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Transfusion 2019 Feb 15. Epub 2019 Feb 15.

Division of Hematology and Oncology, University of Florida, Gainesville, Florida.

Background: Delayed hemolytic transfusion reaction (DHTR) with hyperhemolysis is a potentially fatal complication resulting from alloimmunization that can cause severe hemolysis of both transfused and intrinsic red blood cells (RBCs). Patients with sickle cell disease often receive multiple RBC units during their lifetime and thus are likely to develop alloantibodies that increase the risk for DHTR. Treatment to decrease hemolysis includes intravenous immunoglobulin (IVIG), steroids, eculizumab, rituximab, and plasmapheresis in addition to erythropoietin (EPO), intravenous (IV) iron, vitamin B12, and folate to support erythropoiesis. Read More

Afr Health Sci 2018 Dec;18(4):979-987

Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria.

Background: Serological safety is an integral part of overall safety for blood banks.

Objectives: The aim of the study was to determine the prevalence and specificities of red blood cell alloimmunization in multi-transfused patients with chronic kidney disease (CKD).

Methods: A cross-sectional case-control study carried out at the University of Port Harcourt Teaching Hospital in which 186 patients with CKD were enrolled consecutively, 124 had received multiple transfusions (more than one unit of blood in one month, or at least 10 units within 3 months), while 62 had never been transfused. Read More

Transfusion 2019 Feb 13. Epub 2019 Feb 13.

Department of Experimental Immunohematology, Sanquin, Amsterdam, Netherlands.

Background: The routine pretransfusion investigations in Southern Ghana involve only ABO-D blood group typing and ABO compatibility testing without screening for irregular red blood cell (RBC) antibodies. The prevalence and specificities of RBC antibodies and frequencies of most minor blood group antigens in transfused patients with sickle cell disease (SCD) in Ghana are not known and are the objectives of this study.

Study Design And Methods: This was a cross-sectional study that investigated transfused patients with SCD for the presence of irregular RBC antibodies and Rhesus, Kell, Duffy, Kidd, and Ss antigens. Read More

Vox Sang 2019 Feb 7. Epub 2019 Feb 7.

Vitalant Research Institute, San Francisco, CA, USA.

Background And Objectives: Alloimmunization is common following transfusion with platelet-rich plasma (PRP) and can cause complications such as platelet refractoriness or transplant rejection. It has previously been shown that pathogen reduction of PRP with riboflavin and UV light (UV+R) can protect against alloimmunization in mice and induce partial tolerance to subsequent transfusions.

Materials And Methods: Using B6 H2 congenic mice, this study evaluated the relative contributions of major histocompatibility complex (MHC) antigens and minor antigens to both the alloresponse to PRP transfusion and the partial tolerance induced by UV+R treatment. Read More

Rev Med Chil 2018 Nov;146(11):1347-1350

Servicio de Medicina, Santiago, Chile.

Sickle cell anemia was a rare disease in Chile, especially in adults, however the recent immigration wave from Haiti is changing this scenario. We report a 29 year old black female from Haiti with a non-disclosed history of sickle cell anemia. She was transfused with two units of red blood cells, found unconscious and with jaundice five days later and admitted to the hospital. Read More

Best Pract Res Clin Obstet Gynaecol 2019 Jan 9. Epub 2019 Jan 9.

Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy.

Fetal anemia has been known for many years as a dangerous complication of pregnancy. Its most common causes are maternal alloimmunization and parvovirus B19 infection, although it can be associated with many different pathological conditions including fetal aneuploidies, vascular tumors, and arteriovenous malformations of the fetus or placenta and inherited conditions such as alpha-thalassemia or genetic metabolic disorders. Doppler ultrasonographic assessment of the peak velocity of systolic blood flow in the middle cerebral artery for the diagnosis of fetal anemia and intravascular intrauterine transfusion for its treatment are the current practice standards. Read More

Blood Rev 2019 Jan 28. Epub 2019 Jan 28.

Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

An alternative to human red blood cells (RBCs) for clinical transfusion would be advantageous, particularly in situations of massive acute blood loss (where availability and compatibility are limited) or chronic hematologic diseases requiring frequent transfusions (resulting in alloimmunization). Ideally, any alternative must be neither immunogenic nor pathogenic, but readily available, inexpensive, and physiologically effective. Pig RBCs (pRBCs) provide a promising alternative due to their several similarities with human RBCs, and our increasing ability to genetically-modify pigs to reduce cellular immunogenicity. Read More

Transfusion 2019 Jan 31. Epub 2019 Jan 31.

Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, AUMC, Amsterdam, The Netherlands.

Background: Alloimmunization against the high-frequency Vel blood group antigen may result in transfusion reactions or hemolytic disease of fetus and newborn. Patients with anti-Vel alloantibodies require Vel-negative blood but Vel-negative individuals are rare (1:4000). Identification of Vel-negative donors ensures availability of Vel-negative blood; however, accurate Vel blood group typing is difficult due to variable Vel antigen expression and limited availability of anti-Vel typing sera. Read More

Transfusion 2019 Feb 25;59(2):744-753. Epub 2019 Jan 25.

BloodworksNW Research Institute, Seattle, Washington.

Background: Humoral alloimmunization to human leukocyte antigen (HLA) can represent a barrier to solid-organ transplantation, can lead to a refractory state in patients requiring platelet transfusion, and can also contribute to transfusion-related acute lung injury (TRALI). While exposure to HLA-mismatched cells/tissues are generally required for HLA alloimmunization, the effect of the extent of major histocompatibility complex (MHC) mismatch between donor and recipient is poorly understood.

Study Design And Methods: A novel mouse was generated that allows the expression of a single MHC Class I alloantigen, K . Read More

Transfus Apher Sci 2019 Jan 2. Epub 2019 Jan 2.

Division of Transfusion Medicine and Therapeutic Pathology, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.

Background: In sickle cell disease (SCD), red blood cells (RBCs) containing hemoglobin S can be denser than RBCs containing wild-type hemoglobin, especially when dehydrated. We hypothesize that targeting denser RBCs during red blood cell (RBC) exchange for SCD could result in more efficient removal of dehydrated, sickled RBCs and preservation of non-sickled RBCs.

Study Design And Methods: Waste products from RBC exchanges for SCD were used as "simulated patients". Read More

Transfusion 2019 Jan 3. Epub 2019 Jan 3.

Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.

Background: Recent reports have indicated that the risk of anti-D alloimmunization following D-incompatible platelet (PLT) transfusion is low in hematology and oncology patients. We investigated the rate of anti-D alloimmunization in RhD-negative (D ) patients with chronic liver disease transfused with D platelet concentrates (PCs) and the factors involved, at a liver transplant (LT) center.

Study Design And Methods: We reviewed the blood bank database from January 2003 to October 2016. Read More

Transfus Apher Sci 2018 Dec 5. Epub 2018 Dec 5.

U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), University of Campania "L. Vanvitelli", Naples, Italy; Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania "L. Vanvitelli", Naples, Italy.

Background: The development of alloantibodies may complicate the management of patients with β-thalassemia. An extended antigenic matching may reduce the risk of alloimmunization. Our previous study showed that the introduction of molecular red blood cell (RBC) typing allows finding suitable blood units for multi-transfused patients. Read More

Blood Adv 2018 Dec;2(24):3637-3647

Department of Molecular and Human Genetics and.

Red blood cell (RBC) transfusion remains a critical therapeutic intervention in sickle cell disease (SCD); however, the apparent propensity of some patients to regularly develop RBC alloantibodies after transfusion presents a significant challenge to finding compatible blood for so-called alloimmunization responders. Predisposing genetic loci have long been thought to contribute to the responder phenomenon, but to date, no definitive loci have been identified. We undertook a genome-wide association study of alloimmunization responder status in 267 SCD multiple transfusion recipients, using genetic estimates of ancestral admixture to bolster our findings. Read More

Transfus Med Hemother 2018 Nov 31;45(6):429-436. Epub 2018 Oct 31.

Department of Gynecology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Background: Alloimmunization to red blood cells (RBCs) may result in fetal anemia prior to 20 weeks gestation. The question as to whether early commencement of antenatal treatment with high-dose intravenous immunoglobulins (IVIG) may prevent or at least delay the development of fetal anemia in the presence of alloantibodies to RBCs is highly relevant.

Patients And Results: Here we describe a patient with high-titer anti-K and two other severely affected pregnant women with a history of recurrent pregnancy loss due to high-titer anti-D or anti-D plus anti-C. Read More

Transfus Med Hemother 2018 Nov 11;45(6):388-396. Epub 2018 May 11.

Serviço de Pesquisa, Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Fundação Hemominas, Belo Horizonte, Brazil.

Background: The frequency of human platelet antigens (HPA) varies according to ethnicity, which causes differences in the morbidity of alloimmune and autoimmune thrombocytopenic disorders in different populations. Studies on HPA frequencies in Brazil have reported differences among Brazilian populations produced by the diverse degrees of admixture throughout the country.

Methods: In the present study, we investigated the variation of HPA distribution in Brazil, compared with worldwide populations, and describe the frequencies of HPA-1, -2, -3, -5, and -15 in a large urban center in Southern Brazil (Belo Horizonte) based on a sample of blood donors. Read More

Front Immunol 2018 16;9:2516. Epub 2018 Nov 16.

Department of Laboratory Medicine and Pathology, Center for Transfusion Medicine and Cellular Therapies, Emory University School of Medicine, Atlanta, GA, United States.

Red blood cell (RBC) alloimmunization represents a significant immunological challenge for some patients. While a variety of immune constituents likely contribute to the initiation and orchestration of alloantibodies to RBC antigens, identification of key immune factors that initiate alloantibody formation may aid in the development of a therapeutic modality to minimize or prevent this process. To define the immune factors that may be important in driving alloimmunization to an RBC antigen, we determined the specific immune compartment and distinct cells that may initially engage transfused RBCs and facilitate subsequent alloimmunization. Read More

Hematology Am Soc Hematol Educ Program 2018 11;2018(1):553-560

Laboratory Medicine and Pathobiology (Transfusion Medicine) and Medicine (Clinical Hematology), University Health Network/University of Toronto, Toronto, ON, Canada.

The transfusion support of hematological malignancies considers 2 dimensions: the quantity of what we order (in terms of triggers, doses, targets, and intervals), and the special qualities thereof (with respect to depths of matching and appropriate product modifications). Meanwhile, transfusion-related enhancements in the quantity and quality of life may not be dose dependent but rather tempered by unintended patient harms and system strains from overexposure. Evidence and guidelines concur in endorsing clinically noninferior conservative red blood cell (RBC) transfusion care strategies (eg, triggering at hemoglobin <7-8 g/dL and in single-unit doses for stable, nonbleeding inpatients). Read More

Indian J Pediatr 2018 Dec 4. Epub 2018 Dec 4.

Department of Pediatrics, Government Medical College, Thiruvananthapuram, Kerala, India.

Objectives: To estimate the prevalence and specificity pattern of red blood cell (RBC) alloimmunization among pediatric multitransfused patients, and to identify the factors associated with alloimmunization.

Methods: This was a descriptive cross-sectional study conducted among mutitransfused pediatric patients over a period of two years. The relevant clinical details of patients were collected, and RBC antibody screening was done. Read More

Transfusion 2019 Feb 30;59(2):470-481. Epub 2018 Nov 30.

Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.

Background: Platelet transfusions can induce alloimmunization against HLA antigens. The use of pathogen-reduced platelet concentrates (PCs) was suggested to reduce HLA alloimmunization and concomitant transfusion refractoriness.

Methods: This study investigated HLA alloimmunization in available samples from 448 hemato-oncological patients who were randomized for the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) trial to receive either untreated or pathogen-reduced PCs (Mirasol, Terumo BCT Inc. Read More

Transfusion 2019 Feb 29;59(2):754-761. Epub 2018 Nov 29.

Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Background: Blood-group typing of donors and patients is essential to avoid incompatible transfusions. Transfusion of incompatible RBCs may result in alloimmunization complicating future transfusions or in the presence of antibodies in adverse reactions. With more than 300 blood group antigens identified, it is difficult to provide fully compatible blood. Read More

Hematology 2019 Dec;24(1):208-214

a Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand.

The study was to determine the prevalence and clinical significances of red blood cell (RBC)-bound IgG as detected by flow cytometry in polytransfused patients with thalassemias. Relationship of the presence of RBC-bound IgG with RBC alloimmunization was also evaluated. This study included 59 polytransfused patients with β-thalassemia disease. Read More

Transfusion 2019 Jan 15;59(1):177-184. Epub 2018 Nov 15.

Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Background: Hemoglobin E-β thalassemia and homozygous β -thalassemia are the most common chronic transfusion-dependent thalassemias in Thailand. Patients with these conditions can experience clinical complications such as RBC alloimmunization. In this study we aimed to determine the prevalence, alloimmunization risk factors, antigenic exposure, and evaluation of antigen- (C, c, E, e, Mi ) matched RBC transfusion. Read More

Ann Lab Med 2019 Mar;39(2):218-222

Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Red blood cell (RBC) alloimmunization varies across human populations and ethnic groups. We evaluated the characteristics of RBC alloimmunization and compared the risk of alloimmunization in Korean patients with myelodysplastic syndrome (MDS) and liver cirrhosis (LC), two representative diseases in which chronic transfusion is required. In total, 115 MDS patients and 202 LC patients transfused with RBCs between 2013 and 2015 were retrospectively included. Read More

JCI Insight 2018 Nov 15;3(22). Epub 2018 Nov 15.

Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology.

RBC alloimmunization represents a significant immunological challenge for patients requiring lifelong transfusion support. The majority of clinically relevant non-ABO(H) blood group antigens have been thought to drive antibody formation through T cell-dependent immune pathways. Thus, we initially sought to define the role of CD4+ T cells in formation of alloantibodies to KEL, one of the leading causes of hemolytic transfusion reactions. Read More

Transfusion 2019 Jan 14;59(1):217-225. Epub 2018 Nov 14.

Department of Laboratory Medicine, Yale University, New Haven, Connecticut.

Background: Little information exists on red blood cell (RBC) alloimmunization in healthy US blood donors, despite the potential significance for donors themselves, blood recipients, and the blood center.

Study Design And Methods: Donor/donation data were sourced from the Recipient Epidemiology and Donor Evaluation Study-III, which contains information from four US blood centers during 2012 through 2016. Multivariable logistic regression was used to assess prevalence of positive antibody screen by donor demographics, blood type, parity, and transfusion history. Read More

Am J Clin Pathol 2019 Feb;151(3):344-348

Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.

Objectives: Transfusions are often needlessly aborted after occurrence of a mild allergic transfusion reaction (ATR), leading to wastage and reexposure of recipients to additional blood products (with potential alloimmunization). We aimed to determine the symptoms associated with such reactions (along with other parameters) as a possible reason of concern for transfusionists aborting such transfusions.

Methods: We reviewed the symptomology of all mild ATRs (as well as the associated wastage and costs of aborted transfusions) at an academic medical center that occurred over a period of 1 year. Read More

Hum Immunol 2019 Feb 7;80(2):120-125. Epub 2018 Nov 7.

Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France; Etablissement Français du Sang PACA Corse, Marseille, France. Electronic address:

Factors determining anti-HLA immunization are poorly understood, although anti-HLA immunization following pregnancy is well described. The HLA-G molecule has been extensively described for its implication in immunological tolerance, especially during pregnancy. Transplant studies show an association between HLA-G haplotypes and alloimmunization. Read More

Blood Adv 2018 Nov;2(21):2986-3000

Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA; and.

Alloantibodies developing after exposure to red blood cell (RBC) alloantigens can complicate pregnancy and transfusion therapy. The only method currently available to actively inhibit RBC alloantibody formation is administration of antigen-specific antibodies, a phenomenon termed antibody-mediated immune suppression (AMIS). A well-known example of AMIS is RhD immune globulin prophylaxis to prevent anti-D formation in RhD individuals. Read More

Transfusion 2018 Nov 28;58(11):2483-2489. Epub 2018 Sep 28.

Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland.

Multiple hematopoietic progenitor cell (HPC) transplantation options for patients with sickle cell disease (SCD) are currently under investigation. Patients with SCD have a high rate of alloimmunization to red blood cell antigens, often complicating transfusion support. Transfusion reactions, including acute and delayed hemolytic reactions, have been observed despite immunosuppressive regimens. Read More

Hematol Transfus Cell Ther 2018 Oct-Dec;40(4):326-331. Epub 2018 May 22.

Hospital das Clinicas da Universidade Federal de Goiás (HC/UFG), Goiânia, GO, Brazil.

Background: Unexpected red blood cell alloantibodies can cause hemolytic transfusion reactions. In this study, the prevalence of alloimmunization, the rate of identification of alloantibodies and the rate of blood transfusion reactions among transfused patients were identified in a clinical emergency hospital in Brazil.

Methods: Transfusions and clinical records of patients who had a positive indirect antiglobulin test between January and December 2013 were analyzed. Read More

Front Immunol 2018 5;9:2200. Epub 2018 Oct 5.

Bloodworks Northwest Research Institute, Seattle, WA, United States.

Each year, over 5 million red blood cell (RBC) transfusions are administered to patients in the USA. Despite the therapeutic benefits of RBC transfusions, there are associated risks. RBC-specific alloantibodies may form in response to antigenic differences between RBC donors and recipients; these alloantibodies can be a problem as they may mediate hemolysis or pose barriers to future transfusion support. Read More

Transfus Med Hemother 2018 Jul 19;45(4):271-276. Epub 2018 Jul 19.

Pathology & Laboratory Medicine Division, Children's National Health System, Washington, DC, USA.

One of the most important and persistent complications of blood transfusion is red blood cell (RBC) alloimmunization. When a patient is exposed to RBC antigens that differ from their own they can form alloantibodies to these foreign antigens. Blood group antigens are highly conserved and follow ancestral patterns of inheritance that may demonstrate population restriction. Read More

Transfus Med Hemother 2018 Jul 6;45(4):258-262. Epub 2018 Jul 6.

Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, Brazil.

The development of red blood cell (RBC) alloantibodies and autoantibodies complicates transfusion therapy in sickle cell disease (SCD) patients. In an effort to reduce the risk of alloimmunization, some strategies have been used to provide antigen-matched RBC transfusions to patients with SCD in Brazil, including molecular matching in 3 levels: RH and K matching; extended matching (RH, KEL, FY, JK, MNS, DI), and extended matching including and variant alleles. Molecular matching has shown clinical benefits to the patients with SCD, contributing significantly to reduce the rates of alloimmunization. Read More

Transfus Med Hemother 2018 Jul 5;45(4):252-257. Epub 2018 Jul 5.

Department of Blood Transfusion, The First Affiliated Hospital of Shenzhen University School of Medicine, The Second People's Hospital of Shenzhen, Shenzhen, China.

Background: Molecular typing for blood group alleles has been established in many countries for patients and blood donors. In the Chinese literature nearly 80% of transfused patients with alloimmunization have antibodies specific for antigens of the Rh blood group system. We investigated if it is feasible to match packed red blood cells (RBCs) for Chinese β-thalassemia patients by genotyping. Read More

Transfusion 2018 Nov 19;58(11):2490-2494. Epub 2018 Sep 19.

Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.

Background: The blood bank and transfusion medicine services (BBTMS) engages with electronic health records (EHRs), clinicians, and outside hospitals (OHs) to obtain comprehensive patient history to optimize care. Detection of anti-D in a pregnant patient underscores this work. Differentiating passive anti-D due to RhIG administration versus alloanti-D affects clinical decision making. Read More

Haematologica 2019 Feb 13;104(2):263-268. Epub 2018 Sep 13.

Center for Clinical Transfusion Research, Sanquin Research, Leiden.

The observation, by Ray Owen and colleagues in 1954, that D-negative women were less likely to form anti-D antibodies against their D-positive fetus if their mother possessed the D-antigen, was not found in all later studies. We hypothesized that breastfeeding, received by the mother, may affect her immunity against non-inherited maternal red blood cell antigens. We studied a cohort of 125 grandmother-mother-child combinations, from a follow-up study of mothers after intrauterine transfusion of the fetus for alloimmune hemolytic disease. Read More

Prenat Diagn 2018 Nov 27;38(12):943-950. Epub 2018 Sep 27.

Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.

Objective: In this study, we aim to evaluate trends in the condition of fetuses and neonates with hemolytic disease at the time of first intrauterine transfusion (IUT) and at birth, in relation to routine first-trimester antibody screening, referral guidelines, and centralization of fetal therapy.

Method: We conducted a 30-year cohort study including all women and fetuses treated with IUT for red cell alloimmunization at the Dutch national referral center for fetal therapy.

Results: Six hundred forty-five fetuses received 1852 transfusions between 1 January 1987 and 31 December 2016. Read More

J Pediatr Hematol Oncol 2018 Aug 31. Epub 2018 Aug 31.

Departments of Pediatrics.

Beta thalassemia major (βTM) is the most common inherited hemoglobinopathy. Management essentially focuses on preventing and treating complications. Conventional treatment is based on a regular blood transfusion program, and chelation therapy. Read More

Arch Med Sci 2018 Aug 15;14(5):1041-1047. Epub 2016 Nov 15.

Department of Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.

Introduction: Pregnant women negative for human platelet antigen 1a (HPA-1a) are at risk of alloimmunization with fetal HPA-1a antigen inherited from the father, and their offspring may develop fetal and neonatal alloimmune thrombocytopenia (FNAIT). The aim of this study was to analyze the frequency of HPA-1a alloimmunization in pregnant Polish women, the feasibility of using maternal platelets for intrauterine transfusions in women subjected to diagnostic fetal blood sampling (FBS) and to discuss potential consequences of alloimmunization.

Material And Methods: Fifteen thousand two hundred and four pregnant women were typed for HPA-1a; HPA-1a negative were screened for anti-HPA-1a. Read More

Indian J Hematol Blood Transfus 2018 Jul 10;34(3):506-509. Epub 2017 Oct 10.

4Graduate Program, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand.

Diego (DI) blood group genotyping is clinically important in Asian populations. Data of Diego blood type among southern Thais is still unknown. This study aimed to report and allele frequencies in southern Thai blood donors and to estimate potential risk of Di incompatibility and alloimmunization in Thai populations. Read More

Transfus Med Rev 2019 01 26;33(1):12-23. Epub 2018 Jul 26.

Department of Hematology & Oncology, Emory University School of Medicine, Atlanta, GA.

Red blood cells (RBC) transfusion is critical in managing acute and chronic complications in sickle cell disease (SCD); however, it is complicated by RBC alloimmunization, iron overload, transfusion reactions and infection. Several reports documented an increased incidence of alloantibodies in transfused individuals with SCD, especially for Rh and Kell antigens. As a result, the National Institutes of Health Expert Panel and British Society for Haematology guidelines recommend primary matching for C/c, E/e and K antigens in addition to ABO/RhD for RBC transfusions. Read More

Int Urol Nephrol 2018 Oct 17;50(10):1787-1793. Epub 2018 Aug 17.

Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France.

Purpose: To determine the impact of transplant nephrectomy on morbidity and mortality and HLA immunization.

Methods: All patients who underwent transplant nephrectomy in our centre between 2000 and 2016 were included in this study. A total of 2822 renal transplantations and 180 transplant nephrectomies were performed during this period. Read More

Transfus Med Rev 2018 10 19;32(4):213-219. Epub 2018 Jul 19.

Children's National Health System, Washington, D.C., USA; The George Washington University, Departments of Pediatrics & Pathology, Washington, DC, USA.

Alloimmunization to red blood cell (RBC) antigens represents a challenge for physicians caring for women of child bearing potential. Exposure to non-self RBC antigens may occur during transfusion or pregnancy leading to the development of antibodies. If a subsequent fetus bears that antigen, maternal antibodies may attack the fetal red blood cells causing red cell destruction and clinically significant hemolytic disease of the fetus and newborn (HDFN). Read More

Front Med (Lausanne) 2018 25;5:199. Epub 2018 Jul 25.

Department of Transfusion Technology Assessment, Sanquin Research, Amsterdam, Netherlands.

Alloimmunization is currently the most frequent adverse blood transfusion event. Whilst completely matched donor blood would nullify the alloimmunization risk, this is practically infeasible. Current matching strategies therefore aim at matching a limited number of blood groups only, and have evolved over time by systematically including matching strategies for those blood groups for which (serious) alloimmunization complications most frequently occurred. Read More

Transfus Apher Sci 2018 Aug 1;57(4):582-586. Epub 2018 Aug 1.

Graduate Program in Biomedical Sciences, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand.

Background: S and s antigens of the MNS system are of clinical importance because alloanti-S and -s have usually caused delayed hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. Various red cell genotyping has been established to predict the phenotypes to solve serological test limitations.

Objectives And Methods: This study aimed to determine S and s genotype frequencies and to estimate the alloimmunization risks among central, northern and southern Thai populations. Read More

Am J Obstet Gynecol 2018 Oct 29;219(4):393.e1-393.e8. Epub 2018 Jul 29.

Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands; Department of Clinical Transfusion Research, Sanquin Research, Amsterdam, The Netherlands.

Background: There is controversy on critical cut-off values of laboratory testing to select pregnancies at increased risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. Without early detection and treatment, anti-Kell-mediated hemolytic disease of the fetus and newborn may result in progressive fetal anemia, fetal hydrops, asphyxia, and perinatal death.

Objective: We aimed to determine the value of repeated anti-Kell titer determination and biological activity measurement using the antibody-dependent cellular cytotoxicity test determination in the management of pregnancies at risk for anti-Kell-mediated hemolytic disease of the fetus and newborn. Read More

Hematol Transfus Cell Ther 2018 Apr-Jun;40(2):107-111. Epub 2018 Feb 17.

Hemocentro Regional de Uberaba, Fundação Hemominas, Uberaba, MG, Brazil.

Background: The large diversity of red blood cell antigens favors, especially in multi-transfused patients, the occurrence of autoimmunization and alloimmunization with the risk of hemolytic transfusion reactions. Thus, this study aimed to determine the rates of alloimmunization and autoimmunization in these individuals, as well as the types of alloantibodies and their systems, clinical and epidemiological aspects and the frequency of autoimmunity in alloimmunized and non-alloimmunized patients.

Methods: In a retrospective study, 153 multi-transfused patients from 2006 to 2014 were evaluated. Read More

Ann Lab Med 2018 Nov;38(6):599-603

The Division of Human Blood Safety Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea.

Frequencies of red blood cell (RBC) blood group antigens differ by ethnicity. Since the number of immigrants is increasing in Korea, RBC antigens should be assessed in children/youths with parents of different ethnicities to ensure safe transfusions. We investigated the frequency of RBC antigens, except for ABO and RhD, in 382 children and youths with parents having Korean and non-Korean ethnicities. Read More

Blood 2018 Sep 19;132(11):1198-1207. Epub 2018 Jul 19.

Laboratory of Immunohematology and Genomics, New York Blood Center, New York, NY.

Rh alloimmunization remains a challenge for patients with sickle cell disease (SCD) despite transfusion of serologic Rh C, E, and K antigen-matched red cells. Inheritance of altered alleles contributes to the prevalence of Rh antibodies after blood transfusion in patients with SCD and explains approximately one-third of cases. The remainder seem to be stimulated by altered Rh proteins on African American donor red cells. Read More

Pract Lab Med 2018 Nov 7;12:e00100. Epub 2018 May 7.

Department of Pathology and Laboratory Medicine, Michael J. Crescenz Veteran Affairs, Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States.

Anti-A antibodies can be found as a usually clinically insignificant naturally occurring cold IgM antibody in A-subgroup patients. It is known from multiple prior case reports that warm-reactive anti-A that reacts at 37 °C can be clinically significant, and it has been previously reported that it could form after alloimmunization with donor A red blood cell (RBC) transfusion. In addition, the development of anti-A, often as an autoantibody, have been described in the setting of various malignancies, perhaps due to expressed subtle alterations of the ABO antigens provoking an immune response. Read More