Transfusion Complications in Thalassemia Patients: A Report from the Centers for Disease Control and Prevention (CDC)
Published Date:Jul 25 2013
Corporate Authors:CDC thalassemia investigators
Centers For Disease Control And Prevention (U.S.)
Hematology – Red Cells
Transfusion Complications - Non Infectious
Transfusion Practices (Oncology- Hematology)
Funding:5U01DD000310-05/DD/NCBDD CDC HHS/United States
AVU3/Intramural CDC HHS/United States
M01-RR02172/RR/NCRR NIH HHS/United States
U01-DD0003075/DD/NCBDD CDC HHS/United States
U01-DD000308-05/DD/NCBDD CDC HHS/United States
U01-DD000311-05/DD/NCBDD CDC HHS/United States
U01-DD00306/DD/NCBDD CDC HHS/United States
U01-DD00309/DD/NCBDD CDC HHS/United States
Description:Background and Study Objectives
Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. The purpose of this report is to summarize the patient population as well as previous non-immune and immune transfusion complications at the time of enrollment into the program. A focus on factors associated with allo- and auto-immunization in chronically transfused patients and a description of blood product preparation and transfusion practices at the participating institutions are included.
Study Design and Methods
The CDC Thalassemia Blood Safety Network is a consortium of thalassemia centers, longitudinally following patients to determine transfusion-related complications. Enrollment occurred from 2004 through 2012 and annual data collection is ongoing. Demographic data, transfusion history, and previous transfusion and non-transfusion complications were summarized for patients enrolled between 2004 and 2011. Logistic analyses of factors associated with allo- and auto-immunization were developed. Summary statistics of infections reported at the time of enrollment were also calculated.
The race/ethnicity of the 407 thalassemia patients enrolled in the Network was predominantly Asian or Caucasian and 27% were immigrants. The average age was 22.3 years ± 13.2 and patients received an average total number of 149 ± 103.4 units of red blood cells. Iron-induced multi-organ dysfunction was common despite chelation. At study entry, 86 patients had previously been exposed to possible transfusion-associated pathogens, including Hepatitis-C (61), Hepatitis B (20), Hepatitis A (3), Parvovirus (9), HIV (4), malaria (1), staphylococcus aureus (1) and babesia (1). As 27% of the population was born outside of the United States (India, Pakistan, Thailand, China, Vietnam and Iran accounting for 57%), the source of infection cannot be unequivocally tied to transfusion. In total, 24% of transfused patients were reported to have possible transfusion-associated pathogens. Transfusion reactions occurred in 48% of patients, including allergic, febrile, and hemolytic; 19% of transfused patients were alloimmunized (defined as a having an antibody to a foreign red blood cell antigen). The most common antigens were E, Kell and C. One hemolytic reaction to an anti-Mia antibody was noted. Years of transfusion was the strongest predictor of alloimmunization. However, initiating transfusions in infancy may induce immune tolerance. Autoantibodies occurred in 6.5% and were predicted by previous alloimmunization (p < .0001). Local institutional transfusion policies, rather than patient characteristics, were the major determinants in the preparation of red-blood cells for transfusion.
Hemosiderosis and immunologic and non-immunologic transfusion reactions are major problems in thalassemia patients. Infections continue to be a problem in thalassemia and new pathogens have been noted. National transfusion guidelines for red cell phenotyping and preparation are needed in thalassemia to decrease transfusion-related morbidity.
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