Details:

Alternative Title:
Transfusion
Personal Author:
Yee, Marianne E. M. ; Josephson, Cassandra D. ; Winkler, Anne M. ; Webb, Jennifer ; Luban, Naomi L.C. ; ... More +
Yee, Marianne E. M. ; Josephson, Cassandra D. ; Winkler, Anne M. ; Webb, Jennifer ; Luban, Naomi L.C. ; Leong, Traci ; Stowell, Sean R. ; Roback, John D. ; Fasano, Ross M. Less -
Description:
BACKGROUND

Chronic transfusion therapy (CTT) for sickle cell anemia (SCA) reduces disease complications by diluting sickle-erythrocytes with hemoglobin A (HbA)-containing erythrocytes and suppressing erythropoiesis. Minor antigen mismatches may result in alloimmunization, but it is unknown if antigen mismatches or recipient characteristics influence HbA clearance post-transfusion.

STUDY DESIGN AND METHODS

Children with SCA on CTT were followed prospectively for 12 months. All patients received units serologically matched for C/c, E/e, and K; patients with prior red blood cell (RBC) antibodies had additional matching for Fya, Jkb, and any previous alloantibodies. Patients’ RBC antigen genotypes, determined by PreciseType Human Erythrocyte Antigen (HEA), RHCE and RHD BeadChip assays, were compared to genotypes of transfused RBC units to assess for antigen mismatches. Decline in HbA (ΔHbA) from post-transfusion to the next transfusion was calculated for each transfusion episode.

RESULTS

Sixty patients received 789 transfusions, 740 with ∆HbA estimations, and 630 with donor HEA genotyping. In univariate mixed model analysis, ΔHbA was higher in patients with past RBC antibodies or splenomegaly and lower with in patients with splenectomy. RBC antigen mismatches were not associated with ∆HbA. In multivariate linear mixed effects modeling, ΔHbA was associated with RBC antibodies (2.70 vs. 2.45 g/dL/28 days, p=0.0028), splenomegaly (2.87 vs. 2.28 g/dL/28 days, p=0.019), and negatively associated with splenectomy (2.46 vs. 2.70 g/dL/28 days, p=0.011). CONCLUSIONS: HbA decline was increased among SCA patients with prior immunologic response to RBC antigens and decreased among those with prior splenectomy, demonstrating that recipient immunologic characteristics influenced the clearance of transfused RBC.


Subject:
[+]
Anemia, Sickle Cell
Article
Child
Erythrocyte Transfusion
Hemoglobin A
Humans
Isoantibodies
Isoantigens
Splenectomy
Splenomegaly

Source:
Transfusion. 58(6):1363-1371
Pubmed ID:
29664198
Pubmed Central ID:
PMC6021219
Document Type:
Journal Article
Funding:
P01 HL086773/HL/NHLBI NIH HHS/United States ; R01 HL095479/HL/NHLBI NIH HHS/United States ; U58 DD001138/DD/NCBDD CDC HHS/United States ; UL1 TR000424/TR/NCATS NIH HHS/United States
P01 HL086773/HL/NHLBI NIH HHS/United States ; R01 HL095479/HL/NHLBI NIH HHS/United States ; U58 DD001138/DD/NCBDD CDC HHS/United States ; UL1 TR000424/TR/NCATS NIH HHS/United States Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:4ae0573ebf2aa44d0c100a512d2ec65f502256d82f60900b08e8067e95b674e7
File Type:

Supporting Files

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