Human leucocyte antigen alloimmunisation in repeatedly transfused thalassemic Egyptian children and its relation to febrile non-haemolytic transfusion reactions

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Abstract

Objectives

To document the incidence of lymphocytotoxic antibodies (LCA) in chronically transfused children with β thalassemia major and the relationship between alloimmunisation and febrile non-haemolytic transfusion reactions. We also compared the effect of leucoreduced-packed red blood cells (RBCs) by bed-side filtration and washed RBCs in preventing FNHTRs and in inducing haemoglobin rise.

Background

Alloimmunisation to human leucocytic antigens is one of the common complications of transfusions, particularly in chronically transfused patients as those with thalassemia major, a common disease in Northern Egypt.

Methods/Materials

LCA were screened for in 45 chronically transfused β thalassemia major children (group I), 20 splenectomised ones (group II) and 20 healthy controls (group III), using qualitative lymphocytotoxic antibody (LCA) enzyme-linked immunosorbent assay (ELISA) kit.

Results

Nine out of 65 thalassemic children (˜14%) were positive for LCA antibodies. Frequency of transfusions and LCA positivity were significantly higher in group I than group II (p = 0·036 and 0·014). There was no statistically significant difference between LCA positive and negative cases regarding age of starting transfusion, frequency of transfusions or FNHTRs. There was no statistically significant difference between washed and filtered RBCs in reducing FNHTRs (p = 1·000) and in inducing haemoglobin rise in positive LCA cases (p = 0·409).

Conclusion

Human leukocyte antigen (HLA) alloimmunisation was only 14% in the children with β thalassemia major we studied. Surprisingly FNHTRs were not more common in those with HLA antibodies. Splenectomy plays a role in reducing the frequency of transfusion and HLA alloimmunisation. Washed and filtered RBCs are comparable in reducing FNHTRs and in inducing haemoglobin rise.

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