Skip to main content

Advertisement

SpringerLink
Log in

Rh and Kell Phenotype Matched Blood Versus Randomly Selected and Conventionally Cross Matched Blood on Incidence of Alloimmunization

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

There is paucity of literature regarding efficacy of transfusion of Rh and Kell matched blood in reducing alloimmunization risk among non-chronically transfused patients. A prospective study to compare efficacy of Rh and Kell phenotype matched blood over randomly selected and conventionally cross-matched blood on the incidence of alloimmunization in patients undergoing cardiac surgery was carried out in the Department of Transfusion Medicine at Indraprastha Apollo Hospitals, New Delhi, from 1st September, 2013 to 31st December, 2014. Two groups, A and B of 250 each were studied. Group A received ABO, Rh and Kell phenotype matched units. Group B received units matched only for ABO and Rh D. Retrospective analysis for antigenic exposures was done. Alloimmunization rate was evaluated for both groups after 72 h and 4 weeks and compared. A p value ≤0.05 was considered statistically significant. None of the patients in Group A were alloimmunized. In Group B, 119 patients received antigenic stimulus (single antigen stimuli- 93; multiple- 26). The probability of a patient being exposed was 52.4 %. At 6 weeks post transfusion, one patient developed ‘Anti-E’ and had received ‘E’ stimulus once. The rate of alloimmunization was 0.4 % in group B, 0.8 % overall and the risk of alloimmunization per unit transfused was 0.17 %. Non responders were 99.16 %. The study did not reach statistical significance (p = 0.238). Majority of our population are non-responders therefore, the resources and time can be reserved for providing Rh and Kell matched units for multiply transfused patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Chow EYD (1999) The impact of the type and screen test policy on hospital transfusion practice. Hong Kong Med J 5:275–279

    PubMed  Google Scholar 

  2. Alves VM, Martins PR, Soares S, Araújo G, Schmidt LC, Costa SS, Langhi DM, Moraes-Souza H (2012) Alloimmunization screening after transfusion of red blood cells in a prospective study. Rev Bras Hematol Hemoter 34(3):206–211

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pujani M, Pahuja S, Dhingra B, Chandra J, Jain M (2013) Alloimmunization in thalassaemics: a comparison between recipients of usual matched and partial better matched blood. An evaluation at a tertiary care centre in India. Blood Transfus 6:1–6

    Google Scholar 

  4. Shehata N, Naglie G, Alghamdi AA, Callum J, Mazer CD, Hebert P, Streiner D, Wilson K (2007) Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review. Vox Sang 93:1–11

    Article  CAS  PubMed  Google Scholar 

  5. Simon TL, Snyder EL, Solheim BG, Stowell CP, Strauss RG, Petrides M (2009) Rossi’s principles of transfusion medicine, 4th edn. Blackwell Publishing, West Sussex

    Book  Google Scholar 

  6. Makroo RN, Bhatia A, Gupta R, Phillip J (2013) Prevalence of Rh, Duffy, Kell, Kidd & MNSs blood group antigens in the Indian blood donor population. Indian J Med Res 137(3):521–526

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP (2000) Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly Asian descent. Blood 96(10):3369–3373

    CAS  PubMed  Google Scholar 

  8. Pahuja S, Pujani M, Gupta SK, Chandra J, Jain M (2010) Alloimmunization and red cell autoimmunization in multitransfused thalassemics of Indian origin. Hematology 15(3):174–177

    Article  PubMed  Google Scholar 

  9. Makroo RN, Arora JS, Chowdhry M, Bhatia A, Thakur UK, Minimol A (2013) Red cell alloimmunization and infectious marker status (human immunodeficiency virus, hepatitis B virus and hepatitis C virus) in multiply transfused thalassemia patients of North India. Indian J Pathol Microbiol 56(4):378–383

    Article  PubMed  Google Scholar 

  10. Thakral B, Saluja K, Sharma RR, Marwaha N (2008) Red cell alloimmunization in a transfused patient population: a study from a tertiary care hospital in north India. Hematology 13(5):313–318

    Article  CAS  PubMed  Google Scholar 

  11. Joshua DJ, Krishnamoorthy R, Muddegowda PH, Subash S, Lingegowda JB (2012) Red cell alloimmunization and transfusion transmitted infections in repeatedly transfused thalassemia major patients. Int J Curr Sci Res 2:251–254

    Google Scholar 

  12. Gupta R, Singh DK, Singh B, Rusia U (2011) Alloimmunization to red cells in thalassemics: emerging problem and future strategies. Transfus Apher Sci 45(2):167–170

    Article  PubMed  Google Scholar 

  13. Skov F, Ericksen M, Hagerup L (1970) Distribution of the ABO, MNS, P, Rhesus, Lutheran, Kell, Lewis and Duffy blood groups and frequency of irregular red cell antibodies in a population of Danes aged fifty years and a population of Danes aged seventy years. From the Glostrup population studies. Acta Pathol Microbiol Scand B. Microbiol Immunol 78(5):553–559

    CAS  Google Scholar 

  14. Spielmann W, Seidl S (1974) Prevalence of irregular cell antibodies and their significance in blood transfusion and antenatal care. Vox Sang 26(6):551–559

    Article  CAS  PubMed  Google Scholar 

  15. Giblett ER (1977) Blood group alloantibodies: an assessment of some laboratory practices. Transfusion 17(4):299–308

    Article  CAS  PubMed  Google Scholar 

  16. Boral LI, Henry JB (1977) The type and screen: a safe alternative and supplement in selected surgical procedures. Transfusion 17(2):163–168

    Article  CAS  PubMed  Google Scholar 

  17. Ko KH, Yoo BH, Kim KM, Lee WY, Yon JH, Hong KH et al (2012) Frequency of unexpected antibody and consideration during transfusion. Korean J Anesthesiol 62(5):412–417

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schonewille H, van de Watering LM, Brand A (2006) Additional RBC alloantibodies after blood transfusions in a non-haematological alloimmunized patient cohort: is it time to take precautionary measures? Transfusion 46(4):630–635

    Article  CAS  PubMed  Google Scholar 

  19. Tormey CA, Fisk J, Stack G (2008) Red blood cell alloantibody frequency, specificity, and properties in a population of male military veterans. Transfusion 48(10):2069–2076

    Article  PubMed  Google Scholar 

  20. Makroo RN, Bhatia A, Hegde V, Chowdhry M, Thakur UK, Rosamma NL (2014) Antibody screening & identification in the general patient population at a tertiary care hospital in New Delhi, India. Indian J Med Res 140(3):401–405

    PubMed  PubMed Central  Google Scholar 

  21. Michail-Merianou V, Pamphili-Panousopoulou L, Piperi-Lowes L, Pelegrinis E, Karaklis A (1987) Alloimmunization to red cell antigens in thalassemia: comparative study of usual versus better-match transfusion programmes. Vox Sang 52(1–2):95–98

    Article  CAS  PubMed  Google Scholar 

  22. Spanos T, Karageora M, Ladis V, Peristeri J, Hatziliani A, Kattamis C (1990) Red cell alloantibodies in patients with thalassemia. Vox Sang 58(1):50–55

    Article  CAS  PubMed  Google Scholar 

  23. Siegrist CA, Aspinall R (2009) B-cell responses to vaccination at the extremes of age. Nat Rev Immunol 9(3):185–194

    Article  CAS  PubMed  Google Scholar 

  24. Lostumbo MM, Holland V, Schmidt PJ (1966) Isoimmunization after multiple transfusions. N Engl J Med 275:141–144

    Article  CAS  PubMed  Google Scholar 

  25. Stiegler G, Sperr W, Lorber C, Fabrizii V, Hocker P, Panzer S (2001) Red cell antibodies in frequently transfused patients with myelodysplastic syndrome. Ann Hematol 80(6):330–333

    Article  CAS  PubMed  Google Scholar 

  26. Fluit CR, Kunst VA, Drenthe-Schonk AM (1990) Incidence of red cell antibodies after multiple blood transfusions. Transfusion 30(6):532–535

    Article  CAS  PubMed  Google Scholar 

  27. Blumberg N, Peck K, Ross K, Avila E (1983) Immune response to chronic red blood cell transfusion. Vox Sang 44(4):212–217

    Article  CAS  PubMed  Google Scholar 

  28. Shukla JS, Chaudhary RK (1999) Red cell alloimmunization in multitransfused chronic renal failure patients undergoing hemodialysis. Ind J Pathol Microbiol 42(3):299–302

    CAS  Google Scholar 

  29. Sharma DC, Singhal S, Rai S, Iyenger S, Sao S, Jain B (2013) Incidence of Rh Antigens, Phenotype & Probable Genotype in the Population of Gwalior and Chambal Region, Central India. Int Blood Res Rev 1(1):29–43

    Article  Google Scholar 

  30. Hoffbrand AV, Catovsky D, Tuddenham EGD (2011) Postgraduate hematology, 6th edn. Wiley, West Sussex

    Google Scholar 

  31. Frohn C, Dümbgen L, Brand JM, Görg S, Luhm J, Kirchner H (2003) Probability of anti-D development in D- patients receiving D + RBCs. Transfusion 43(7):893–898

    Article  PubMed  Google Scholar 

  32. Körmöczi GF, Mayr WR (2014) Responder individuality in red blood cell alloimmunization. Transfus Med Hemother. 41(6):446–451

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schonewille H (2008) Red blood cell alloantibodies after transfusion. University Press, Leiden

    Google Scholar 

  34. Lee WH, Kim SY, Kim HO (2000) The incidence of unexpected antibodies in transfusion candidates. Korean J Blood Transfus 11:99–103

    CAS  Google Scholar 

  35. Shin JH, Lee JY, Kim JH, Kim HR, Lee JN (2009) Screening and identification of unexpected red cell antibodies by simultaneous LISS/coombs and NaCl/enzyme gel methods. J Korean Med Sci 24:632–635

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, India

    Raj Nath Makroo, Soma Agrawal & Mohit Chowdhry

Authors
  1. Raj Nath Makroo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soma Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohit Chowdhry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Soma Agrawal.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Makroo, R.N., Agrawal, S. & Chowdhry, M. Rh and Kell Phenotype Matched Blood Versus Randomly Selected and Conventionally Cross Matched Blood on Incidence of Alloimmunization. Indian J Hematol Blood Transfus 33, 264–270 (2017). https://doi.org/10.1007/s12288-016-0704-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-016-0704-9

Keywords

Search

Navigation