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Vol 2, No 1 (2009)
Research paper
Published online: 2009-02-12

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Alloimmunization in patients with autoimmune haemolytic anaemia and red cell genotyping to improve selection of blood for transfusion

Bogumiła Michalewska, Barbara Żupańska, Monika Pelc-Kłopotowska, Agnieszka Orzińska, Justyna Bednarz, Katarzyna Guz, Agnieszka Ożóg, Hanna Łopieńska, Beata Wojciechowska, Magdalena Łakomy, Ewa Brojer
Journal of Transfusion Medicine 2009;2(1):14-19.

Abstract

Background: The presence of warm autoantibodies in the sera of patients with autoimmune haemolytic anaemia are the cause of incompatibility in the compatibility test, which produces difficulties in the detection of clinically significant alloantibodies thus generating the risk of haemolytic transfusion reactions. For such patients the selection of red cells for transfusion requires special procedures to ensure safety.
Material and methods:Alloimmunization was analyzed in 163 AIHA patients (155 with warm type and 8 with mixed type of autoantibodies). In all patients, red cell phenotyping for Rh, K, was performed prior to transfusion and in 53 of them, red cells were phenotyped additionally in Kidd, Duffy, S, s, k with genotyping as well.
Results: Clinically significant alloantibodies were found in 31 patients (19%). In all, 42 antibodies of different specificities were identified (in 7 cases we detected antibodies with two or more specificities) within the following blood group systems: Rh, Kell, Kidd, Duffy, MNS and LW. In 14 of the alloimmunized patients, auto- or alloadsorption was required for alloantibody detection. In the group of 53 patients, phenotyping of Rh, K, Kidd and S antigens was successful in 37 patients (70%) with serological tests only, whereas the extended phenotype for Duffy, s, k antigens was successful only in 9 patients (17%). In each case, the genotype results were consistent with the phenotype. In the remaining patients, the results of extended phenotyping with serological method proved unreliable, due either to mixed-field reactions (after recent transfusion < 3 months) or autoagglutination. Genotyping was useful for predicting the phenotype in such cases.
Conclusions: In addition to phenotyping, genotyping of red cells is necessary for establishing the extended phenotype in AIHA patients. Such procedure is important for blood transfusion safety.

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