Red cell alloimmunization in a transfused patient population: A study from a tertiary care hospital in north India

Abstract

Background: Red blood cell (RBC) alloimmunization results from genetic disparity of RBC antigens between donor and recipients. There is a paucity of data on the incidence of RBC alloimmunization in transfused recipients from the region studied, as pre-transfusion antibody screening is not routinely performed. Aim: To assess the incidence of RBC alloimmunization in a transfused patient population at a tertiary care hospital in north India. Materials and methods: Antibody screening was carried out in 531 multi-transfused patients prior to crossmatching with a commercially available three-cell panel (Diacell; Diamed AG, Cressiersur-Morat, Switzerland) by the tube method, using a saline indirect antiglobulin test. Antibody screen-positive samples were analyzed for the specificity of the alloantibody with an 11-cell identification panel (Diapanel; Diamed AG). Antigen-negative crossmatch-compatible blood was transfused if the antibody was clinically significant, whereas for clinically insignificant antibodies, crossmatch-compatible blood at anti-human globulin phase was issued for transfusion. Results: The overall incidence of RBC alloimmunization in transfused patients was 3.4% (18/531), with anti-c being the most common specificity (38.8%), followed by anti-E (22.2%), anti-M (11.1%), anti-Le a (11.1%), anti-D (5.6%), anti-Jk a (5.6%) and anti-Le b (5.6%). The highest incidence of alloimmunization was observed in gastroenterology patients (4.5%), followed by hematology patients (3.5%). Of the antibodies detected, 16.7% (3/18) were clinically insignificant with Le a, Le b and M specificities. Conclusions: The majority of alloantibodies detected in the current study were clinically significant. Thus, pre-transfusion antibody screening on patients' samples prior to crossmatching needs to be initiated in India to ensure safe transfusion practice. © W. S. Maney & Son Ltd 2008.