Assessment of erythrocyte alloimmunization among patients treated at a Brazilian university hospital

Abstract

Introduction: Alloimmunization and transfusion reactions underscore the crucial role of precise immunohematological techniques to enhance safety in transfusion. This study aims to determine the frequency of alloimmunization in patients treated at a Brazilian university hospital, investigate demographic, clinical, and epidemiological characteristics of patients with positive irregular antibody screening, as well as to assess the frequency of erythrocyte antigens and anti-erythrocyte antibodies in the population.

Materials and methods: This retrospective observational study included all irregular antibody-positive patients treated at the transfusion service of Hospital de Clínicas of the Federal University of Uberlandia between January 2019 and December 2020.

Results: Of the 201 irregular antibody-positive patients, alloimmunization was more common in women (64.2%) than in men (35.8%). Blood groups A (39.8%) and O (38.8%), and Rh positive samples (69.1%) predominated, and about half (48.2%) of the patients were transfused for preoperative procedures. The most frequently found clinically significant alloantibodies were anti-D (27.2%), anti-E (15.0%), and anti-Kell (11.5%). Of the patients, 30.6% had multiple antibody associations, with anti-D and anti-C being the most common combination. Erythrocyte immunophenotyping was performed for 76 patients with the most frequent antigens detected being e (100%), c (86.8%), and C (40.8%). Among the 14 pregnant women evaluated, most were multiparous, 85.7% had anti-D as the most prevalent antibody, and had the A-negative blood type (33.3%).

Conclusion: Alloantibody screening and identification associated with erythrocyte immunophenotyping are necessary for a better understanding of the alloimmunized population, ensuring greater safety and efficacy of transfusion therapy in the hospital setting.

Keywords: Antigen-antibody reactions; Blood group antigens; Blood group incompatibility; Erythrocyte transfusion; Transfusion reaction.

Figure 1

Flow diagram of the patients analyzed in the study.

Figure 2

Frequency of alloantibodies detected in 121 of 201 irregular antibody-positive patients evaluated by the transfusion service (AGETRA) of Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU/EBSERH), from January 2019 to December 2020 according to the type of alloantibody (A) and the blood system (B). ^aAntibodies not identified by the RBC panel used.