title: Red cell alloimmunisation in patients with different types of infections.
abstract: Red cell alloantigen exposure can cause alloantibody-associated morbidity. Murine models have suggested that inflammation modulates red cell alloimmunisation. This study quantifies alloimmunisation risks during infectious episodes in humans. We performed a multicentre case-control study within a source population of patients receiving their first and subsequent red cell transfusions during an 8-year follow-up period. Patients developing a first transfusion-induced red cell alloantibody (N = 505) were each compared with two similarly exposed, but non-alloimmunised controls (N = 1010) during a 5-week 'alloimmunisation risk period' using multivariate logistic regression analysis. Transfusions during 'severe' bacterial (tissue-invasive) infections were associated with increased risks of alloantibody development [adjusted relative risk (RR) 1·34, 95% confidence interval (95% CI) 0·97-1·85], especially when these infections were accompanied with long-standing fever (RR 3·06, 95% CI 1·57-5·96). Disseminated viral disorders demonstrated a trend towards increased risks (RR 2·41, 95% CI 0·89-6·53), in apparent contrast to a possible protection associated with Gram-negative bacteraemia (RR 0·58, 95% CI 0·13-1·14). 'Simple' bacterial infections, Gram-positive bacteraemia, fungal infections, maximum C-reactive protein values and leucocytosis were not associated with red cell alloimmunisation. These findings are consistent with murine models. Confirmatory research is needed before patients likely to develop alloantibodies may be identified based on their infectious conditions at time of transfusion.
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Evers
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johanna G
authors.initials: JG
authors.lastname: van der Bom
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Tijmensen
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rutger A
authors.initials: RA
authors.lastname: Middelburg
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.|Department of Immunohaematology Diagnostics, Sanquin, Amsterdam, The Netherlands.
authors.forename: Masja
authors.initials: M
authors.lastname: de Haas
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Zalpuri
authors.affiliation: Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karen M K
authors.initials: KM
authors.lastname: de Vooght
authors.affiliation: Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: van de Kerkhof
authors.affiliation: Department of Haematology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto
authors.initials: O
authors.lastname: Visser
authors.affiliation: Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Nathalie C V
authors.initials: NC
authors.lastname: Péquériaux
authors.affiliation: LabWest, Haga Teaching Hospital, The Hague, The Netherlands.
authors.forename: Francisca
authors.initials: F
authors.lastname: Hudig
authors.affiliation: Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.|Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap Jan
authors.initials: JJ
authors.lastname: Zwaginga
mesh_terms: D000368:Aged; D000818:Animals; D016470:Bacteremia / Q000276:immunology; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000276:immunology; D016908:Gram-Positive Bacterial Infections / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000096:biosynthesis*; D008297:Male; D051379:Mice; D008875:Middle Aged; D014777:Virus Diseases / Q000276:immunology
chemical_list: D007518:Isoantibodies
keywords: blood transfusion; humans; infections; inflammation; red blood cell alloimmunisation