Resolution of the complexity of transfusion support by alloadsorption in a patient of thalassaemia intermedia with multiple alloantibodies

Abstract

Thalassemia intermedia (TI) patients are generally more prone to alloimmunization against red blood cell antigen. Laboratory diagnosis of multiple alloantibodies faces challenges due to history of recent transfusion, lack of infrastructure, and skilled workforce. Alloadsorption is commonly used for a recently transfused patient suspected of having multiple alloantibodies. In this case, alloadsorption was performed with rr cells only to rule out the presence of allo-anti-E. Blood transfusion is the mainstay of treatment, and transfusion dependence is the primary measure for determining the severity. A 12-year-old young female patient, already diagnosed case of TI, presented with anemia, jaundice, and abdominal pain (on ultrasonography, hepatosplenomegaly and cholelithiasis) and planned for splenectomy with cholecystectomy. Cross-match was incompatible with the group-specific A-positive red cell unit in the antihuman globulin phase. Antibody screening and antibody identification (AI) revealed the possibility of anti-c and anti-E. Repeated alloadsorption with c+E-(rr) red cells, and further AI with remaining serum, confirmed the presence of both anti-c and anti-E. The patient was transfused with two units of c and E antigen-negative, A-positive compatible unit and operated without any transfusion-related adverse event. Here, we depicted the importance of alloadsorption as a tool to resolve multiple alloantibodies.