Transfusion Complications in Thalassemia Patients: A Report from the Centers for Disease Control and Prevention (CDC)

Details

• Alternative Title:
  Transfusion
• Personal Author:
  Vichinsky, Elliott ; Neumayr, Lynne ; Trimble, Sean ; Giardina, Patricia J. ; Cohen, Alan R. ; Coates, Thomas ; Boudreaux, Jeanne ; Neufeld, Ellis J. ; Kenney, Kristy ; Grant, Althea ; Thompson, Alexis A.
• Corporate Authors:
  CDC thalassemia investigators
• 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.
  
  Results
  
  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.
  
  Conclusion
  
  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.
  
  
• Subjects:
  Adolescent Adult Blood Safety Child Child, Preschool Erythrocyte Transfusion Female Humans Infant Longitudinal Studies Male Thalassemia Young Adult

  More +
• Source:
  Transfusion. 54(4):972-971
• Pubmed ID:
  23889533
• Pubmed Central ID:
  PMC4410835
• Document Type:
  Journal Article
• Funding:
  U01-DD000308-05/DD/NCBDD CDC HHSUnited States/ ; U01-DD00309/DD/NCBDD CDC HHSUnited States/ ; M01 RR002172/RR/NCRR NIH HHSUnited States/ ; U01 DD000306/DD/NCBDD CDC HHSUnited States/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U01 DD000309/DD/NCBDD CDC HHSUnited States/ ; U01 DD000310/DD/NCBDD CDC HHSUnited States/ ; U01-DD000311-05/DD/NCBDD CDC HHSUnited States/ ; U01-DD0003075/DD/NCBDD CDC HHSUnited States/ ; U01 DD000308/DD/NCBDD CDC HHSUnited States/ ; M01-RR02172/RR/NCRR NIH HHSUnited States/ ; 5U01DD000310-05/DD/NCBDD CDC HHSUnited States/ ; U01-DD00306/DD/NCBDD CDC HHSUnited States/ ; U01 DD000311/DD/NCBDD CDC HHSUnited States/
• Name as Subject:
  Centers for Disease Control and Prevention (U.S.)
• Place as Subject:
  United States
• Volume:
  54
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b825a2a1d590301972428bee41ef35fa9d011b46f4cac502a0574fd3b44372ed
• Download URL:
  https://stacks.cdc.gov/view/cdc/30656/cdc_30656_DS1.pdf
• File Type:
  [PDF - 237.44 KB ]