Predictors of red cell alloimmunization in multitransfused Egyptian patients with β-thalassemia.
Thalassemia is a major health problem in Egypt. Red blood cell alloimmunization is an important complication in transfusion-dependent patients.



To determine alloimmunization prevalence in Egyptian patients with β-thalassemia and to evaluate risk factors that could influence alloimmunization, with the hope of minimizing transfusion-associated risks in those patients.



Records of 272 patients with β-thalassemia who are receiving regular blood transfusions, matched for ABO-Rh(D), were analyzed. Alloantibody identification was performed by DiaMed-ID microtyping system. Autoantibodies were detected by direct Coombs test.



Alloimmunization incidence was 22.8% with 123 alloantibodies detected in 62 patients. The most common alloantibody was Rh-related (37.4%; 46 of 123), comprising anti-E (14.6%; 18 of 123), anti-D (8.9%; 11 of 123), anti-C (8.9%; 11 of 123), and anti-c (4.9%; 6 of 123), followed by anti-Kell (26%; 32 of 123), → anti-MNS (9.8%; 12 of 123), → anti-Kidd (8.9%; 11 of 123) → anti-Duffy (8.1%; 10 of 123), → anti-Le (5.7%; 7 of 123), → anti-Lu (2.4%; 3 of 123), and → anti-P1 (1.6%; 2 of 123). Anti-D antibodies developed in 34.5% of all Rh-negative patients. Eighty percent of all anti-D antibodies developed in patients older than 18 years. Males had the highest alloimmunization incidence. Alloimmunization incidence increased with the number of units transfused (P = .01). Patients who received unfiltered blood had a higher alloimmunization rate than did those who always received leukoreduced blood (P < .001). Splenectomized patients had a higher alloimmunization rate (32%; 40 of 125) than did those who did not have a splenectomy (16.3%; 24 of 147; P = .003). Autoantibodies occurred in 1.5% (4 of 272) of all patients.



Transfusion of leukoreduced and phenotypically matched cells for selective antigens may help reduce expenses and risks of alloimmunization in patients with thalassemia.
From the Cairo University Blood Bank, Clinical Pathology Department, Cairo University, Cairo, Egypt.
Eiman
E
Hussein
Nermeen
N
Ahmed Eldesoukey
Abeer
A
Rihan
Abeer
A
Kamal
D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D002648:Child; D004534:Egypt / Q000453:epidemiology; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D015995:Prevalence; D012203:Rh Isoimmunization / Q000453:epidemiology* / Q000276:immunology; D012204:Rh-Hr Blood-Group System / Q000276:immunology; D012307:Risk Factors; D065227:Transfusion Reaction; D017086:beta-Thalassemia / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy*
D000017:ABO Blood-Group System; D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System; C026410:Rho(D) antigen