The effect of limited donor phenotyped blood transfusion on alloimmunisation in children with thalassaemia and sickle cell anaemia.

Abstract

Background: Chronic transfusion therapy has improved outcomes in children with Beta-Thalassaemia Major (BTM) and sickle cell disease (SCD). However, exposure to multiple blood transfusions introduces challenges such as alloimmunisation, which hinders further transfusions and makes finding matching units more difficult. As a measure to limit exposure of multi-transfused patients to multiple donors, the limited donor exposure program (LDEP) was introduced, where phenotyped blood from committed voluntary 3-5 donors is donated at intervals to each patient. In this study, we aimed to compare the frequency of alloantibodies in a group of patients in LDEP with those receiving blood from multiple donors.

Study design and methods: The study was carried out on 140 randomly selected multi-transfused paediatric BTM and SCD patients from Ain Shams University Paediatrics Hospital (66 of whom were in LDEP). All participants were subjected to full history taking including clinical and transfusion history, antibody screening for alloantibodies, and antibody identification.

Results: The studied group of patients had a mean age of 5.8 ± 2.9 years with M/F ratio 1.1:1. Factors like gender (higher in females), splenectomy, frequent transfusions, and history of receiving non-phenotyped blood were significantly associated with higher alloimmunisation. LDEP group showed significantly lower alloimmunisation rates than those receiving blood from multiple donors (7.6% vs. 86.5%, p < 0.001).

Conclusion: LDEP applied on a segment of multi-transfused patients at Ain Shams University Paediatric Haematology Clinic was associated with a lower, statistically significant prevalence of red cell alloantibodies.