title: Red blood cell alloimmunization in transfused patients in sub-Saharan Africa: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Previous studies of Sub-Saharan Africans show significant alloimmunization to red blood cell (RBC) antigens, but country-specific data are limited. Thus, the aim of this study was to estimate, by meta-analysis, the overall proportion of red blood cell alloantibodies among transfused patients.
  
  
  METHODS
  We systematically searched Medline, Embase, and the Africa-Wide Information database to identify relevant studies in any language. Case reports, comments, letters, conference abstracts, editorials, and review articles were excluded. Of the 269 potentially relevant articles, 11 studies fulfilled our selection criteria.
  
  
  RESULTS
  Overall proportions of alloimmunization were 6.7 (95% CI: 5.7, 7.8) per 100 transfused patients. With regard to antibody specificity, among clinically significant antibodies, anti-E ranked as the most common, followed by anti-K, anti-C and anti-D.
  
  
  CONCLUSIONS
  Meta-analysis of available literature quantifies and qualifies the clinical challenge of RBC alloimmunization among transfused patients in Sub-Saharan Africa. These results should drive policy decisions in favour of routine testing of RBC antigens and irregular antibodies for transfused patients as a standard of care throughout Sub-Saharan Africa.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Electronic address: alain.ngoma@mail.mcgill.ca.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Ngoma
authors.affiliation: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Paulin B
authors.initials: PB
authors.lastname: Mutombo
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan; Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan; Radiation Medical Science Center, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Nollet
authors.affiliation: Department of Hematology and Transfusion Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Bernard
authors.initials: B
authors.lastname: Natukunda
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohto
mesh_terms: D017954:Africa South of the Sahara; D001787:Blood Group Incompatibility / Q000097:blood* / Q000453:epidemiology*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D007519:Isoantigens / Q000097:blood*; D008297:Male
chemical_list: D007518:Isoantibodies; D007519:Isoantigens
keywords: Blood transfusion; Haemolytic transfusion reactions; RBC alloantibodies; Sub-Saharan Africa