The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion-induced red blood cell alloimmunisation
Oud, Josine A.; Evers, Dorothea; de Haas, Masja; de Vooght, Karen M.K.; van de Kerkhof, Daan; Som, Nel; Péquériaux, Nathalie C.V.; Hudig, Francisca; Albersen, Arjan; van der Bom, Johanna G.; Zwaginga, Jaap Jan
(2021) British Journal of Haematology, volume 195, issue 4, pp. 604 - 611
(Article)
Abstract
Maternal alloantibodies directed against fetal red blood cell (RBC) antigens may cause potentially life-threatening haemolytic disease of the fetus and newborn (HDFN). Dutch transfusion guidelines therefore prescribe preventive cEK matching for all (pre-)fertile females. To quantify the impact of cEK matching, we compared overall and antigen-specific cumulative RBC alloimmunisation incidences
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in females and males aged <45 years. Among a multicentre cohort comprised of patients who received their first and subsequent RBC unit between 2005 and 2019, first-formed RBC alloantibodies were detected in 47 of 2998 (1·6%) females and 49 of 2507 (2·0%) males. Comparing females and males, overall alloimmunisation incidences were comparable (3·1% [95% confidence interval (CI) 2·1–4·4] versus 3·5% (95% CI 2·4–4·9, P = 0·853) after 10 units transfused). However, cEK alloimmunisation incidences were significantly lower among females (0·6% (95% CI 0·3–1.5) versus 2·2% (95% CI 1·5–3·4, P = 0·001) after 10 units transfused). Yet, despite cEK-matching guidelines being in effect, 6·5%, 3·6% and 0·2% of all RBC units remained mismatched for c, E or K antigens respectively. Most of these mismatches were almost always due to emergency settings. Even though cEK alloimmunisation was not prevented completely, implementation of cEK matching resulted in an alloantigen-exposure risk reduction of up to 98%.
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Keywords: alloimmunisation, blood transfusion, extended matching, females, HDFN, Hematology
ISSN: 0007-1048
Publisher: Wiley-Blackwell
Note: Funding Information: The authors would like to thank Saurabh Zalpuri for his major contribution in the design of the R-FACT study. Furthermore, they thank Karen van Brussel-de Groot (LUMC, Leiden), André Ringeling (UMC Utrecht, Utrecht), Ruud van Woensel (Catharina Hospital, Eindhoven), Leo van den Boogaard (Catharina Hospital, Eindhoven), Ton Wolfhagen (Jeroen Bosch Hospital, ‘s Hertogenbosch), Eugenie Gemen (Jeroen Bosch Hospital, ‘s Hertogenbosch), and Gerard Smouter (LabWest / Haga Teaching Hospital, The Hague) for their support regarding the data collection. Publisher Copyright: © 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.
(Peer reviewed)