Prevalence and risk factors of alloimmunization in multi-transfused pediatric patients: A cross-sectional study from a sub-Himalayan tertiary care hospital in Uttarakhand India

IF 1.4 4区医学 Q4 HEMATOLOGY

Transfusion Clinique et Biologique Pub Date : 2025-02-01 DOI:10.1016/j.tracli.2024.10.007

Rajat Maini , Anil Kumar Rawat , Rakesh Kumar , Manish Raturi

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引用次数: 0

Abstract

Background

Packed red blood cell (PRBC) transfusion is critical in managing pediatric patients with conditions requiring frequent transfusions, such as leukemia, thalassemia, and bone marrow disorders. Alloimmunization, the formation of antibodies against foreign antigens present in the donor's blood, is a significant complication of repeated transfusions. Further, auto/alloimmunization is influenced by multiple factors, including antigenic differences between donor and recipient and the recipient’s immune status.

Objectives

This study aimed to assess the prevalence and risk factors of auto/alloimmunization among pediatric patients undergoingmultiple PRBC transfusions in a tertiary care hospital in the sub-Himalayan region of Uttarakhand, India.

Methods

A cross-sectional study was conducted on 113 multi-transfused pediatric patients aged 4 months to 18 years who received more than one PRBC transfusion between September 2022 and August 2023. Antibody screening and identification were performed using column agglutination techniques. Statistical analysis was conducted to evaluate associations between demographic, clinical factors, and antibody detection.

Results

Alloimmunization was observed in 5.31% of patients, with the majority developing antibodies against the MNS blood group system. Autoantibodies were more common, detected in 17.7% of patients. Significant associations were found between the history of prior PRBC transfusions and the formation of alloantibodies (p = 0.005). Age, gender, and ethnicity did not show a statistically significant association with antibody detection.

Conclusions

The study reveals a relatively higher prevalence of autoimmunization among multi-transfused pediatric patients. The history of PRBC transfusions was a significant risk factor, indicating the need for extended RBC phenotyping and tailored transfusion strategies to reduce alloimmunization risks in these patients. Most patients and blood donors in this region belong to the local Garhwali community. This homogeneity may help explain the lower rate of alloimmunization observed, suggesting a degree of antigenic similarity among the blood donors and the recipients.

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多重输血的儿科患者中的自身免疫流行率和风险因素：印度北阿坎德邦一家次喜马拉雅地区三级医院的横断面研究。

背景：输注成组红细胞（PRBC）对于治疗白血病、地中海贫血和骨髓疾病等需要频繁输血的儿科患者至关重要。异体免疫（针对献血者血液中的外来抗原形成抗体）是反复输血的一个重要并发症。此外，自身/同种免疫受多种因素影响，包括供血者和受血者之间的抗原差异以及受血者的免疫状态：本研究旨在评估印度北阿坎德邦次喜马拉雅地区一家三级医院中需要多次输注 PRBC 的儿科患者自身/高免疫的患病率和风险因素：对 2022 年 9 月至 2023 年 8 月期间接受过一次以上 PRBC 输血的 113 名 4 个月至 18 岁的多次输血儿科患者进行了横断面研究。采用柱凝集技术进行抗体筛查和鉴定。统计分析评估了人口统计学、临床因素和抗体检测之间的关联：结果：5.31%的患者出现了同种免疫，其中大多数人产生了针对 MNS 血型系统的抗体。自身抗体更为常见，在 17.7% 的患者中检测到。既往PRBC输血史与出现同种抗体之间存在显著关联（P=0.005）。年龄、性别和种族与抗体检测没有统计学意义：研究显示，多次输血的儿科患者中自身免疫的发病率相对较高。结论：该研究显示，多次输血的儿科患者中自身免疫的发生率相对较高，PRBC 输血史是一个重要的风险因素，这表明有必要扩大 RBC 表型检测范围并制定有针对性的输血策略，以降低这些患者的自身免疫风险。该地区的大多数患者和献血者都属于当地的 Garhwali 族群。这种同质性可能有助于解释所观察到的较低的同种免疫率，表明献血者和受血者之间存在一定程度的抗原相似性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transfusion Clinique et Biologique 医学-免疫学

CiteScore

2.50

自引率

11.80%

发文量

234

审稿时长

36 days

期刊介绍： Transfusion Clinique et Biologique, the official journal of the French Society of Blood Transfusion (SFTS): - an aid to training, at a European level - the only French journal indexed in the hematology and immunology sections of Current Contents Transfusion Clinique et Biologique spans fundamental research and everyday practice, with articles coming from both sides. Articles, reviews, case reports, letters to the editor and editorials are published in 4 editions a year, in French or in English, covering all scientific and medical aspects of transfusion: immunology, hematology, infectious diseases, genetics, molecular biology, etc. And finally, a convivial cross-disciplinary section on training and information offers practical updates. Readership: "Transfusers" are many and various: anesthetists, biologists, hematologists, and blood-bank, ICU and mobile emergency specialists...