Clinical Prevalence and Dominant Patterns of alloimmunization in Transfusion- Dependent Thalassemia Patients at Ahvaz Shafa Hospital

A Hiradfar, Keikhai Keikhai, M Pedram


Background and objective: Thalassemia patients require regular blood transfusions due to the nature of their disease. Alloantibody (ies) cause delayed hemolysis leading to increased need for blood and to intensified complications resulting from frequent transfusions in these patients. This study was conducted to determine alloimmunization prevalence among the study group and to identify the dominant alloantibody (ies) pattern.

Methodology: This cross-sectional study was carried out on 133 transfusion-dependent thalassemia patients at Ahvaz Shafa Hospital, Standard antibody sampler kits produced by the Iranian Blood Transfusion Organization were employed to determine types of alloimmunization in patients to red blood cell antigens using the test tube method.

Results: Of the 133 patients in the study, 66 (49.1) were males and 67 (50.9%) females, with the age range of 2-54 and mean age of 17.63±7.6 years. Screening tests were positive in 42 (31.57%) of the patients, 25 (59.52%) of whom had alloantibody (ies) and 17 (40.5%) autoantibody. The dominant alloimmunization types in the study were antibody against Rh subgroups (55%) and against Kell groups (33%). Alloimmunization had a significant relationship with increased age at the start of blood transfusions, with the removal of the spleen, and with the type of thalassemia.

Conclusions: The high prevalence of alloimmunization in the study population showed the need for determining blood subgroup types, especially Rh and Kell subgroups, in thalassemia patients before starting treatment with blood transfusion, and for preparing bloods compatible with the blood subgroups with the purpose of reducing delayed immune responses. 

Full Text:



-Nathan DG, Orkin SH, Look AT, Ginsburg D. (Eds). Nathan and Oski's Hematology of Infancy and Childhood. 6th ed. Philadelphia: WB Saunders,2003;Vol 1,pp:482-921.

-Cappellini MD, Cohen A, Eleftheriou A, Piga A, Porter J, Taher A.(Eds). Guidelines for the Clinical Management of Thalassemia.2nd ed. Cyprus:Thalassemia International Federation, 2007. ISBN:978-9963-623-59-4.

-Abolghasemi H, Eshghi P.Comprehensive Textbook of Thalassemia, Tehran:Baqiyatallah University of Medical Sciences Publication 2004;pp:151-86.

-Rudmann SV. Textbook of Blood Banking and Transfusion Medicine. 2nd ed. Philadelphia:WB Saunders, 2005, pp:282-343.

-Ansari S, Voosogh P, Moshtaghian S. Assessment of Frequency of Alloimmunization and Erythrocyte Autoimmunization in Transfusion Dependent Thalassemia Patients .Acta Medica Iranica 2008;46(2):141-4.

-Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and Erythrocyte Autoimmunization in Transfusion-Dependent Thalassemia patients of Predominantly Asian Descent. Blood 2000; 96(10):3369-73.

-Ho HK, Ha SY, Lam CK, Chan GC, Lee TL, Chiang AK, et al. Alloimmunization in Hong Kong Southern Chinese Transfusion-Dependent Thalassemia Patients. Blood. 2001; 97 (12) :3999-4000.

-Zumberg MS, Procter JL, Lottenberg R, Kitchens CS, Klein HG. Autoantibody Formation in the Alloimmunized Red Blood Cell Recipient: Clinical and Laboratory Implications. Arch Intern Med 2001,161(2):285-90.

-Karimi M, Nikrooz P, Kashef S, Jamalian N, Davatolhagh Z. RBC Alloimmunization in Blood Transfusion- Dependent Beta-Thalassemia Patients in Southern Iran. Int J Lab Hematol 2007; 29(5):321-6.

-Ameen R, Al-Shemmari S, Al-Humood S, Chowdhury RI, Al-Eyaadi O, Al-Bashir A. RBC Alloimmunization and Autoimmunization Among Transfusion-Dependent Arab Thalassemia Patients. Transfusion 2003; 43(11):1604-10.

-Sesok-Pizzini DA, Eder AF, Larson PJ. Transfusion Reactions. In: Hillyer CD, Hillyer KL, Strobl FJ, Jefferies LC, Silberstein LE. (Eds). Handbook of Transfusion Medicine. 1st ed. London:Academic press, 2001:274-314. ISBN-13: 978-0123487759

-Schonewille H, van de Watering LM, Loomans DS, Brand A. Red Blood Cell Alloantibodies After Transfusion: Factors Influencing Incidence and Specificity. Transfusion 2006; 46 (2): 250-6.

-Schonewille H, Brand A. Alloimmunization to Red Blood Cell Antigens after Universal Leucodepletion. A Regional Multicentre Retrospective Study. Br J Haematol 2005; 129 (1): 151-6.

-Schonewille H, van Zijl AM, Wijermans PW. The importance of antibodies against Low-incidence RBC antigens in complete and abbreviated cross-matching. Transfusion 2003; 43(7):939-44.

-Canatan D, Acar N, Kilic B. Rh subgroups and Kell Antigens with thalassemia and in donors in turkey. Tr J of Medical Sciences 1999; 29:155-7.

-Hassan K, Younus M, Ikram N, Naseem L, Zaheer HA. Red cell Alloimmunization in Repeatedly Transfused Thalassemia Major Patients. Int J Pathol 2004;l 2(1):16-9.

-Castilho L, Rios M, Pellegrino Jr J, Carvalho MHM, Alberto FL, Saad ST. Genotyping of Kell, Duffy ,Kidd and RhD in Patients with β Thalassemia. Rev bras Hematol Hemoter 2000;22(2):69-76.

-Zumberg MS, Procter JL, Lottenberg R, Kitchens CS, Klein HG. Autoantibody Formation in the Alloimmunized Red Blood Cell Recipient: Clinical and Laboratory Implications. Arch Intern Med. 2001;161(2):285-90.

-Bilwani F, Kakepoto GN, Adil SN, Usman M, Hassan F, Khurshid M. Frequency of Irregular Red Cell Alloantibodies in Patients with Thalassemia Major: a Bicenter Study. J Pak Med Assoc 2005; 55(12):563-5.

-Rebulla P, Modell B. Transfusion requirements and effects in patients with thalassemia major Cooleycare Programme Lancet.1991;337(8736):277-80..

-Shamsian B SH, Arzanian MT, Shamshiri AR, Alavi S, Khojasteh O. Frequency of Red Cell Alloimmunization in Patients with β-Major Thalassemia in an Iranian Referral Hospital. Iran J Pediatr 2008;18(2):149-53.

-Eshghi P, Sanei Moghaddam A, Mir Masoodi M. Frequency of Alloimmunization in β-Major Thalassemia Patients in Zahedan City in 2001. J Mazandaran University of Medical Sciences 2003;13(40):36-42.


  • There are currently no refbacks.

Home  Journals  Conferences  Store  Services  About Us  Contact Us