title: Red blood cell transfusions are associated with HLA class I but not H-Y alloantibodies in children with sickle cell disease.
abstract: Blood transfusions can induce alloantibodies to antigens on red blood cells (RBCs), white blood cells and platelets, with these alloantibodies affecting transfusion and transplantation. While transfusion-related alloimmunization against RBC antigens and human leucocyte antigens (HLA) have been studied, transfusion-related alloimmunization to minor histocompatibility antigens (mHA), such as H-Y antigens, has not been clinically characterized. We conducted a cross-sectional study of 114 children with sickle cell disease (SCD) and tested for antibodies to 5 H-Y antigens and to HLA class I and class II. Few patients had H-Y antibodies, with no significant differences in the prevalence of any H-Y antibody observed among transfused females (7%), transfused males (6%) and never transfused females (4%). In contrast, HLA class I, but not HLA class II, antibodies were more prevalent among transfused than never transfused patients (class I: 33% vs. 13%, P = 0·046; class II: 7% vs. 8%, P = 0·67). Among transfused patients, RBC alloantibody history but not amount of transfusion exposure was associated with a high (>25%) HLA class I panel reactive antibody (Odds ratio 6·8, 95% confidence interval 2·1-22·3). These results are consistent with immunological responder and non-responder phenotypes, wherein a subset of patients with SCD may be at higher risk for transfusion-related alloimmunization.
authors.affiliation: Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.|Department of Pathology, Emory University, Atlanta, GA, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Nickel
authors.affiliation: Departments of Laboratory Medicine and Paediatrics, Yale University, New Haven, CT, USA.
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Hendrickson
authors.affiliation: Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Yee
authors.affiliation: Department of Pathology, Emory University, Atlanta, GA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bray
authors.affiliation: Department of Pathology, Emory University, Atlanta, GA, USA.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Gebel
authors.affiliation: Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.|Ben Towne Centre for Childhood Cancer Research, Seattle Children's Research Institute, Department of Paediatrics, University of Washington, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Kean
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Miklos
authors.affiliation: Aflac Cancer and Blood Disorders Centre, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Horan
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000276:immunology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006182:H-Y Antigen / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006801:Humans; D016130:Immunophenotyping; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D008297:Male; D016017:Odds Ratio; D055815:Young Adult
chemical_list: D006182:H-Y Antigen; D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies
keywords: H-Y; HLA antibody; alloimmunization; sickle cell disease; transfusion