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Transfusion and alloimmunization in sickle cell disease. The Cooperative
Study of Sickle Cell Disease
WF Rosse, D Gallagher, TR Kinney, O Castro, H Dosik, J Moohr, W Wang and PS Levy
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
In 1,814 patients with sickle cell disease who had been transfused, the
overall rate of alloimmunization to erythrocyte antigens was 18.6%. The
rate of alloimmunization in this group appears to be an explicit function
of the number of transfusions received because it increases exponentially
with increasing numbers of transfusions. Alloimmunization usually occurred
with less than 15 transfusions, although the rate of alloimmunization
continued to increase when more transfusions were given. The rate of
alloimmunization was less in patients with hemoglobin SC disease and
sickle-beta+ thalassemia because these patients had received fewer
transfusions. Children less than 10 years old had a slightly lower rate of
alloimmunization than patients in other age groups even after correction
for the number of transfusions given. Women were more frequently
alloimmunized than men; this was largely due to the fact that women
received more transfusions than men, but in the age group 16 to 20 years
the increase may have been due in part to alloimmunization owing to
pregnancy. Forty-five percent of those alloimmunized made antibodies of
only one specificity; 17% made four or more antibodies reacting with
different antigens. Antibodies to the C and E antigens of the Rh group, the
Kell antigen, and the Lewis antigens were most commonly made. These
findings may be important in formulating a rational transfusion policy in
sickle cell disease.
Volume 76,
Issue 7,
pp. 1431-1437,
10/01/1990
Copyright © 1990 by The American Society of Hematology
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