group 1 who, from April 2009, were given partial better matched blood. Antibody screening (using a 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibodies.
  
  
  RESULTS
  None of the thalassaemic patients in group 2 (PBM) developed alloantibodies. Eight thalassaemics in group 3 (UM→PBM) developed new alloantibodies (after April 2009).
  
  
  CONCLUSIONS
  According to the results of the present study, providing at least partially better matched blood appears to improve the efficacy of transfusion for chronically transfused thalassaemics. Large-scale, comprehensive, multicentre studies need to be carried out to formulate realistic, evidence-based, economically feasible transfusion policies for thalassaemic children based on the red blood cell antigen profile of the population.
authors: Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors: Mukta
authors: M
authors: Pujani
authors: Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors: Sangeeta
authors: S
authors: Pahuja
authors: Department of Paediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors: Bhavna
authors: B
authors: Dhingra
authors: Department of Paediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors: Jagdish
authors: J
authors: Chandra
authors: Department of Pathology, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
authors: Manjula
authors: M
authors: Jain
mesh_terms: D000017:ABO Blood-Group System / Q000032:analysis / Q000276:immunology; D001787:Blood Group Incompatibility / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003298:Coombs Test; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007114:Immunization; D007194:India / Q000453:epidemiology; D007223:Infant; D007518:Isoantibodies / Q000096:biosynthesis / Q000097:blood; D007626:Kell Blood-Group System / Q000032:analysis / Q000276:immunology; D008297:Male; D011933:Reagent Kits, Diagnostic; D012204:Rh-Hr Blood-Group System / Q000032:analysis / Q000276:immunology; D062606:Tertiary Care Centers; D013789:Thalassemia / Q000276:immunology / Q000628:therapy*; D065227:Transfusion Reaction
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies; D007626:Kell Blood-Group System; D011933:Reagent Kits, Diagnostic; D012204:Rh-Hr Blood-Group System
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