BACKGROUND: Anemia is highly prevalent in inflammatory bowel disease patients, and red blood cell transfusion is often indicated already at reproductive age. Both transfusion and pregnancy may induce red cell alloantibodies, potentially complicating further transfusions and pregnancies. As recent evidence suggests that inflammation may promote red cell antibody induction, the alloimmunization risk of these patients after allogenic erythrocyte exposure was investigated. METHODS: Red cell alloantibody status and clinical data were analyzed in 193 inflammatory bowel disease patients with a history of transfusion or pregnancy, and compared with transfused controls with noninflammatory diseases (n=357). RESULTS: In transfused patients with inflammatory bowel disease, a 2.5-fold-increased red cell antibody prevalence was found (10/119, 8.4%), compared with transfused sex-matched controls with noninflammatory diseases (12/357, 3.4%; P=.023). Patients with inflammatory bowel disease had fewer transfusions (mean 3.0 vs 4.2, P=.003) but higher C-reactive protein levels during transfusion than controls (mean 8.4 vs 5.4 mg/dL, P <.001). The red cell antibodies of inflammatory bowel disease patients were clinically significant, directed against different Rh, Kell, Duffy, or Lutheran blood group antigens, and associated with higher number of transfusions (odds ratio 1.57; 95% confidence interval, 1.03-2.39). Conversely, immunomodulatory therapy during transfusion showed negative association (odds ratio 0.12; 95% confidence interval, 0.02-0.61). Only 1.4% of inflammatory bowel disease patients with pregnancy alone had antibodies. CONCLUSIONS: Patients with inflammatory bowel disease exhibited a very high risk of transfusion-induced red cell alloimmunization, possibly potentiated by inflammation. Aside from a restrictive transfusion strategy, the implementation of prophylactic blood group phenotype matching of red cell concentrates (not only for ABO and RhD but also RhCcEe, Kell, Kidd, Duffy) could prevent antibody induction and associated complications in these patients.
BACKGROUND:Anemia is highly prevalent in inflammatory bowel diseasepatients, and red blood cell transfusion is often indicated already at reproductive age. Both transfusion and pregnancy may induce red cell alloantibodies, potentially complicating further transfusions and pregnancies. As recent evidence suggests that inflammation may promote red cell antibody induction, the alloimmunization risk of these patients after allogenic erythrocyte exposure was investigated. METHODS: Red cell alloantibody status and clinical data were analyzed in 193 inflammatory bowel diseasepatients with a history of transfusion or pregnancy, and compared with transfused controls with noninflammatory diseases (n=357). RESULTS: In transfused patients with inflammatory bowel disease, a 2.5-fold-increased red cell antibody prevalence was found (10/119, 8.4%), compared with transfused sex-matched controls with noninflammatory diseases (12/357, 3.4%; P=.023). Patients with inflammatory bowel disease had fewer transfusions (mean 3.0 vs 4.2, P=.003) but higher C-reactive protein levels during transfusion than controls (mean 8.4 vs 5.4 mg/dL, P <.001). The red cell antibodies of inflammatory bowel diseasepatients were clinically significant, directed against different Rh, Kell, Duffy, or Lutheran blood group antigens, and associated with higher number of transfusions (odds ratio 1.57; 95% confidence interval, 1.03-2.39). Conversely, immunomodulatory therapy during transfusion showed negative association (odds ratio 0.12; 95% confidence interval, 0.02-0.61). Only 1.4% of inflammatory bowel diseasepatients with pregnancy alone had antibodies. CONCLUSIONS:Patients with inflammatory bowel disease exhibited a very high risk of transfusion-induced red cell alloimmunization, possibly potentiated by inflammation. Aside from a restrictive transfusion strategy, the implementation of prophylactic blood group phenotype matching of red cell concentrates (not only for ABO and RhD but also RhCcEe, Kell, Kidd, Duffy) could prevent antibody induction and associated complications in these patients.
Authors: David R Gibb; Jingchun Liu; Prabitha Natarajan; Manjula Santhanakrishnan; David J Madrid; Stephanie C Eisenbarth; James C Zimring; Akiko Iwasaki; Jeanne E Hendrickson Journal: J Immunol Date: 2017-06-19 Impact factor: 5.422
Authors: Benjamin Voss; Alexander Kurdi; Alexander Skopec; Jasmine Saleh; Mouhanad M El-Othmani; Joseph M Lane; William M Mihalko; Khaled J Saleh Journal: J Nat Sci Date: 2015-02-01
Authors: Seema R Patel; Ashley Bennett; Kathryn Girard-Pierce; Cheryl L Maier; Satheesh Chonat; Connie M Arthur; Patricia E Zerra; Amanda Mener; Sean R Stowell Journal: Blood Adv Date: 2018-01-23
Authors: David R Gibb; Jingchun Liu; Manjula Santhanakrishnan; Prabitha Natarajan; David J Madrid; Seema Patel; Stephanie C Eisenbarth; Christopher A Tormey; Sean R Stowell; Akiko Iwasaki; Jeanne E Hendrickson Journal: Transfusion Date: 2017-08-23 Impact factor: 3.157
Authors: Matthew S Karafin; Matt Westlake; Ronald G Hauser; Christopher A Tormey; Philip J Norris; Nareg H Roubinian; Yanyun Wu; Darrell J Triulzi; Steve Kleinman; Jeanne E Hendrickson Journal: Br J Haematol Date: 2018-04-19 Impact factor: 6.998