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Blood Transfus. 2019 Jan;17(1):4-15. doi: 10.2450/2019.0229-18.

Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review.

Author information

1
Italian National Blood Centre, National Institute of Health, Rome, Italy.
2
Department of Haematology and Transfusion Medicine, "Carlo Poma" Hospital, Mantua, Italy.
3
Centre for Microcythemia and Congenital Anaemia, "Galliera" Hospital, Genoa, Italy.
4
Infection Control Committee and Antibiotic Stewardship Programme, AULSS9 "Scaligera", Verona, Italy.
5
Department of Medicine, University of Verona and AOUI-Verona, Policlinico "G.B. Rossi", Verona, Italy.
6
Department of Transfusion Medicine, University Hospital of Modena, Modena, Italy.
7
Department of Women, Children and General and Specialised Surgery, "Luigi Vanvitelli" University of Campania, Naples, Italy.
8
Italian Foundation for Research on Anaemia (FORANEMIA) and Haemoglobinopathies, Genoa, Italy.
9
Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.
10
Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.

Abstract

BACKGROUND:

Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation.

MATERIALS AND METHODS:

We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients.

RESULTS:

The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%).

DISCUSSION:

Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.

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