Review Article
Impact of alloimmunization on transfusion-dependent patients
Surapon Tangvarasittichai*
Published: 16 November, 2017 | Volume 1 - Issue 1 | Pages: 070-082
Red blood cell (RBC) alloimmunization can be a life-threatening complication for patients with thalassemia major and sickle cell disease (SCD) who must receive chronic therapeutic transfusions. Chronic transfusions can lead to erythrocyte alloimmunization, patients continue to develop alloantibodies due to the transference of the immunogenic antigens on the donor RBCs. Many complications are possible. Difficulty in finding compatible match units for the patients can cause transfusion delays delayed, or present alternative risks to the patients from delayed hemolytic transfusion reactions. This review discusses the possible mechanisms, risk factors associated with alloimmunization formation and the hemolytic transfusion reactions and also describe the guideline for transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication.
Read Full Article HTML
DOI: 10.29328/journal.aac.1001009
Cite this Article
Read Full Article PDF
Keywords:
Alloimmunization; RBC transfusion; RBC antigen; Hemolytic transfusion reaction; β-thalassemia syndrome; Sickle cell disease
References
- Kruatrachue M, Sirisinha S, Pacharee P, Chandarayingyong D, Wasi P. An association between thalassemia and autoimmune haemolytic anaemia (AIHA). Scand J Haematol. 1980; 25: 259-263. Ref.: https://goo.gl/cmb2Jd
- Argiolu F, Diana G, Arnone M, Batzella MG, Piras P, et al. High-dose intravenous immunoglobulin in the management of autoimmune hemolytic anemia complicating thalassemia major. Acta Haematol. 1990; 83: 65-68. Ref.: https://goo.gl/tNQZDG
- Cianciulli P, Sorrentino F, Morino L, Massa A, Sergiacomi GL, et al. Radiotherapy combined with erythropoietin for the treatment of extramedullary hematopoiesis in an alloimmunized patient with thalassemia intermedia. Ann Hematol. 1996; 73: 379-381. Ref.: https://goo.gl/84UXXV
- Tangvarasittichai S. Thalassemia syndromes. In: Ikehara K. eds. Advances in the study of genetic disorders. InTech. Janeza Trdine 9, 51000 Rijeka, Croatia. 2011; 101-148.
- Galanello R, Sanna S, Perseu L, Sollaino MC, Satta S, et al. Amelioration of Sardinian beta0 thalassemia by genetic modifiers. Blood. 2009; 114: 3935-3937. Ref.: https://goo.gl/6Yprtc
- Rachmilewitz EA, Giardina PJ. How I treat thalassemia. Blood. 2011; 118: 3479-3788. Ref.: https://goo.gl/upxZhy
- Muncie HL Jr, Campbell J. Alpha and beta thalassemia. Am Fam Physician. 2009; 80: 339-344. Ref.: https://goo.gl/U53rf5
- Rivella S. b-Thalassemias: paradigmatic diseases for scientific discoveries and development of innovative therapies. Haematologica. 2015; 100: 418-430. Ref.: https://goo.gl/ypkaSd
- Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010; 5: 11. Ref.: https://goo.gl/AXyJyD
- Ameen R, Al-Shemmari S, Al-Humood S, Chowdhury RI, Al-Eyaadi O, et al. RBC alloimmunization and autoimmunization among transfusion dependent Arab Thalassemia patients. Transfusion. 2003; 43: 1604-1610. Ref.: https://goo.gl/NVMY5o
- Jansuwan S, Tangvarasittichai O, Tangvarasittichai S. Alloimmunization to Red Cells and the Association of alloantibodies formation with splenectomy among transfusion-dependent b-thalassemia major/HbE patients. Ind J Clin Biochem. 2015; 30: 198-203. Ref.: https://goo.gl/uavmMo
- Frenette PS, Atweh GF. Sickle cell disease: old discoveries, new concepts, and future promise. J Clin Invest. 2007; 117: 850-858. Ref.: https://goo.gl/Yz7php
- Walter PB, Harmatz P, Vichinsky E. Iron metabolism and iron chelation in sickle cell disease. Acta Haematol. 2009; 122: 174-183. Ref.: https://goo.gl/NZnxiA
- Yazdanbakhsh K, Ware RE, Noizat-Pirenne F. Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management. Blood. 2012; 120: 528-537. Ref.: https://goo.gl/xi9nqr
- Prigent A, Maillard N, Absi L, Aloui C, Cognasse F, et al. From donor to recipient: Current questions relating to humoral alloimmunization. Antibodies.2014; 3: 130-152. Ref.: https://goo.gl/kFA3f9
- Shamsian BS, Taghi AM, Shamshiri AR, Alavi S, Khojasteh, O. Frequency of red cell alloimmunization in patients with β-major thalassemia in an Iranian referral hospital. Iran J Pediatr. 2008; 18: 149-153. Ref.: https://goo.gl/vTTXAGf
- Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, et al. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly Asian descent. Blood. 2000; 96: 3369-3373. Ref.: https://goo.gl/f7vpEF
- 2017; Ref.: http://www.isbtweb.org
- Ballif BA, Helias V, Peyrard T, Menanteau C, Saison C, et al. Disruption of SMIM1 causes the Vel-blood type. EMBO Mol Med. 2013; 5: 751-761. Ref.: https://goo.gl/wpkZ7Y
- Storry JR, Jöud M, Christophersen MK, Thuresson B, Åkerström B, et al. Homozygosity for a null allele of SMIM1 defines the Vel-negative blood group phenotype. Nat Genet. 2013; 45: 537-541. Ref.: https://goo.gl/X7MtPD
- Cvejic A, Haer-Wigman L, Stephens JC, Kostadima M, Smethurst PA, et al. SMIM1 underlies the Vel blood group and influences red blood cell traits. Nat Genet. 2013; 45: 542-545. Ref.: https://goo.gl/3JKJFY
- De La Vega Elena CD, Nogués N, Fernández Montoya A, Chialina S, Blanzaco PD, et al. Human platelet-specific antigens frequencies in the Argentinean population. Transfus Med. 2008; 18: 83-90. Ref.: https://goo.gl/WJXh8k
- Curtis BR, McFarland JG. Human platelet antigens - 2013. Vox Sang. 2014; 106: 93-102. Ref.: https://goo.gl/AU1etB
- Metcalfe P, Watkins NA, Ouwehand WH, Kaplan C, Newman P, et al. Nomenclature of human platelet antigens. Vox Sang. 2003; 85: 240-245. Ref.: https://goo.gl/CzpXDw
- Zimring JC, Welniak L, Semple JW, Ness PM, Slichter SJ, et al. Current problems and future directions of transfusion-induced alloimmunization: summary of an NHLBI working group. Transfusion. 2011; 51: 435-441. Ref.: https://goo.gl/c6QMCS
- Brouk H, Halle L, Bertrand G, Neche FZ, Ouelaa H, et al. Human platelet antigen allele frequencies in different Algerian populations. Tissue Antigens. 2010; 75: 673-678. Ref.: https://goo.gl/T2Pu8W
- Pavenski K, Freedman J, Semple JW. HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management. Tissue Antigens. 2012; 79: 237-245. Ref.: https://goo.gl/BxLxiC
- van de Watering L, Hermans J, Witvliet M, Versteegh M, Brand A. HLA and RBC immunization after filtered and buffy coat-depleted blood transfusion in cardiac surgery: a randomized controlled trial. Transfusion. 2003; 43: 765-771. Ref.: https://goo.gl/rtgXS3
- de La Vega Elena CD, Nogués N, Fernández Montoya A, Oyonarte S, Solis E, et al. HNA-1a, HNA-1b and HNA-1c gene frequencies in Argentineans. Tissue Antigens. 2008; 71: 475-477. Ref.: https://goo.gl/jfi2Ay
- Xia W, Bayat B, Sachs U, Chen Y, Shao Y, et al. The frequencies of human neutrophil alloantigens in the Chinese Han population of Guangzhou. Transfusion. 2011; 51: 1271-1277. Ref.: https://goo.gl/gFoSw6
- Bux J. Human neutrophil alloantigens. Vox Sang. 2008; 94: 277-285. Ref.: https://goo.gl/EkwJ3b
- Bux J, Behrens G, Jaeger G, Welte K. Diagnosis and clinical course of autoimmune neutropenia in infancy: analysis of 240 cases. Blood. 1998; 91: 181-186. Ref.: https://goo.gl/9mV6ov
- Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: A review. Chest. 2004; 126: 249-258. Ref.: https://goo.gl/7LPjK1
- Garratty G. Advances in red blood cell immunology 1960 to 2009. Transfusion. 2010; 50: 526-535. Ref.: https://goo.gl/xMfBnq
- The Trial to Reduce Alloimmunization to Platelets Study Group. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med. 1997; 337: 1861-1869. Ref.: https://goo.gl/Jafw9j
- Mincheff M. Changes in donor leukocytes during blood storage. Implications on post-transfusion immunomodulation and transfusion-associated GVHD. Vox Sang. 1998; 74: 189-200. Ref.: https://goo.gl/mFGGNj
- Zimring JC, Stowell SR, Johnsen JM, Hendrickson JE. Effects of genetic, epigenetic, and environmental factors on alloimmunization to transfused antigens: Current paradigms and future considerations. Transfus Clin Biol. 2012; 19: 125-131. Ref.: https://goo.gl/Qy1tza
- Zalpuri S, Middelburg RA, Schonewille H, de Vooght KM, le Cessie S, et al. Intensive red blood cell transfusions and risk of alloimmunization. Transfusion. 2014; 54: 278-284. Ref.: https://goo.gl/j6RdFm
- Bauer MP, Wiersum-Osselton J, Schipperus M, Vandenbroucke JP, Briët E. Clinical predictors of alloimmunization after red blood cell transfusion. Transfusion. 2007; 47: 2066-2071. Ref.: https://goo.gl/rPR8Av
- Giblett ER. A critique of the theoretical hazard of inter vs intra-racial transfusion. Transfusion. 1961; 1: 233-238. Ref.: https://goo.gl/Kum3U3
- Tormey CA, Stack G. Immunogenicity of blood group antigens: a mathematical model corrected for antibody evanescence with exclusion of naturally occurring and pregnancy-related antibodies. Blood. 2009; 114: 4279-4282. Ref.: https://goo.gl/52qhTs
- Alves VM, Martins PRJ, Soares S, Araújo G, Schmidt LC, et al. Alloimmunization screening after transfusion of red blood cells in a prospective study. Rev Bras Hematol Hemoter. 2012; 34: 206. Ref.: https://goo.gl/tR7mbC
- Santos FW, Magalhaes SM, Mota RM, Pitombeira MH. Post transfusion red cells alloimmunization in patients with acute disorders and medical emergencies. Rev Bras Hematol Hemother. 2007; 29: 369. Ref.: https://goo.gl/1K3Vvo
- Verduin EP, Brand A, Schonewille H. Is female sex a risk factor for red blood cell alloimmunization after transfusion? A systematic review. Transfus Med Rev. 2012; 26: 342-353. Ref.: https://goo.gl/9b3zqm
- Lomas-Francis C. Testing for rare blood donors by DNA analysis. ISBT Sci Series. 2006; 1: 213-219. Ref.: https://goo.gl/6WjNLQ
- Daniels G. The molecular genetics of blood group polymorphism.Transpl Immunol. 2005; 14: 143-153. Ref.: https://goo.gl/hm7KND
- Lasalle-Williams M, Nuss R, Le T, Hassell K, Murphy JR, et al. Extended red blood cell antigen matching for transfusions in sickle cell disease: a review of a 14-year experience from a single center. Transfusion. 2011; 51: 1732-1739. Ref.: https://goo.gl/S9aEsp
- Spanos TH, Karageorga M, Ladis V, Peristeri J, Hatziliami A, Kattamis C. Red cell alloantibodies in patients with thalassemia. Vox Sang. 1990; 58: 50-55. Ref.: https://goo.gl/oVmskT
- Hendrickson JE, Desmarets M, Deshpande SS, Chadwick TE, Hillyer CD, et al. Recipient inflammation affects the frequency and magnitude of immunization to transfused red blood cells. Transfusion. 2006; 46: 1526-1536. Ref.: https://goo.gl/o6oFp1
- Cognasse F, Boussoulade F, Chavarin P, Acquart S, Fabrigli P, et al. Release of potential immunomodulatory factors during platelet storage. Transfusion. 2006; 46: 1184-1189. Ref.: https://goo.gl/WJ6W8X
- Hod EA, Spitalnik SL. Stored red blood cell transfusions: Iron, inflammation, immunity, and infection. Transfus Clin Biol. 2012; 19: 84-89. Ref.: https://goo.gl/fS2q4X
- Seftel MD, Growe GH, Petraszko T, Benny WB, Le A, et al. Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness. Blood. 2004; 103: 333-339. Ref.: https://goo.gl/V62djQ
- Slichter SJ. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N. Engl. J. Med. 1997; 337: 1861-1869. Ref.: https://goo.gl/thsUDF
- Marschner S, Fast LD, Baldwin WM 3rd, Slichter SJ, Goodrich RP. White blood cell inactivation after treatment with riboflavin and ultraviolet light. Transfusion. 2010; 50: 2489-2498. Ref.: https://goo.gl/LFqnC9
- Bilgin YM, van de Watering LM, Brand A. Clinical effects of leucoreduction of blood transfusions. Neth J Med. 2011; 69: 441-450. Ref.: https://goo.gl/c32HML
- Hendrickson JE, Chadwick TE, Roback JD, Hillyer CD, Zimring JC. Inflammation enhances consumption and presentation of transfused RBC antigens by dendritic cells. Blood. 2007; 110: 2736-2743. Ref.: https://goo.gl/uwQnUK
- Smith NH, Hod EA, Spitalnik SL, Zimring JC, Hendrickson JE. Transfusion in the absence of inflammation induces antigen-specific tolerance to murine RBCs. Blood. 2012; 119: 1566-1569. Ref.: https://goo.gl/hDr95M
- Zimring JC, Stowell SR, Johnsen JM, Hendrickson JE. Effects of genetic, epigenetic, and environmental factors on alloimmunization to transfused antigens: Current paradigms and future considerations. Transfus Clin Biol. 2012; 19: 125-131. Ref.: https://goo.gl/wznBkj
- Papay P, Hackner K, Vogelsang H, Novacek G, Primas C, et al. High risk of transfusion-induced alloimmunization of patients with inflammatory bowel disease. Am J Med. 2012; 125: 717. Ref.: https://goo.gl/eWqwjJ
- Yazer MH, Triulzi DJ, Shaz B, Kraus T, Zimring JC. Does a febrile reaction to platelets predispose recipients to red blood cell alloimmunization? Transfusion. 2009; 49: 1070-1075. Ref.: https://goo.gl/ttnZzx
- Tatari-Calderone Z, Luban NLC, Vukmanovic S. Genetics of Transfusion Recipient Alloimmunization: Can Clues from Susceptibility to Autoimmunity Pave the Way?. Transfus Med Hemother. 2014; 41: 436-445. Ref.: https://goo.gl/YHJtNz
- Aygun B, Padmanabhan S, Paley C, Chandrasekaran V. Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions. Transfusion. 2002; 42: 37-43. Ref.: https://goo.gl/bgLJGk
- Bao W, Yu J, Heck S, Yazdanbakhsh K. Regulatory T-cell status in red cell alloimmunized responder and nonresponder mice. Blood. 2009; 113: 5624-5627. Ref.: https://goo.gl/6d4qoQ
- Yu J, Heck S, Yazdanbakhsh K. Prevention of red cell alloimmunization by CD25 regulatory T cells in mouse models. Am. J. Hematol. 2007; 82: 691-696. Ref.: https://goo.gl/59Euzw
- Bao W, Zhong H, Manwani D, Vasovic L, Uehlinger J, Lee MT, et al. Regulatory B-cell compartment in transfused alloimmunized and nonalloimmunized patients with sickle cell disease. Am J Hematol. 2013; 88: 736-740. Ref.: https://goo.gl/DCikdP
- Bao W, Zhong H, Li X, Lee MT, Schwartz J, et al. Immune regulation in chronically transfused alloantibody responder and nonresponder patients with sickle cell disease and beta-thalassemia major. Am J Hematol. 2011; 86: 1001-1006. Ref.: https://goo.gl/dfa6Q1
- Aslam R, Hu Y, Gebremeskel S, Segel GB, Speck ER, et al. Thymic retention of CD 4+CD 25+FoxP 3+ T regulatory cells is associated with their peripheral deficiency and thrombocytopenia in a murine model of immune thrombocytopenia. Blood. 2012; 120: 2127.
- Castellino SM, Combs MR, Zimmerman SA, Issitt PD, Ware RE. Erythrocyte autoantibodies in paediatric patients with sickle cell disease receiving transfusion therapy: Frequency, characteristics and significance. Br. J. Haematol. 1999; 104: 189-194. Ref.: https://goo.gl/XPe1fk
- Strobel E. Chronic hemolytic transfusion reactions. Transfus Med Hemother. 2008; 35: 346-353. Ref.: https://goo.gl/GHcrtb
- Chapman JF, Elliott C, Knowles SM, Milkins CE, Poole GD, Transfusion Task Force members. Guidelines for compatibility procedures in blood transfusion laboratories. Working Party of the British Committee for Standards in Haematology Blood Transfusion Task Force. Transfus Med. 2004; 14: 59.
- Silvy M, Tournamille C, Babinet J, Pakdaman S, Cohen S, et al. Red blood cell immunization in sickle cell disease: evidence of a large responder group and a low rate of anti-Rh linked to partial Rh phenotype. Haematologica. 2014; 99: 115-117. Ref.: https://goo.gl/24wcMN
- Cappellini MD, Cohen A, Porter J, Taher A, Viprakasit V, editors. Guidelines for the management of TransfusionDependent Thalassaemia (TDT). 3rd ed. Nicosia (CY): Thalassaemia International Federation; 2014.
- Michail-Merianou V, Pamphili-Panousopoulou L, Piperi-LowesL, Pelegrinis E, Karaklis A. Alloimmunization to red cellantigens in thalassemia: comparative study of usual versusbetter-match transfusion programmes. Vox Sang.1987; 52: 95-98. Ref.: https://goo.gl/wGV2JM
- Cazzola M, Borgna-Pignatti C, Locatelli F, Ponchio L, Beguin Y, et al. A moderate transfusion regimen may reduce iron loading in beta-thalassemia major without producing excessive expansion of erythropoiesis. Transfusion.1997; 37:135-140. Ref.: https://goo.gl/NJSUdc
- Cazzola M, De Stefano P, Ponchio L, Locatelli F, Beguin Y, Dessi C, et al. Relationship between transfusion regimen and suppression of erythropoiesis in beta-thalassaemia major. Br J Haematol. 1995; 89: 473-478. Ref.: https://goo.gl/oSy4PD
- Noizat-Pirenne F, Bachir D, Chadebech P, Michel M, Plonquet A, et al. Rituximab for prevention of delayed hemolytic transfusion reaction in sickle cell disease. Haematologica. 2007; 92: 132-135. Ref.: https://goo.gl/J183wj
- Veldhuisen B, van der Schoot CE, de Haas M. Blood group genotyping: from patient to high through put donor screening. Vox Sang. 2009; 97: 198-206. Ref.: https://goo.gl/kysVnY