Prevalence and specificity of red blood cell alloantibodies and autoantibodies in transfused Iranian β-thalassemia patients: A systematic review and meta-analysis
Hosein Rostamian1, Ehsan Javandoost2, Mozhdeh Mohammadian3, Abbas Alipour4
1 Department of Medical Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
3 Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran; Department of Medical Laboratory, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
4 Department of Community Medicine, Thalassemia Research Center, Medical Faculty, Mazandaran University of Medical Sciences, Sari, Iran
Mazandaran University of Medical Sciences, Sari, Imam Sq., Joybar 3way, Start of Valiye Asr Highway, P. O. Box: 44157-33971, Sari
Source of Support: None, Conflict of Interest: None
BACKGROUND: Repeated allogeneic blood transfusions in thalassemia major patients stimulate the patient's immune system to generate antibodies against foreign erythrocyte antigens. This study was carried out to systematically review the findings of available studies about the prevalence of alloantibodies and autoantibodies, as well as the type of causative antigens among transfusion-dependent thalassemia patients in Iran.
METHODS: Electronic search was conducted on Medline, PubMed, Cochrane, EMBASE, ScienceDirect, and Persians databases. All relevant articles published from January 1990 to July 2018 were included. Abstracts of conference booklets which that been published in the last 5 years were also included in the meta-analysis. The search language was restricted to English and Persian. The quality of studies was evaluated according to a checklist developed by authors, and Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias.
RESULTS: Twenty-three relevant articles met all the inclusion criteria. The prevalence of alloimmunization was 13%. Our study showed that anti-D (25%) and anti-K (25%) were most prevalent among Iranian β-thalassemia patients. Data analysis shows the autoantibody prevalence to be 1% among 3787 patients. Meta-regression revealed that the prevalence of alloantibodies increases with each year as the average age of the study population increases.
CONCLUSION: The prevalence of red blood cell (RBC) alloantibodies in transfused Iranian β-thalassemia patients was high. Appropriate preventive strategies such as RBC phenotyping for patients before beginning transfusion and using extended RBC donor–recipient matching, specifically for Rh and Kell system, could be implemented to avoid complications in thalassemia patients.