Alloimmunization in β-Thalassemia and Sickle Cell Disease in Middle Eastern Countries: A Systemic Review.

IF 1.2 4区 医学 Q4 BIOCHEMISTRY & MOLECULAR BIOLOGY
Nasir Al-Allawi, Muqdad Mn Al-Mousawi, Sarah Al Allawi, Kevi J Ibrahim
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Abstract

Sickle cell disease and β-thalassemia are important health problems in Middle Eastern countries. Transfusion is the cornerstone of the management in these disorders, and red blood cell alloimmunization is among the well-recognized adverse effects associated with it. We reviewed the literature on published studies on alloimmunization prevalence, its associated risk factors, and transfusion policies employed in these countries. Our review included 39 studies on thalassemia (including 9005 patients), and 19 on sickle cell disease (including 3867 patients). The mean alloimmunization prevalence rate in thalassemia was 13.0% (95% CI: 10.0-15.0%), while that in sickle cell disease was 14.0% (95% CI: 10.0 - 19.0%). The distribution of the prevalence rates showed considerable heterogeneity in both diseases. The most frequent alloantibodies detected were anti-K (25.9%), Anti-E (21.8%), and Anti-D (9.2%), with Rhesus and K antibodies comprising 74.2% of all antibodies detected. Some risk factors were significant in several studies, including older age, female sex, older age at first transfusion, number of transfused units, and splenectomy. The prevalence of alloimmunization was significantly higher in retrospective studies compared to cross-sectional ones, in both thalassemia and sickle cell disease (P = 0.04 in each). This review reaffirmed the need to provide ABO+Rhesus + K matched blood to hemoglobinopathy patients in the Middle East, and the need for more research on Rhesus variants in this part of the world.

中东国家β-地中海贫血和镰状细胞病的同种异体免疫:系统综述
镰状细胞病和β-地中海贫血是中东国家的重要健康问题。输血是这些疾病管理的基石,而红细胞同种异体免疫是与输血相关的公认不良反应之一。我们回顾了已发表的关于这些国家同种异体免疫流行率、相关危险因素和输血政策的研究文献。我们的综述包括39项地中海贫血研究(包括9005例患者)和19项镰状细胞病研究(包括3867例患者)。地中海贫血的平均同种异体免疫率为13.0% (95% CI: 10.0-15.0%),而镰状细胞病的平均同种异体免疫率为14.0% (95% CI: 10.0- 19.0%)。两种疾病的患病率分布均表现出相当大的异质性。检出最多的同种异体抗体为抗K抗体(25.9%)、抗e抗体(21.8%)和抗d抗体(9.2%),其中恒河抗体和K抗体占检出抗体总数的74.2%。一些危险因素在一些研究中是显著的,包括年龄较大、女性、首次输血年龄较大、输血单位数和脾切除术。在地中海贫血和镰状细胞病的回顾性研究中,同种异体免疫的流行率明显高于横断面研究(各P = 0.04)。这篇综述重申了为中东地区的血红蛋白病患者提供ABO+恒河猴+ K匹配血液的必要性,以及对世界这一地区的恒河猴变异进行更多研究的必要性。
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来源期刊
Hemoglobin
Hemoglobin 医学-生化与分子生物学
CiteScore
1.70
自引率
10.00%
发文量
59
审稿时长
3 months
期刊介绍: Hemoglobin is a journal in the English language for the communication of research and information concerning hemoglobin in humans and other species. Hemoglobin publishes articles, reviews, points of view The journal covers topics such as: structure, function, genetics and evolution of hemoglobins biochemical and biophysical properties of hemoglobin molecules characterization of hemoglobin disorders (variants and thalassemias), consequences and treatment of hemoglobin disorders epidemiology and prevention of hemoglobin disorders (neo-natal and adult screening) modulating factors methodology used for diagnosis of hemoglobin disorders
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