Prevalence and risk factors of alloimmunization in multi-transfused pediatric patients: A cross-sectional study from a sub-Himalayan tertiary care hospital in Uttarakhand India - 08/11/24

Doi : 10.1016/j.tracli.2024.10.007

Rajat Maini ^a, Anil Kumar Rawat ^a, Rakesh Kumar ^a, Manish Raturi ^b,^⁎
^a Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun, 248016, Uttarakhand, India
^b Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant Dehradun 248016 Uttarakhand, India

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 08 November 2024

Highlights

•	This study offers a comprehensive overview of 113 multi-transfused pediatric patients.
•	It includes in-depth immunological assessments and a thorough analysis of various factors that influence alloimmunization in these children.
•	The frequency of autoantibodies was notably higher, occurring in approximately 17.7% of patients, compared to a 5.31% alloimmunization rate.
•	The most common alloantibodies were against the MNS blood group system, unlike those reported for Rh and Kell.
•	A history of PRBC transfusions is the most significant risk factor for alloimmunization, with an odds ratio of 3.217.

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Abstract

Background

Packed red blood cell (PRBC) transfusion is critical in managing pediatric patients with conditions requiring frequent transfusions, such as leukemia, thalassemia, and bone marrow disorders. Alloimmunization, the formation of antibodies against foreign antigens present in the donor's blood, is a significant complication of repeated transfusions. Further, auto/alloimmunization is influenced by multiple factors, including antigenic differences between donor and recipient and the recipient’s immune status.

Objectives

This study aimed to assess the prevalence and risk factors of auto/alloimmunization among pediatric patients undergoingmultiple PRBC transfusions in a tertiary care hospital in the sub-Himalayan region of Uttarakhand, India.

Methods

A cross-sectional study was conducted on 113 multi-transfused pediatric patients aged 4 months to 18 years who received more than one PRBC transfusion between September 2022 and August 2023. Antibody screening and identification were performed using column agglutination techniques. Statistical analysis was conducted to evaluate associations between demographic, clinical factors, and antibody detection.

Results

Alloimmunization was observed in 5.31% of patients, with the majority developing antibodies against the MNS blood group system. Autoantibodies were more common, detected in 17.7% of patients. Significant associations were found between the history of prior PRBC transfusions and the formation of alloantibodies (p = 0.005). Age, gender, and ethnicity did not show a statistically significant association with antibody detection.

Conclusions

The study reveals a relatively higher prevalence of autoimmunization among multi-transfused pediatric patients. The history of PRBC transfusions was a significant risk factor, indicating the need for extended RBC phenotyping and tailored transfusion strategies to reduce alloimmunization risks in these patients. Most patients and blood donors in this region belong to the local Garhwali community. This homogeneity may help explain the lower rate of alloimmunization observed, suggesting a degree of antigenic similarity among the blood donors and the recipients.

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Keywords : PRBC transfusions, Alloimmunization, Pediatric Patients, Blood group systems, Immunohematology, Transfusion-related complications, Uttarakhand