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

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

Massimo Franchini  1   2 , Gian Luca Forni  3 , Giuseppe Marano  1 , Mario Cruciani  1   4 , Carlo Mengoli  1 , Valeria Pinto  3 , Lucia De Franceschi  5 , Donatella Venturelli  6 , Maddalena Casale  7 , Martina Amerini  1   8 , Martina Capuzzo  9 , Giuliano Grazzini  1   8 , Francesca Masiello  1 , Ilaria Pati  1 , Eva Veropalumbo  1 , Stefania Vaglio  1   10 , Simonetta Pupella  1 , Giancarlo M Liumbruno  1
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Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review

Massimo Franchini et al. Blood Transfus. 2019 Jan.

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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Conflict of interest statement

Diclosure of conflicts of interest

Giancarlo M. Liumbruno is the Editor-in-Chief of Blood Transfusion. As a result, this manuscript was subjected to an additional external review. The Authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the selection of the studies.
Figure 2
Figure 2
Forest plot of the prevalence of red blood cell alloantibodies in patients with thalassaemia. CI: confidence intervals.
Figure 3
Figure 3
Forest plots of the prevalence of red blood cell alloantibodies in patients with thalassaemia major (TM) or thalassaemia intermedia (TI). CI: confidence intervals.
See this image and copyright information in PMC

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