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Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review
Franchini M, Forni GL, Marano G, Cruciani M, Mengoli C, Pinto V, De Franceschi L, Venturelli D, Casale M, Amerini M, et al
Blood transfusion = Trasfusione del sangue. 2019;17(1):4-15
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Abstract
BACKGROUND Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. MATERIALS AND METHODS We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. RESULTS The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). DISCUSSION Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.
PICO Summary
Population
Patients with transfusion-dependent thalassaemia (41 studies, n= 9,256).
Intervention
Systematic review on the prevalence of red blood cell alloimmunisation.
Comparison
Outcome
The prevalence of erythrocyte alloimmunisation was 11.4% with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs. 12.8%).