Immune erythrocyte antibodies in adult patients with sickle cell disease and blood donors in Lagos, Nigeria: a comparative study

Abstract

Sickle cell disease (SCD) poses a major public health challenge in sub-Saharan Africa, including Nigeria. Blood transfusion is a mainstay in SCD treatment. Erythrocyte alloimmunization is known to complicate the transfusional care of patients with SCD. Immune alloantibodies are associated with hemolytic transfusion reactions and transfusion refractoriness. We aimed to determine the prevalence, specificities, and clinical associations/ risk factors of immune erythrocyte alloantibodies among adult patients with SCD compared with healthy blood donors in Lagos, Nigeria, through a cross-sectional study. All participants were interviewed using a structured questionnaire to obtain details on bio-data, hemoglobin phenotype, blood transfusion history, and SCD history where relevant. Blood specimens obtained from each participant were subjected to antibody screening/identification using tube agglutination method. The mean age of the SCD participants and healthy blood donors was 27.92 and 29.04 years, respectively. The majority (72.5%) of the SCD participants had received at least 1 unit of red blood cell (RBC) transfusion in their lifetime, compared with only 7.5 percent of blood donors. Six SCD participants (7.5%) tested positive for atypical erythrocyte alloantibodies, with none among blood donors. Most of the antibodies (75%) belonged to the Rh blood group system. The most frequent antibody was anti-E, followed by anti-C and anti-D. Advancing age (30 years or more), recent transfusions (last 4 weeks), higher transfusion rates, and established renal disease were significantly associated with alloimmunization (p values of 0.026, 0.043, 0.002, and 0.043, respectively). This study suggests blood transfusion as a strong risk factor for RBC alloimmunization in SCD patients. Extended RBC phenotyping is recommended for all patients with SCD, especially those receiving regular transfusions.