Transfusion management in autoimmune haemolytic anaemia patients: A 5-year experience from a tertiary care referral centre in India.

Objectives: The study aimed to analyse transfusion practices in sensitised autoimmune haemolytic anaemia (AIHA) patients and transfusion outcomes following transfusion of antigen-matched best-matched (AMBM) red cells.

Background: Transfusion practices in AIHA patients across resource-poor settings remain a challenge. The outcome of transfusions following the practice of transfusing best-matched (BM) units remains unknown. The data on alloimmunisation rates in sensitised AIHA patients, the utility of adsorption, and transfusion of AMBM red cells from resource-poor settings will enhance the adoption of optimal practices.

Methods and materials: Retrospective data on AIHA patients' work-up were collected and analysed for a 5-year interval. Patients were grouped based on the presence or absence of alloimmunisation and whether they received transfusion of AMBM versus BM units based on serological testing. Inter-transfusion interval (ITI) and post-transfusion haemoglobin increment (PTHI) were calculated and compared.

Results: Of 368 AIHA patients during the study period, adsorption was performed in 138 patients with a history of a sensitising event. Red cell alloantibodies were identified in 74 patients (53.6%). Shorter ITI was observed in alloimmunised patients when transfused BM red cells versus AMBM red cells [2 (1-3) days vs. 4 (3-5) days; p < 0.001]. Lower PTHI was observed in alloimmunised patients when transfused BM red cells versus AMBM red cells [0.65 (0.45-0.8) g/dl vs. 0.9 (0.7-1.2) g/dL; p < 0.001].

Conclusion: High alloimmunisation rates were observed in sensitised AIHA patients. Significantly higher PTHI and longer ITI were observed with transfusion of AMBM units. These findings highlight the benefits of identifying and matching against alloantibodies for better transfusion outcomes.