Red Blood Cell Alloantibodies among Multi-Transfused Patients in a Single Tertiary Center
Abstract
Objective: This study investigated the prevalence and specificity of red blood cell (RBC) alloantibodies and assessed the factors associated with their development in multi-transfused patients at a single tertiary center.
Material and Methods: This cross-sectional study retrospectively analyzed data from 384 multi-transfused patients who underwent pre-transfusion or immunohematology (IH) testing at Hospital Raja Permaisuri Bainun, Malaysia. Patients were selected using systematic random sampling, and data were extracted from electronic hospital systems and IH test reports. Variables included demographics, clinical diagnosis, transfusion history, and transplant status. Data were analyzed using descriptive statistics and logistic regression.
Results: A total of 5,675 multi-transfused patients were identified during the study period. Of the 384 patients selected for analysis, 155 (44.5%) exhibited RBC alloantibodies. Anti-E was the most frequently identified alloantibody (39.6%), followed by anti-Mia (26.2%). Patients with chronic kidney disease and thalassemia had a significantly higher risk of alloantibody development (p-value<0.001 and p-value=0.032, respectively).
Conclusion: The high rate of RBC alloimmunization in multi-transfused patients highlights the importance of extended RBC antigen matching, not only for thalassemia patients but also for those with chronic kidney disease, to reduce the risk of alloantibody formation.
Keywords
Full Text:
PDFReferences
Evers D, Middelburg RA, de Haas M, Zalpuri S, de Vooght KM, van de Kerkhof D, et al. Red-blood-cell alloimmunisation in relation to antigens’ exposure and their immunogenicity: a cohort study. Lancet Haematol 2016;3:e284-92.
Natukunda B, Schonewille H, van de Watering L, Brand A. Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases. Vox Sang 2010;98:167-71.
Tormey CA, Hendrickson JE. Transfusion-related red blood cell alloantibodies: induction and consequences. Blood 2019;133:1821-30.
Makarovska-Bojadzieva T, Velkova E, Blagoevska M. The impact of extended typing on red blood cell alloimmunization in transfused patients. Open Access Maced J Med Sci 2017;5:107-11.
Zaman S, Chaurasia R, Chatterjee K, Thapliyal RM. Prevalence and specificity of RBC alloantibodies in Indian patients attending a tertiary care hospital. Adv Hematol 2014;2014:749218.
Kulkarni S, Maru H. Extended phenotyping of blood group antigens: Towards improved transfusion practices. Global J Transfus Med 2020;5:120-5.
Almorish MAW, Al-Absi B, Elkhalifa AME, Alhamidi AH, Abdelrahman M. Red blood cell alloimmunization in blood transfusion-dependent β thalassemia major patients in Sana’a City-Yemen. Sci Rep 2024;14:1005.
Annual report of the Malaysian thalassaemia registry 2019. Putrajaya: Ministry of Health Malaysia; 2019 [cited 2025 May 3]. Available from: https://www.moh.gov.my/ moh/resources/Penerbitan/Perkhidmatan%20OnG%20&%20 Ped/THALASSAEMIA/3._Annual_Report_of_the_Malaysian_ Thalassaemia_Registry_2019_.pdf
Obi EI, Pughikumo CO, Oko-Jaja RI. Red blood cell alloimmunization in multi-transfused patients with chronic kidney disease in Port Harcourt, South-South Nigeria. Afr Health Sci 2018;18:979-87.
Valle Neto OGD, Alves VM, Pereira GA, Moraes-Souza H, Martins PRJ. Clinical and epidemiological profile of alloimmunized and autoimmunized multi-transfused patients against red blood cell antigens in a blood center of Minas Gerais. Hematol Transfus Cell Ther 2018;40:107-11.
Yusoff SM, Bahar R, Hassan MN, Noor NHM, Ramli M, Shafii NF. Prevalence of red blood cell alloimmunization among transfused chronic kidney disease patients in Hospital Universiti Sains Malaysia. Oman Med J 2020;35:e177.
Ismahanisa Ismail W, Al-Hassan FM, Shatar A, Roslan M, Rosdan NH, Zainuddin N, et al. Prevalence of red cell alloantibodies among multi transfused dependent thalassemia patient in the Malaysian state of Penang. J Sci Res Dev 2016;3:62-6.
Franchini M, Forni GL, Marano G, Cruciani M, Mengoli C, Pinto V, et al. Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review. Blood Transfus 2019;17:4-15.
Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly Asian descent. Blood 2000;96:3369-73.
Ghasemi A, Abbasian S, Ghaffari K, Salmanpour Z. Prevalence of alloantibodies and autoantibodies in transfusion dependent thalassemia patients. Iran J Blood Cancer 2016;8:80-5.
Musa RH, Ahmad NH, Muniandi G, Mahmud NN, Ismail AA, Zahrin MM, et al. Mapping red blood cell phenotypes in Malaysia: A tool to overcome transfusion challenges for providing phenotype blood. Asian J Transfus Sci 2023;19:29-35.
Al-Joudi F, Ali AB, Ramli MB, Ahmed S, Ismail M. Prevalence and specificities of red cell alloantibodies among blood recipients in the Malaysian state of Kelantan. Asian J Transfus Sci 2011;5:42-5.
Patel J, Shukla R, Gupte S. Red cell alloimmunization in multitransfused patients and multiparous women. Indian J Hematol Blood Transfus 2009;25:49-52.
Philip J, Biswas AK, Hiregoudar S, Kushwaha N. Red blood cell alloimmunization in multitransfused patients in a tertiary care center in Western India. Lab Med 2014;45:324-30.
Jan RH, Yu LC, Wen SH, Tsai SS, Lin TY. Incidence of alloantibodies in transfused patients in Eastern Taiwan. Tzu Chi Med J 2009;21:66-9.
Yousuf R, Abdul Aziz S, Yusof N, Leong CF. Incidence of Red Cell Alloantibody among the transfusion recipients of Universiti Kebangsaan Malaysia Medical Centre. Indian J Hematol Blood Transfus 2013;29:65-70.
Navaretnam G, Leong CF, Yousuf R, Vyas N, Tang YL. Prevalence of Mia antigen and anti-Mia antibody among patients from a university hospital in Malaysia. Bangladesh J Med Sci 2025;24:621-8.
Yang MH, Chen JW, Sayaka K, Uchikawa M, Tsuno NH, Wei ST, et al. Universal detection of Mia antigen and frequencies of glycophorin hybrids among blood donors in Taiwan by human monoclonal antibodies against Mia (MNS7), Mur (MNS10), and MUT (MNS35) antigens. Diagnostics 2021;11:806.
Park SW, Park JH, Kim Y, You JH, Cho HM, Kim EY, et al. A case of neonatal isoimmune hemolytic disease due to anti-Mia antibody with massive fetomaternal hemorrhage. Korean J Perinatol 2013;24:310-4.
Broadberry RE, Lin M. The incidence and significance of anti-“Mia” in Taiwan. Transfusion 1994;34:349-52.
Verduin EP, Brand A, Middelburg RA, Schonewille H. Female sex of older patients is an independent risk factor for red blood cell alloimmunization after transfusion. Transfusion 2015;55:1478-85.
Elmobark ME, Abbass AA, Anwer E, Elsharief UA, Nour BY. Red blood cell alloimmunization in multitransfused hemodialysis renal patients in central Sudan. Int J Blood Transfus Immunohematol 2019;9:1-6.
Schonewille H, van de Watering LM, Loomans DS, Brand A. Red blood cell alloantibodies after transfusion: factors influencing incidence and specificity. Transfusion 2006;46:250-6.
Gehrie EA, Tormey CA. The influence of clinical and biological factors on transfusion-associated non-ABO antigen alloimmunization: responders, hyper-responders, and non-responders. Transfus Med Hemother 2014;41:420-9.
Pirenne F, Floch A, Habibi A. How to avoid the problem of erythrocyte alloimmunization in sickle cell disease. Hematology Am Soc Hematol Educ Program 2021;2021:689-95.
Datta SS, Mukherjee S, Talukder B, Bhattacharya P, Mukherjee K. Frequency of red cell alloimmunization and autoimmunization in thalassemia patients: A report from Eastern India. Adv Hematol 2015;2015:610931.
Osman NH, Sathar J, Leong CF, Zulkifli NF, Raja Sabudin RZA, Othman A, et al. Importance of extended blood group genotyping in multiply transfused patients. Transfus Apher Sci 2017;56:410-6.
Hendrickson JE. Red blood cell alloimmunisation: induction of immunity and potential mitigation strategies. ISBT Sci Ser 2018;13:105-11.
Lal A, Wong T, Keel S, Pagano M, Chung J, Kamdar A, et al. The transfusion management of beta thalassemia in the United States. Transfusion 2021;61:3027-39.
Pavenski K, Howell A, Mazer CD, Hare GMT, Freedman J. ONTraC: A 20-year history of a successfully coordinated provincewide patient blood management program: Lessons learned and goals achieved. Anesth Analg 2022;135:448-58.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.