title: Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre.
abstract: Patients with sickle cell disease (SCD) show a high prevalence of red blood cell (RBC) alloimmunization, but few studies have focused on children. We aimed to study the prevalence and risk factors of RBC alloimmunization in SCD children. We retrospectively analysed the medical and transfusion files for 245 SCD children hospitalized in our centre in 2014 and included 175 patients who had received at least one RBC unit in their lifetime. The main clinical and immuno-haematological characteristics of alloimmunized and non-alloimmunized patients were compared. The prevalence of alloimmunization was 13·7% [95% confidence interval (CI) (8·6-18·6)], and 7·4% [95% CI (3·5-11·3)] after excluding the probable irregular natural antibodies (anti-M, anti-Lea, anti-Leb, anti-Lex). Main risk factors for alloimmunization were increased number of RBC units received (median of 65 vs. 10 units per patient; P = 0·01) and the presence of one or more red cell autoantibodies (46·2% vs. 4·7%; P < 0·0001). The alloimmunization rate was higher for episodically transfused than chronically transfused patients (1·43 vs. 0·24/100 units received; P < 0·001). The presence of red cell autoantibodies appears to be a major risk factor for alloimmunization in SCD children and could justify specific transfusion guidelines.
authors.affiliation: Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.|Laboratory of Excellence GR-Ex, Paris, France.
authors.forename: Slimane
authors.identifier: 0000-0001-7068-4530
authors.initials: S
authors.lastname: Allali
authors.affiliation: Laboratory of Excellence GR-Ex, Paris, France.|Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut National de la Transfusion Sanguine (INTS), Paris, France.|Inserm UMR_S1134, Paris Diderot University, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Peyrard
authors.affiliation: Etablissement Français du Sang (EFS), Necker Hospital for Sick Children, Paris, France.
authors.forename: Denise
authors.initials: D
authors.lastname: Amiranoff
authors.affiliation: Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.|Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France.
authors.forename: Jérémie F
authors.initials: JF
authors.lastname: Cohen
authors.affiliation: Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.|Laboratory of Excellence GR-Ex, Paris, France.|Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
authors.affiliation: Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.|Laboratory of Excellence GR-Ex, Paris, France.
authors.forename: Valentine
authors.initials: V
authors.lastname: Brousse
authors.affiliation: Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.|Laboratory of Excellence GR-Ex, Paris, France.
authors.forename: Mariane
authors.initials: M
authors.lastname: de Montalembert
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D002648:Child; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004912:Erythrocytes / Q000276:immunology*; D005602:France; D006720:Homozygote; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014181:Transplantation Immunology
chemical_list: D007518:Isoantibodies
keywords: blood transfusion; children; immunohaematology; red blood cell alloimmunization; sickle cell disease