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Observational Study
. 2023 Sep;21(5):390-399.
doi: 10.2450/2022.0131-22. Epub 2022 Oct 18.

Red blood cell alloantibodies in the context of critical bleeding and massive transfusion

Krishna G Badami  1 , Catherine Neal  2 , Rosemary L Sparrow  3 , Cameron Wellard  3 , Helen E Haysom  3 , Zoe K McQuilten  3 , Erica M Wood  3
Affiliations
Observational Study

Red blood cell alloantibodies in the context of critical bleeding and massive transfusion

Krishna G Badami et al. Blood Transfus. 2023 Sep.

Abstract

Background: In the context of critical bleeding and massive transfusion (CB/MT), little is known about the development of new red blood cell (RBC) alloantibodies. We performed a retrospective, observational study to examine the frequency of RBC alloantibodies (pre-existent, anamnestic, or new) in patients with CB/MT, defined as transfusion of five or more RBC units in any 4-hour period, for any cause of CB.

Materials and methods: Data on 2,585 New Zealand patients (date/time of MT initiation, demographic data, blood group, clinical context, and transfused RBCs) were obtained from the Australian and New Zealand Massive Transfusion Registry. RBC alloantibody screening/identification data were extracted from the New Zealand Blood Service database. We calculated summary statistics, compared proportions between different independent groups using the Chi-squared test, and performed logistic regression analysis to examine the effects of variables on alloantibody presence or formation. We also determined the immunogenicities of selected RBC antigens in the context of CB/MT.

Results: Of 1,234 assessable patients, 1,166 (94.5%) showed no evidence of any alloantibody. Pre-existent, anamnestic, and new alloantibodies were found, respectively, in 4.3%, 0.4%, and 7.2% of assessable patients. By multivariable regression analysis, transfusion of D-positive RBC to D-negative patients was independently associated with new alloantibody formation. Neither the quantum of RBC transfused nor trauma as clinical context were so associated although the latter trended towards a predisposition. "Antibodies of undetermined specificity" were the commonest pre-existent and new alloantibodies. The immunogenicity of Jka was the highest in this setting.

Discussion: RBC alloantibodies of any type were rare in this CB/MT population. Patients undergoing CB/MT appear to have low risks of re-stimulating anamnestic alloantibodies, or of developing new RBC alloantibodies.

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Conflict of interest statement

The Authors declare no conflicts of interest.

References

    1. Tormey CA, Hendrickson JE. Transfusion-related red blood cell antibodies: induction and consequences. Blood. 2019;133:1821–1830. doi: 10.1182/blood-2018-08-833962. - DOI - PMC - PubMed
    1. Garg N, Sharma T, Singh B. Prevalence of irregular red blood cell antibodies among healthy blood donors in Delhi population. Transfus Apher Sci. 2014;50:415–417. doi: 10.1016/j.transci.2014.03.004. - DOI - PubMed
    1. Tormey CA, Fisk J, Stack G. Red blood cell alloantibody frequency, specificity, and properties in a population of male military veterans. Transfusion. 2008;48:2069–2076. doi: 10.1111/j.1537-2995.2008.01815.x. - DOI - PubMed
    1. Smith HM, Shirey RS, Thoman SK, Jackson JB. Prevalence of clinically significant red blood cell alloantibodies in pregnant women at a large tertiary-care facility. Immunohematology. 2013;29:127–130. - PubMed
    1. Pal M, Williams B. Prevalence of maternal red cell alloimmunisation: a population study from Queensland, Australia. Pathology. 2015;47:151–155. doi: 10.1097/PAT.0000000000000225. - DOI - PubMed

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