Asian Journal of Transfusion Science
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LETTER TO THE EDITOR  
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Red cell alloimmunization in chronic kidney disease


 Department of Transfusion Medicine, The Mission Hospital, Durgapur, West Bengal, West Bengal, India

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Date of Submission21-Sep-2022
Date of Decision25-Oct-2022
Date of Acceptance06-Nov-2022
Date of Web Publication12-Dec-2022
 


How to cite this URL:
Datta SS. Red cell alloimmunization in chronic kidney disease. Asian J Transfus Sci [Epub ahead of print] [cited 2023 Jan 28]. Available from: https://www.ajts.org/preprintarticle.asp?id=363206


Sir,

The causes of anemia in patients with chronic kidney disease (CKD) are multifactorial. Blood transfusion still remains an important alternative for treating anemia in CKD patients undergoing hemodialysis (HD). According to the first study from India, there is a 1.3% risk of alloimmunization in CKD patients.[1] After that several studies showed the minimum risk of red blood cell (RBC) alloimmunization in CKD patients.[2],[3] There is no data available in the eastern Indian population, therefore, this study was planned to determine the prevalence and specificity of RBC alloimmunization in CKD patients undergoing HD.

This was a prospective study which was done over a 1-year period. A total of 68 CKD patients were recruited who were undergoing HD at least once in a 2-week interval and had received at least one unit of red cells which were only matched for ABO/RhD. The mean age of the cohort was 52.4 ± 8.7 years (range: 44.5–83 years) with a male-to-female ratio of 1.37. Patients with an initial negative antibody screening on the day of enrolment were recruited and prospectively followed up by doing antibody screening and direct antiglobulin test (DAT) before each HD for 1 year irrespective of their transfusion requirements. Antibody screening and identification were performed using 3-cell and 11-cell panels with LISS/Coombs cards. Out of the 68 patients, only 2 (2.94%) were identified to develop erythrocytes alloantibody. One patient had developed anti-E and anti-M was identified in the second case. Henceforth, both received corresponding antigen-negative red cell transfusions. In both cases, DAT was negative. A total of 520 units of red cells were transfused in these patients, and the median number of transfusions was 6.5 (interquartile range: 3–9). Patients undergoing HD showed the lowest alloimmunization risk (calculated risk, 0.38 [95% confidence interval, 0.20–0.49]). There was no link observed between the rate of alloimmunization and the number of red cell units transfused to these patients.

The innate and adaptive immune responses are altered in patients suffering from renal failure and there are quantitative and qualitative deficiencies of the T-and B-lymphocytes.[4] Furthermore, specific HD-related factors (e.g., interactions with bio-incompatible solutions, contamination of dialysis solutions, etc.) may aggravate this reversible immune paralysis. In conclusion, this data show significantly lower incidences of transfusion-induced RBC alloimmunization among CKD patients undergoing HD; therefore, these patients are not at a higher risk of alloimmunization compared to the general population, and extended phenotype matching for routine transfusion is not warranted in this group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shukla JS, Chaudhary RK. Red cell alloimmunization in multi-transfused chronic renal failure patients undergoing hemodialysis. Indian J Pathol Microbiol 1999;42:299-302.  Back to cited text no. 1
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2.
Philip J, Biswas AK, Hiregoudar S, Kushwaha N. Red blood cell alloimmunization in multitransfused patients in a tertiary care center in Western India. Lab Med 2014;45:324-30.  Back to cited text no. 2
    
3.
Agrawal A, Mathur A, Dontula S, Jagannathan L. Red Blood Cell Alloimmunization in Multi - transfused Patients: A Bicentric Study in India. Glob J Transfus Med 2016;1:12-5.  Back to cited text no. 3
  [Full text]  
4.
Oud JA, Evers D, Middelburg RA, de Vooght KM, van de Kerkhof D, Visser O, et al. Association between renal failure and red blood cell alloimmunization among newly transfused patients. Transfusion 2021;61:35-41.  Back to cited text no. 4
    

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Correspondence Address:
Suvro Sankha Datta,
Department of Transfusion Medicine, Tata Medical Center, Newtown, Rajarhat, Kolkata - 700 160, West Bengal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajts.ajts_121_22





 

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006