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Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood.

Abstract

Transfusion therapy for sickle cell anemia is limited by the development of antibodies to foreign red cells. To evaluate the frequency and risk factors associated with such alloimmunization, we determined the transfusion history, red-cell phenotype, and development of alloantibodies in 107 black patients with sickle cell anemia who received transfusions. We compared the results with those from similar studies in 51 black patients with sickle cell disease who had not received transfusions and in 19 nonblack patients who received transfusions for other forms of chronic anemia. We assessed the effect that racial differences might have on the frequency of alloimmunization by comparing the red-cell phenotypes of patients and blood-bank donors (n = 200, 90 percent white). Although they received transfusions less frequently, 30 percent of the patients with sickle cell anemia became alloimmunized, in contrast to 5 percent of the comparison-group patients with other forms of anemia (P less than 0.001). Of the 32 alloimmunized patients with sickle cell anemia, 17 had multiple antibodies and 14 had delayed transfusion reactions. Antibodies against the K, E, C, and Jkb antigens accounted for 82 percent of the alloantibodies. Comparison of red-cell phenotypes in the three study groups (the patients with sickle cell anemia, the patients with other forms of anemia, and the blood donors) revealed statistically significant differences between the patients with sickle cell anemia and the donors but not between the patients with other forms of anemia and the donors. These differences are most likely racial. We conclude that alloimmunization is a common, clinically serious problem in sickle cell anemia and that it is partly due to racial differences between the blood-donor and recipient populations.

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  • Authors+Show Affiliations

    ,

    Department of Hematology/Oncology, Children's Hospital Oakland, CA 94609.

    , , , ,

    Source

    The New England journal of medicine 322:23 1990 Jun 7 pg 1617-21

    MeSH

    Adolescent
    Adult
    Anemia
    Anemia, Sickle Cell
    Antibody Formation
    Blood Donors
    Blood Group Incompatibility
    Blood Grouping and Crossmatching
    Blood Transfusion
    Child
    Child, Preschool
    Continental Population Groups
    Humans
    Infant
    Isoantibodies
    Phenotype
    Prospective Studies

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    2342522

    Citation

    TY - JOUR T1 - Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood. AU - Vichinsky,E P, AU - Earles,A, AU - Johnson,R A, AU - Hoag,M S, AU - Williams,A, AU - Lubin,B, PY - 1990/6/7/pubmed PY - 1990/6/7/medline PY - 1990/6/7/entrez SP - 1617 EP - 21 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 322 IS - 23 N2 - Transfusion therapy for sickle cell anemia is limited by the development of antibodies to foreign red cells. To evaluate the frequency and risk factors associated with such alloimmunization, we determined the transfusion history, red-cell phenotype, and development of alloantibodies in 107 black patients with sickle cell anemia who received transfusions. We compared the results with those from similar studies in 51 black patients with sickle cell disease who had not received transfusions and in 19 nonblack patients who received transfusions for other forms of chronic anemia. We assessed the effect that racial differences might have on the frequency of alloimmunization by comparing the red-cell phenotypes of patients and blood-bank donors (n = 200, 90 percent white). Although they received transfusions less frequently, 30 percent of the patients with sickle cell anemia became alloimmunized, in contrast to 5 percent of the comparison-group patients with other forms of anemia (P less than 0.001). Of the 32 alloimmunized patients with sickle cell anemia, 17 had multiple antibodies and 14 had delayed transfusion reactions. Antibodies against the K, E, C, and Jkb antigens accounted for 82 percent of the alloantibodies. Comparison of red-cell phenotypes in the three study groups (the patients with sickle cell anemia, the patients with other forms of anemia, and the blood donors) revealed statistically significant differences between the patients with sickle cell anemia and the donors but not between the patients with other forms of anemia and the donors. These differences are most likely racial. We conclude that alloimmunization is a common, clinically serious problem in sickle cell anemia and that it is partly due to racial differences between the blood-donor and recipient populations. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/2342522/full_citation L2 - http://www.nejm.org/doi/abs/10.1056/NEJM199006073222301?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed ER -