1
|
Al-Asmari B, Baothman A, Almohammadi M, Aljuaid M, Jastaniah W. Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients With Sickle Cell Disease in Saudi Arabia. J Pediatr Hematol Oncol 2024:00043426-990000000-00436. [PMID: 38857199 DOI: 10.1097/mph.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/13/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Sickle cell disease (SCD) is a common hereditary hemoglobin disorder worldwide. One of the main treatments for patients with SCD is the requirement for blood transfusions. Posttransfusion alloimmunization with red blood cell (RBC) antigens continues to be a major risk factor for SCD. The objective of this study was to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric patients with SCD in our center and compare our results with published reports from Saudia Arabia SA, regional countries, and some international countries. MATERIALS AND METHODS A retrospective chart review of patients with SCD at King Abdulaziz Medical City-Jeddah, between 2008 and 2019 was performed. Demographic characteristics and transfusion histories were recorded. Blood samples were analyzed for alloimmunization using immunohematologic techniques. RESULTS In total, 121 patients were analyzed. Alloantibodies were detected in 21 patients (17.4%) and were mostly single in 15 patients (71.4%), anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other 6 patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibody levels were significantly higher in patients with frequent hospital admissions (>5 times annually), those who had an exchange blood transfusion, those younger than 3 years old, and those who received a larger number of blood units (P ≤0.05). CONCLUSION The rate of RBC alloimmunization is determined and considered relatively low compared with that in other nations. Matching for extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fya, Fyb, Jka, and Jkb antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion-related complications.
Collapse
Affiliation(s)
- Badriah Al-Asmari
- Department of Pediatric Hematology and Oncology, Princess Norah Oncology Center, King Abdul Aziz Medical City-Jeddah (KAMC-J)
| | - Abdullah Baothman
- Department of Pediatric Hematology and Oncology, Princess Norah Oncology Center, King Abdul Aziz Medical City-Jeddah (KAMC-J)
- Department of pediatric, College of Medicine, King Saud Bin Abdul Aziz University for Health Science
| | - Mohammed Almohammadi
- Department of Pathology and Laboratory Medicine, KAMC-J, Saudi Arabia. College of Medicine, KSAU-HS
| | - Mohammed Aljuaid
- Department of Pediatrics-Royal commission hospital, Yanbu, Saudi Arabia
| | - Wasil Jastaniah
- Department of Oncology Center, King Faisal Specialist Hospital and Research Center (Gen.Org.), Jeddah
| |
Collapse
|
2
|
Yee MEM, Zerra PE, McCoy JW, Covington ML, Stowell SR, Joiner CH, Lough CM, Delvadia BB, Josephson CD, Roback JD, Fasano RM. Post-transfusion biotin-labeled red blood cell survival studies in pediatric sickle cell disease with antibodies of uncertain significance. Transfusion 2024; 64:800-807. [PMID: 38506450 PMCID: PMC11088511 DOI: 10.1111/trf.17800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Red blood cell (RBC) antibodies are common in multiply transfused patients with sickle cell disease (SCD). Unlike RBC alloantibodies, the potential of autoantibodies to cause post-transfusion hemolysis may be uncertain. Biotin-labeling provides a direct measurement of red cell survival (RCS) over time, thus can be used to assess the clinical significance of RBC antibodies. Antibodies to biotinylated RBC (B-RBC) occasionally are detected after exposure, which may impact B-RBC survival in subsequent RCS studies. STUDY DESIGN AND METHODS Pediatric patients with SCD receiving monthly chronic transfusions underwent RCS studies, receiving aliquots of allogeneic RBC labeled at distinct densities of biotin (2-18 μg/mL). B-RBC survival was followed for 4 months post-transfusion, and B-RBC antibody screening for 6 months. Patients with warm autoantibodies (WAA) or B-RBC antibodies are reported here. RESULTS RBC antibodies were detected during RCS in four patients: one with WAA, one with WAA followed by B-RBC-specific antibodies, and two with transient B-RBC antibodies within the first 5 weeks of exposure. B-RBC half-lives (T50) ranged 37.6-61.7 days (mean 47.8 days). There was no evidence of increased hemolysis or accelerated B-RBC clearance in the presence of WAA or B-RBC antibodies. DISCUSSION Biotinylation of allogenic RBC can be used to assess the possible effects of RBC antibodies on transfusion survival in individual cases, particularly when it is uncertain if the detected antibodies may result in hemolysis. In the cases presented here, neither WAA nor B-RBC antibodies were associated with significant shortening of B-RBC survival in individuals with SCD.
Collapse
Affiliation(s)
- Marianne E M Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patricia E Zerra
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James W McCoy
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mischa L Covington
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher M Lough
- Medical Services, Lifesouth Community Blood Centers, Gainesville, Florida, USA
| | | | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John D Roback
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Ito S, Pandya A, Hauser RG, Krishnamurti L, Stites E, Tormey C, Krumholz HM, Hendrickson JE, Goshua G. Decreasing alloimmunization-specific mortality in sickle cell disease in the United States: Cost-effectiveness of a shared transfusion resource. Am J Hematol 2024; 99:570-576. [PMID: 38279581 DOI: 10.1002/ajh.27211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
Red blood cell alloimmunization and consequent delayed hemolytic transfusion reaction (DHTR) incidence and mortality in patients with sickle cell disease (SCD) are high. A shared transfusion resource has decreased both in other countries, while in the United States cost concerns persist. We conducted a Markov cohort simulation of a birth cohort of alloimmunized patients with SCD to estimate lifetime DHTR incidence, DHTR-specific mortality, quality-adjusted life expectancy (QALE), and costs with the implementation of a shared transfusion resource to identify antibody history versus without (i.e., status quo). We conducted our analysis using a lifetime analytic time horizon and from a United States health system perspective. Implementation of shared transfusion resource projects to decrease cumulative DHTR-specific mortality by 26% for alloimmunized patients with SCD in the United States, relative to the status quo. For an average patient population of 32 000, this intervention would generate a discounted increment of 4000 QALYs at an incremental discounted cost of $0.3 billion, resulting in an incremental cost-effectiveness ratio of $75 600/QALY [95% credible interval $70 200-81 400/QALY]. The results are most sensitive to the baseline lifetime medical expenditure of patients with SCD. Alloantibody data exchange is cost-effective in 100% of 10 000 Monte Carlo simulations. The resource would theoretically need a minimum patient population of 1819 patients or cost no more than $5.29 million annually to be cost-effective. By reducing DHTR-specific mortality, a shared transfusion resource in the United States projects to be a life-saving and cost-effective intervention for patients with SCD in the United States.
Collapse
Affiliation(s)
- Satoko Ito
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ronald G Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Lakshmanan Krishnamurti
- Section of Pediatric Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward Stites
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chris Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine and Pathology, Emory University, Atlanta, Georgia, USA
| | - George Goshua
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| |
Collapse
|
4
|
Zheng Y, Gossett JM, Chen PL, Barton M, Ryan M, Yu J, Kang G, Hankins JS, Chou ST. Proinflammatory state promotes red blood cell alloimmunization in pediatric patients with sickle cell disease. Blood Adv 2023; 7:4799-4808. [PMID: 37023228 PMCID: PMC10469551 DOI: 10.1182/bloodadvances.2022008647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
We examined risk factors for red blood cell (RBC) alloimmunization in pediatric patients with sickle cell disease, focusing on the recipients' inflammatory state at the time of transfusion and anti-inflammatory role of hydroxyurea (HU). Among 471 participants, 55 (11.70%) participants were alloimmunized and formed 59 alloantibodies and 17 autoantibodies with an alloimmunization rate of 0.36 alloantibodies per 100 units. Analysis of 27 participants in whom alloantibodies were formed with specificities showed 23.8% (30/126) of units transfused during a proinflammatory event resulting in alloantibody formation compared with 2.8% (27/952) of units transfused at steady state. Therefore, transfusion during proinflammatory events increased the risk for alloimmunization (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.64-10.85; P = .003). Further analysis of all the 471 participants showed that alloimmunization of patients who received episodic transfusion, mostly during proinflammatory events, was not reduced with HU therapy (OR, 6.52; 95% CI, 0.85-49.77; P = .071), HU therapy duration (OR, 1.13; 95% CI, 0.997-1.28; P = .056), or HU dose (OR, 1.06; 95% CI, 0.96-1.16; P = .242). The analysis also identified high transfusion burden (OR, 1.02; 95% CI, 1.003-1.04; P = .020) and hemoglobin S (HbSS) and HbSβ0-thalassemia genotypes (OR, 11.22, 95% CI, 1.51-83.38; P = .018) as additional risk factors for alloimmunization. In conclusion, the inflammatory state of transfusion recipients affects the risk of RBC alloimmunization, which is not modified by HU therapy. Judicious use of transfusion during proinflammatory events is critical for preventing alloimmunization.
Collapse
Affiliation(s)
- Yan Zheng
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jeffrey M. Gossett
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Pei-Lin Chen
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Martha Barton
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Missy Ryan
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jing Yu
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Stella T. Chou
- Departments of Pediatrics and Pathology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| |
Collapse
|
5
|
Arthur CM, Stowell SR. The Development and Consequences of Red Blood Cell Alloimmunization. ANNUAL REVIEW OF PATHOLOGY 2023; 18:537-564. [PMID: 36351365 PMCID: PMC10414795 DOI: 10.1146/annurev-pathol-042320-110411] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
While red blood cell (RBC) transfusion is the most common medical intervention in hospitalized patients, as with any therapeutic, it is not without risk. Allogeneic RBC exposure can result in recipient alloimmunization, which can limit the availability of compatible RBCs for future transfusions and increase the risk of transfusion complications. Despite these challenges and the discovery of RBC alloantigens more than a century ago, relatively little has historically been known regarding the immune factors that regulate RBC alloantibody formation. Through recent epidemiological approaches, in vitro-based translational studies, and newly developed preclinical models, the processes that govern RBC alloimmunization have emerged as more complex and intriguing than previously appreciated. Although common alloimmunization mechanisms exist, distinct immune pathways can be engaged, depending on the target alloantigen involved. Despite this complexity, key themes are beginning to emerge that may provide promising approaches to not only actively prevent but also possibly alleviate the most severe complications of RBC alloimmunization.
Collapse
Affiliation(s)
- Connie M Arthur
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, ,
| | - Sean R Stowell
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, ,
| |
Collapse
|
6
|
Wong K, Lai WK, Jackson DE. HLA Class II regulation of immune response in sickle cell disease patients: Susceptibility to red blood cell alloimmunization (systematic review and meta-analysis). Vox Sang 2022; 117:1251-1261. [PMID: 36102140 PMCID: PMC9826043 DOI: 10.1111/vox.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Sickle cell disease (SCD) patients are commonly treated with red blood cell (RBC) transfusion. Pretransfusion tests commonly involve limited serological antibody testing. RBC alloimmunization to RBC antigens is a frequently encountered complication seen in chronically transfused patients. Genetic factors such as the human leukocyte antigen (HLA) are known to influence and regulate immune responses. HLAs are highly polymorphic and play an essential role in regulating immune responses, including RBC alloimmunization. The aim of this study was to conduct a systematic review and meta-analysis to evaluate the association between HLA Class II allelic polymorphisms with the possible risk of developing RBC alloantibodies. MATERIALS AND METHODS Four databases were systematically searched for relevant studies between the years 2000 and 2021 following the PRISMA guidelines. Four articles met the eligibility and quality criterion, and three alleles, HLA-DRB1*04, HLA-DRB1*15 and HLA-DQB1*03, that were found to be potentially associated with an increased risk in alloantibody formation were included. RESULTS The primary outcome measure was alloimmunization by RBC antigen exposure in multiply transfused SCD patients. The total estimate of alloimmunization of the SCD patients was 2.33 (95% CI, 1.58-3.44), demonstrating susceptibility to RBC alloantibody formation. Heterogeneity between the studies was insignificant, suggesting the differences associated with random sampling errors. The results showed that SCD patients carry an increased risk of producing RBC alloantibodies. CONCLUSION A strategy to prevent RBC alloimmunization is genotyping for genetically susceptible SCD patients receiving multiple transfusions. Early identification of genetic variants that can potentially increase the risk of RBC alloimmunization could aid in the screening process and selection of phenotypically matched RBC units.
Collapse
Affiliation(s)
- Karmen Wong
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Wing Kit Lai
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Denise E. Jackson
- Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| |
Collapse
|
7
|
Zhang J, Zhang D, Zhao J. CFNAs of RBCs affect the release of inflammatory factors through the expression of CaMKIV in macrophages. Transfus Apher Sci 2022; 61:103494. [PMID: 35773126 DOI: 10.1016/j.transci.2022.103494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Blood transfusions reportedly modulate the recipient's immune system. Transfusion-related immunomodulation has been suggested as a mechanism of some adverse clinical outcomes. Extracellular nucleic acids circulate in plasma and activate relevant immune responses, but little is known about their mechanism of action in transfusion-related immunomodulation (TRIM). The aim of this study was to investigate the effects of cell-free nucleic acids (CFNAs) produced by red blood cells (RBCs) on innate immunity, especially peripheral blood mononuclear cells (PBMCs) and macrophages, and to investigate the mechanism of action. METHODS Differentially expressed genes (DEGs) between PBMCs exposed to RBC-produced CFNA and normal PBMCs were analyzed by gene expression data combined with bioinformatics. KEGG and GO enrichment analyses were performed for the DEGs, and in vitro experiments were performed for the effects of key genes on the release of inflammatory factors from macrophages. RESULTS Analysis of microarray data showed that exposure of monocytes to RBC-produced CFNAs increased the expression of genes involved in the innate immune response, including chemokines, chemokine receptors, and innate response receptors, and that calcium channel activity was highly regulated, with a key gene being CaMKIV. CaMKIV played a critical role in LPS-induced inflammatory factor release from macrophages, which was exacerbated by overexpression of the CaMKIV gene. CONCLUSION RBCs regulate the release of inflammatory factors during blood transfusion by releasing CFNAs and affecting expression of the CaMKIV gene in PBMCs or macrophages, which is a potential regulatory mechanism of blood transfusion-related immune regulation and related adverse reactions.
Collapse
Affiliation(s)
- Jingrui Zhang
- Department of Transfusion Medicine, General Hospital of Northern Theater Command, Shenyang 110000, China.
| | - Dan Zhang
- Department of Transfusion Medicine, General Hospital of Northern Theater Command, Shenyang 110000, China
| | - Jing Zhao
- Department of Transfusion Medicine, General Hospital of Northern Theater Command, Shenyang 110000, China
| |
Collapse
|
8
|
Civelekoglu O, Wang N, Arifuzzman A, Boya M, Sarioglu AF. Automated lightless cytometry on a microchip with adaptive immunomagnetic manipulation. Biosens Bioelectron 2022; 203:114014. [DOI: 10.1016/j.bios.2022.114014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/13/2021] [Accepted: 01/15/2022] [Indexed: 01/08/2023]
|
9
|
Graziadei G, De Franceschi L, Sainati L, Venturelli D, Masera N, Bonomo P, Vassanelli A, Casale M, Lodi G, Voi V, Rigano P, Pinto VM, Quota A, Notarangelo LD, Russo G, Allò M, Rosso R, D'Ascola D, Facchini E, Macchi S, Arcioni F, Bonetti F, Rossi E, Sau A, Campisi S, Colarusso G, Giona F, Lisi R, Giordano P, Boscarol G, Filosa A, Marktel S, Maroni P, Murgia M, Origa R, Longo F, Bortolotti M, Colombatti R, Di Maggio R, Mariani R, Piperno A, Corti P, Fidone C, Palazzi G, Badalamenti L, Gianesin B, Piel FB, Forni GL. Transfusional Approach in Multi-Ethnic Sickle Cell Patients: Real-World Practice Data From a Multicenter Survey in Italy. Front Med (Lausanne) 2022; 9:832154. [PMID: 35372393 PMCID: PMC8967327 DOI: 10.3389/fmed.2022.832154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Sickle cell disease (SCD) is a worldwide distributed hereditary red cell disorder characterized by recurrent acute vaso-occlusive crises (VOCs and anemia). Gold standard treatments are hydroxycarbamide (HC) and/or different red blood cell (RBC) transfusion regimens to limit disease progression. Here, we report a retrospective study on 1,579 SCD patients (median age 23 years; 802 males/777 females), referring to 34 comprehensive Italian centers for hemoglobinopathies. Although we observed a similar proportion of Caucasian (47.9%) and African (48.7%) patients, Italian SCD patients clustered into two distinct overall groups: children of African descent and adults of Caucasian descent. We found a subset of SCD patients requiring more intensive therapy with a combination of HC plus chronic transfusion regimen, due to partial failure of HC treatment alone in preventing or reducing sickle cell-related acute manifestations. Notably, we observed a higher use of acute transfusion approaches for SCD patients of African descent when compared to Caucasian subjects. This might be related to (i) age of starting HC treatment; (ii) patients' low social status; (iii) patients' limited access to family practitioners; or (iv) discrimination. In our cohort, alloimmunization was documented in 135 patients (8.5%) and was more common in Caucasians (10.3%) than in Africans (6.6%). Alloimmunization was similar in male and female and more frequent in adults than in children. Our study reinforces the importance of donor-recipient exact matching for ABO, Rhesus, and Kell antigen systems for RBC compatibility as a winning strategy to avoid or limit alloimmunization events that negatively impact the clinical management of SCD-related severe complications.
Collapse
Affiliation(s)
- Giovanna Graziadei
- Rare Diseases Center, General Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Laura Sainati
- Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Azienda Ospedaliera Universitaria, Padova, Italy
| | - Donatella Venturelli
- Servizio Immunotrasfusionale, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Nicoletta Masera
- Pediatric Clinic Hemato-Oncology Department, University of Milano-Bicocca, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Piero Bonomo
- Servizio Immunotrasfusionale, Azienda Ospedaliera Maria Paternò Arezzo, Ragusa, Italy
| | - Aurora Vassanelli
- UOC Medicina Trasfusionale, Azienda Ospedaliera Universitaria, Verona, Italy
| | - Maddalena Casale
- Department of Women, Child and General and Specialized Surgery, University “Luigi Vanvitelli”, Naples, Italy
| | - Gianluca Lodi
- Medicina Trasfusionale, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Vincenzo Voi
- Centro per le Emoglobinopatie – Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, Torino, Italy
| | - Paolo Rigano
- Campus of Haematology Franco e Piera Cutino, A.O.O.R. “Villa Sofia-Cervello” di Palermo, Palermo, Italy
| | - Valeria Maria Pinto
- Hematology, Thalassemia and Congenital Anemia Center, Ospedale Galliera, Genova, Italy
| | - Alessandra Quota
- Unità Operativa Semplice Dipartimentale Talassemia P.O. Vittorio Emanuele, Gela, Italy
| | - Lucia D. Notarangelo
- Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group, Brescia, Italy
| | - Giovanna Russo
- Pediatric Hematology/Oncology Unit, Università di Catania, Catania, Italy
| | - Massimo Allò
- Servizio Microcitemia, Presidio Ospedaliero SL 5, Crotone, Italy
| | - Rosamaria Rosso
- UOSD di Talassemia ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Policlinico San Marco, Catania, Italy
| | - Domenico D'Ascola
- Centro Microcitemie, Azienda Ospedaliera “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy
| | - Elena Facchini
- SSD Oncoematologia Pediatrica - Policlinico di S.Orsola, Bologna, Italy
| | - Silvia Macchi
- Servizio Trasfusionale, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | | | - Enza Rossi
- Unità Operativa Ematologia, Centro di Microcitemia, Azienda Ospedaliera di Cosenza, Presidio Ospedaliero “Annunziata” Cosenza, Cosenza, Italy
| | | | - Saveria Campisi
- Department of Talassemia, Siracusa Hospital, Siracusa, Italy
| | | | - Fiorina Giona
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Roberto Lisi
- Unità Operativa Dipartimentale Talassemia, Presidio Garibaldi-Centro ARNAS Garibaldi, Catania, Italy
| | - Paola Giordano
- UOC Pediatria Universitaria, Università di Bari, Bari, Italy
| | | | - Aldo Filosa
- UOSD Malattie rare del globulo rosso, AORN A. Cardarelli, Naples, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maroni
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Sette Laghi, Varese, Italy
| | - Mauro Murgia
- Centro Provinciale per le Microcitemia, Ospedale San Martino di Oristano, Oristano, Italy
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico, Università di Cagliari, Cagliari, Italy
| | - Filomena Longo
- Hematology, Thalassemia and Congenital Anemia Center, Ospedale Galliera, Genova, Italy
| | - Marta Bortolotti
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Raffaella Colombatti
- Dipartimento della Salute della Donna e del Bambino Azienda Ospedaliera, Azienda Ospedaliera Universitaria, Padova, Italy
| | - Rosario Di Maggio
- Unità Operativa Semplice Dipartimentale Talassemia P.O. Vittorio Emanuele, Gela, Italy
| | - Raffaella Mariani
- Rare Disease Centre - Hereditary anemias - ASST-Monza, S. Gerardo Hospital - University of Milano-Bicocca, Monza, Italy
| | - Alberto Piperno
- Rare Disease Centre - Hereditary anemias - ASST-Monza, S. Gerardo Hospital - University of Milano-Bicocca, Monza, Italy
| | - Paola Corti
- Pediatric Clinic Hemato-Oncology Department, University of Milano-Bicocca, MBBM Foundation, San Gerardo Hospital, Monza, Italy
| | - Carmelo Fidone
- Servizio Immunotrasfusionale, Azienda Ospedaliera Maria Paternò Arezzo, Ragusa, Italy
| | - Giovanni Palazzi
- Servizio Immunotrasfusionale, Azienda Ospedaliero Universitaria Modena, Modena, Italy
| | - Luca Badalamenti
- Biomedicina, Neuroscienze e Diagnostica avanzata, University of Palermo, Palermo, Italy
| | | | - Frédéric B. Piel
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Gian Luca Forni
- Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group, Brescia, Italy
- *Correspondence: Gian Luca Forni
| |
Collapse
|
10
|
Han H, Hensch L, Tubman VN. Indications for transfusion in the management of sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:696-703. [PMID: 34889416 PMCID: PMC8791131 DOI: 10.1182/hematology.2021000307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The transfusion of red blood cells (RBCs) is a crucial treatment for sickle cell disease (SCD). While often beneficial, the frequent use of transfusions is associated with numerous complications. Transfusions should be offered with specific guidelines in mind. Here we present updates to the indications for transfusion of RBCs in SCD. We review recent publications and include expert perspectives from hematology and transfusion medicine. For some clinical indications, such as ischemic stroke, the role of transfusion has been well studied and can be applied almost universally. For many other clinical scenarios, the use of transfusion therapy has less conclusive data and therefore must be tailored to individual needs. We highlight the roles of RBC transfusions in preventing or mitigating neurological disease, in reducing perioperative complications, in managing acute chest syndrome, and in optimizing pregnancy outcomes in SCD. We further highlight various transfusion techniques and when each might be considered. Potential complications of transfusion are also briefly discussed.
Collapse
Affiliation(s)
- Hyojeong Han
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Lisa Hensch
- Division of Transfusion Medicine and Coagulation, Texas Children's Hospital, Houston, TX
- Department of Pathology and Immunology and Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Venée N Tubman
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| |
Collapse
|
11
|
Pirenne F. How to avoid the problem of erythrocyte alloimmunization in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:689-695. [PMID: 34889373 PMCID: PMC8877235 DOI: 10.1182/hematology.2021000306] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Erythrocyte alloimmunization is a major barrier to transfusion in sickle cell disease (SCD) because it can lead to transfusion deadlock and the development of life-threatening hemolytic transfusion reactions (HTRs). Several risk factors have been identified, such as blood group polymorphism in these patients of African ancestry frequently exposed to antigens they do not carry and an inflammatory clinical state of the disease. The most important preventive measure is prophylactic red blood cell antigen matching, and there is a consensus that matching for Rh (D, C, E, c, e) and K antigens should be performed for all SCD patients. However, some patients are high responders and more at risk of developing antibodies and HTRs. For these patients, the extension of matching to other blood groups, including variant antigens of the RH blood group, the use of genotyping rather than serology to characterize significant blood groups, and the prophylactic administration of immunosuppressive treatments remain a matter of debate due to low levels of certainty concerning their effects and the difficulty of determining which patients, other than those already immunized, are at high risk. These issues were recently addressed by a panel of experts established by the American Society of Hematology. Here, we review and stratify the various interventions for preventing alloimmunization, based on the literature and our experience and taking into account the obstacles to their implementation and any future developments required.
Collapse
Affiliation(s)
- France Pirenne
- University Paris Est Creteil, Inserm, Institut Mondor de Recherche Biomedicale, Creteil, France
- Etablissement Français du sang Ile-de-France, Institut Mondor de Recherche Biomedicale, Creteil, France
- Correspondence France Pirenne, Etablissement Français du Sang, Hôpital Henri Mondor, 51 Ave du Maréchal de Lattre de Tassigny, 94000 Créteil, France; e-mail:
| |
Collapse
|
12
|
Juskewitch JE, Tauscher CD, Moldenhauer SK, Schieber JE, Jacob EK, DiGuardo MA. To Give or Not to Give: RhD Immunoglobulin for an RHD * 39 Pregnant Woman with Sickle Cell Disease. Transfus Med Hemother 2021; 48:244-249. [PMID: 34539319 DOI: 10.1159/000512644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with sickle cell disease (SCD) have repeated episodes of red blood cell (RBC) sickling and microvascular occlusion that manifest as pain crises, acute chest syndrome, and chronic hemolysis. These clinical sequelae usually increase during pregnancy. Given the racial distribution of SCD, patients with SCD are also more likely to have rarer RBC antigen genotypes than RBC donor populations. We present the management and clinical outcome of a 21-year-old pregnant woman with SCD and an RHD*39 (RhD[S103P], G-negative) variant. Case Presentation Ms. S is B positive with a reported history of anti-D, anti-C, and anti-E alloantibodies (anti-G testing unknown). Genetic testing revealed both an RHD*39 and homozygous partial RHCE*ceVS.02 genotype. Absorption/elution testing confirmed the presence of anti-G, anti-C, and anti-E alloantibodies but could not definitively determine the presence/absence of an anti-D alloantibody. Ms. S desired to undergo elective pregnancy termination and the need for postprocedural RhD immunoglobulin (RhIG) was posed. Given that only the G antigen site is changed in an RHD*39 genotype and the potential risk of RhIG triggering a hyperhemolytic episode in an SCD patient, RhIG was not administered. There were no procedural complications. Follow-up testing at 10 weeks showed no increase in RBC alloantibody strength. Discussion/Conclusion Ms. S represents a rare RHD*39 and partial RHCE*ceVS.02 genotype which did not further alloimmunize in the absence of RhIG administration. Her case also highlights the importance of routine anti-G alloantibody testing in women of childbearing age with apparent anti-D and anti-C alloantibodies.
Collapse
Affiliation(s)
| | - Craig D Tauscher
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Eapen K Jacob
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
13
|
Zerra PE, Patel SR, Jajosky RP, Arthur CM, McCoy JW, Allen JWL, Chonat S, Fasano RM, Roback JD, Josephson CD, Hendrickson JE, Stowell SR. Marginal zone B cells mediate a CD4 T-cell-dependent extrafollicular antibody response following RBC transfusion in mice. Blood 2021; 138:706-721. [PMID: 33876205 PMCID: PMC8394907 DOI: 10.1182/blood.2020009376] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
Red blood cell (RBC) transfusions can result in alloimmunization toward RBC alloantigens that can increase the probability of complications following subsequent transfusion. An improved understanding of the immune mechanisms that underlie RBC alloimmunization is critical if future strategies capable of preventing or even reducing this process are to be realized. Using the HOD (hen egg lysozyme [HEL] and ovalbumin [OVA] fused with the human RBC antigen Duffy) model system, we aimed to identify initiating immune factors that may govern early anti-HOD alloantibody formation. Our findings demonstrate that HOD RBCs continuously localize to the marginal sinus following transfusion, where they colocalize with marginal zone (MZ) B cells. Depletion of MZ B cells inhibited immunoglobulin M (IgM) and IgG anti-HOD antibody formation, whereas CD4 T-cell depletion only prevented IgG anti-HOD antibody development. HOD-specific CD4 T cells displayed similar proliferation and activation following transfusion of HOD RBCs into wild-type or MZ B-cell-deficient recipients, suggesting that IgG formation is not dependent on MZ B-cell-mediated CD4 T-cell activation. Moreover, depletion of follicular B cells failed to substantially impact the anti-HOD antibody response, and no increase in antigen-specific germinal center B cells was detected following HOD RBC transfusion, suggesting that antibody formation is not dependent on the splenic follicle. Despite this, anti-HOD antibodies persisted for several months following HOD RBC transfusion. Overall, these data suggest that MZ B cells can initiate and then contribute to RBC alloantibody formation, highlighting a unique immune pathway that can be engaged following RBC transfusion.
Collapse
Affiliation(s)
- Patricia E Zerra
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA and
| | - Seema R Patel
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA and
| | - Ryan Philip Jajosky
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - Connie M Arthur
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
| | - James W McCoy
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
| | - Jerry William Lynn Allen
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA and
| | - Ross M Fasano
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA and
| | - John D Roback
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
| | - Cassandra D Josephson
- Center for Transfusion Medicine and Cellular Therapies, Department of Laboratory Medicine and Pathology, and
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA and
| | | | - Sean R Stowell
- Joint Program in Transfusion Medicine, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and
| |
Collapse
|
14
|
Rankin A, Darbari D, Campbell A, Webb J, Mo YD, Jacquot C, Delaney M, Luban NLC, Nickel RS. Screening for new red blood cell alloantibodies after transfusion in patients with sickle cell disease. Transfusion 2021; 61:2255-2264. [PMID: 34002408 DOI: 10.1111/trf.16444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) are frequent recipients of red blood cell (RBC) transfusions and are at risk for RBC alloimmunization. RBC alloimmunization is diagnosed by identifying RBC alloantibodies as part of pre-transfusion testing, but this testing fails to detect alloantibodies that have evanesced. It may be beneficial to screen for new RBC alloantibody development after transfusion before possible antibody evanescence. STUDY DESIGN AND METHODS Our institution started a new initiative for episodically transfused patients with SCD to obtain at least one antibody screen 2-6 months after transfusion as part of their clinical care. A database was created to prospectively track all transfused patients for 1 year and their post-transfusion antibody screen results. Patients received prophylactically CEK-matched RBC units. RESULTS During the study year, 138 patients with SCD received a total of 242 RBC transfusions. Patients with a history of an RBC alloantibody (n = 13, 9.4%) had previously received more RBC units than non alloimmunized patients (median 11 vs. 2 RBC units, p = .0002). A total of 337 post-transfusion antibody screens were obtained in 127 patients (92.0%) with 110 patients (79.7%) having at least one antibody screen 2-6 months post-transfusion. With this prospective testing, two new RBC alloantibodies (anti-C and -M) were identified in two patients. CONCLUSION It is feasible to test for new RBC alloantibody development in most episodically transfused patients with SCD as part of their routine care. The yield of this screening appears low with CEK matching, but it could still provide important information for individual patients.
Collapse
Affiliation(s)
- Alexander Rankin
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Pediatric Hematology-Oncology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deepika Darbari
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andrew Campbell
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jennifer Webb
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Yunchuan Delores Mo
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cyril Jacquot
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Meghan Delaney
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Naomi L C Luban
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Robert Sheppard Nickel
- Divisions of Hematology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
15
|
Jalali Far MA, Oodi A, Amirizadeh N, Mohammadipour M, Keikhaei Dehdezi B. The Rh blood group system and its role in alloimmunization rate among sickle cell disease and sickle thalassemia patients in Iran. Mol Genet Genomic Med 2021; 9:e1614. [PMID: 33547762 PMCID: PMC8104156 DOI: 10.1002/mgg3.1614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/03/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The alloimmunization following blood transfusion can be life-threatening. The Rh alloantibodies are one of the most common causes contributing to alloimmunization. This study aimed to evaluate the rate and causes of alloimmunization and to determine the Rh phenotypes and genotypes among sickle cell disease (SCD) and sickle thalassemia (Sβ). MATERIALS AND METHODS Our study included 104 SCD and Sβ patients referring to Baghaei 2 Hospital of Ahvaz in 2019 using a non-random simple sampling method. The blood samples were collected for Rh phenotypes, alloantibody screening and identification, and molecular tests. The SSP-PCR and RFLP methods with the Pst 1 enzyme were used. RESULTS The alloimmunization rate was 9.6% and 13.2% based on immunohematological tests and medical records, respectively. The main alloantibodies (90%) were anti-Rh, and 40% of the patients had multiple alloantibodies. A significant correlation was found between gender and alloimmunization. The phenotypes of DCce (37.5%), DCcEe (24%), Dce (20.2%), and dce (5.8%) and genotypes of R1r (25%), R1R2 (20.2%), R1R1 (18.3%), and R1R0 (10.6%) were the most prevalent. The R1R2 was a frequent genotype in Sβ. CONCLUSION R0r' and R1R0 genotypes were limited to our population in Iran. Due to the differences in RH genotypes between our population and others, the blood transfusion from other ethnicities increased our total alloimmunization rate.
Collapse
Affiliation(s)
- Mohammad Ali Jalali Far
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion MedicineTehranIran
| | - Arezoo Oodi
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion MedicineTehranIran
| | - Naser Amirizadeh
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion MedicineTehranIran
| | - Mahshid Mohammadipour
- Blood Transfusion Research CenterHigh Institute for Research and Education in Transfusion MedicineTehranIran
| | - Bijan Keikhaei Dehdezi
- Thalassemia & Hemoglobinopathy Research Center, Research Institute of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
| |
Collapse
|
16
|
Pal M, Bao W, Wang R, Liu Y, An X, Mitchell WB, Lobo CA, Minniti C, Shi PA, Manwani D, Yazdanbakhsh K, Zhong H. Hemolysis inhibits humoral B-cell responses and modulates alloimmunization risk in patients with sickle cell disease. Blood 2021; 137:269-280. [PMID: 33152749 PMCID: PMC7820872 DOI: 10.1182/blood.2020008511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022] Open
Abstract
Red blood cell alloimmunization remains a barrier for safe and effective transfusions in sickle cell disease (SCD), but the associated risk factors remain largely unknown. Intravascular hemolysis, a hallmark of SCD, results in the release of heme with potent immunomodulatory activity, although its effect on SCD humoral response, specifically alloimmunization, remains unclear. Here, we found that cell-free heme suppresses human B-cell plasmablast and plasma cell differentiation by inhibiting the DOCK8/STAT3 signaling pathway, which is critical for B-cell activation, as well as by upregulating heme oxygenase 1 (HO-1) through its enzymatic byproducts, carbon monoxide and biliverdin. Whereas nonalloimmunized SCD B cells were inhibited by exogenous heme, B cells from the alloimmunized group were nonresponsive to heme inhibition and readily differentiated into plasma cells. Consistent with a differential B-cell response to hemolysis, we found elevated B-cell basal levels of DOCK8 and higher HO-1-mediated inhibition of activated B cells in nonalloimmunized compared with alloimmunized SCD patients. To overcome the alloimmunized B-cell heme insensitivity, we screened several heme-binding molecules and identified quinine as a potent inhibitor of B-cell activity, reversing the resistance to heme suppression in alloimmunized patients. B-cell inhibition by quinine occurred only in the presence of heme and through HO-1 induction. Altogether, these data suggest that hemolysis can dampen the humoral B-cell response and that B-cell heme responsiveness maybe a determinant of alloimmunization risk in SCD. By restoring B-cell heme sensitivity, quinine may have therapeutic potential to prevent and inhibit alloimmunization in SCD patients.
Collapse
Affiliation(s)
| | | | | | | | - Xiuli An
- Laboratory of Membrane Biology, New York Blood Center, New York, NY
| | - William B Mitchell
- Department of Pediatrics, Montefiore Health Center, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Cheryl A Lobo
- Laboratory of Blood-Borne Parasites, New York Blood Center, New York, NY
| | - Caterina Minniti
- Department of Medicine, Division of Hematology, Montefiore Health Center, Albert Einstein College of Medicine, Bronx, NY; and
| | - Patricia A Shi
- Sickle Cell Clinical Research Program, New York Blood Center, New York, NY
| | - Deepa Manwani
- Department of Pediatrics, Montefiore Health Center, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | | | - Hui Zhong
- Laboratory of Immune Regulation, and
| |
Collapse
|
17
|
Pediatric Hemovigilance and Adverse Transfusion Reactions. Clin Lab Med 2020; 41:51-67. [PMID: 33494885 DOI: 10.1016/j.cll.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Some types of transfusion reactions occur more frequently in the pediatric than the adult population. Allergic reactions are the most common, followed by nonhemolytic transfusion reactions; male children seem most susceptible to such reactions. Platelets are often implicated and pulmonary reactions are understudied in children. Clinical sequelae in neonates, such as bronchopulmonary dysplasia/chronic lung disease and intraventricular hemorrhage, have received increasing attention in relation to transfusion. There is a need to better understand the pathophysiology of transfusion reactions in neonatal and pediatric populations so preventive strategies can be undertaken. There is also a need for robust hemovigilance systems.
Collapse
|
18
|
El-Beshlawy A, Salama AA, El-Masry MR, El Husseiny NM, Abdelhameed AM. A study of red blood cell alloimmunization and autoimmunization among 200 multitransfused Egyptian β thalassemia patients. Sci Rep 2020; 10:21079. [PMID: 33273689 PMCID: PMC7713136 DOI: 10.1038/s41598-020-78333-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/24/2020] [Indexed: 01/27/2023] Open
Abstract
The development of hemolytic erythrocyte alloantibodies and autoantibodies complicates transfusion therapy in thalassemia patients. These antibodies ultimately increase the need for blood and intensify transfusion complications. There is a scanty data on the frequency of RBC alloimmunization and autoimmunization in Egyptian β thalassemia patients as pretransfusion antibody screening is not routinely performed. We studied the frequency of alloimmunization and autoimmunization among 200 multiply transfused β thalassemia patients and investigated the factors that possibly affect antibody formation. Of the 200 patients in our study, 94 were males and 106 females, with the age range of 2–37 years. Alloantibodies were detected in 36 (18%) of the patients, while autoantibodies were detected in 33 (16.5%). The dominant alloantibodies were directed against Kell (33%) and Rh (24.4%) groups. Alloimmunization had a significant relationship with treatment duration and the frequency of transfusion (P = 0.007, 0.001, respectively). The presence of autoantibodies was significantly related to age (P = 0.001), total number of transfused units (P = 0.000) and splenectomy (P = 0.000). The high prevalence of alloimmunization in the study population disclosed the need for providing phenotypically matched cells for selective antigens especially for Kell and Rh subgroups to reduce risk of alloimmunization and increase the efficiency of blood transfusion.
Collapse
Affiliation(s)
- Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Roshdy El-Masry
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha M El Husseiny
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Asmaa M Abdelhameed
- Department of Internal Medicine and Clinical Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt. .,Armed Forces College of Medicine (AFCM), Cairo, Egypt.
| |
Collapse
|
19
|
Hendrickson JE. Red blood cell alloimmunization and sickle cell disease: a narrative review on antibody induction. ANNALS OF BLOOD 2020; 5:33. [PMID: 33554044 PMCID: PMC7861514 DOI: 10.21037/aob-2020-scd-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The high prevalence of red blood cell (RBC) alloantibodies in people with sickle cell disease (SCD) cannot be debated. Why people with SCD are so likely to form RBC alloantibodies, however, remains poorly understood. Over the past decade, a better understanding of non-ABO blood group antigen variants has emerged; RH genetic diversity and the role this diversity plays in RBC alloimmunization is discussed elsewhere. Outside of antigen variants, the immune systems of people with SCD are known to be different than those of people without SCD. Some of these differences are due to effects of free heme, whereas others are impacted by hyposplenism. Descriptive studies of differences in white blood cell (WBC) subsets, platelet counts and function, and complement activation between people with SCD and race-matched controls exist. Studies comparing the immune systems of alloimmunized people with SCD to non-alloimmunized people with SCD to race-matched controls without SCD have uncovered differences in T-cell subsets, monocytes, Fcγ receptor polymorphisms, and responses to free heme. Studies in murine models have documented the role that recipient inflammation plays in RBC alloantibody formation, with human studies reporting a similar association. Murine studies have also reported the importance of type 1 interferon (IFNα/β), known to play a pivotal role in autoimmunity, in RBC alloantibody formation. The goal of this manuscript is to review existing data on factors influencing RBC alloantibody induction in people with SCD with a focus on inflammation and other immune system considerations, from the bench to the bedside.
Collapse
Affiliation(s)
- Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
20
|
CD4 + T Cell Profile and Activation Response in Sickle Cell Disease Patients with Osteonecrosis. Mediators Inflamm 2020; 2020:1747894. [PMID: 33132753 PMCID: PMC7568812 DOI: 10.1155/2020/1747894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Recent evidence suggests that abnormalities involving CD4+T lymphocytes are associated with the pathophysiology of osteonecrosis (ON); however, few studies have addressed the CD4+T cells in ON related to sickle cell disease (SCD/ON). In addition, T cells producing multiple cytokines simultaneously are often present in the inflammatory milieu and may be implicated in the immune response observed in SCD/ON. In the present study, we aimed to characterize the functional status of CD4+T cells in SCD by simultaneously determining the frequency of IFN-γ +, IL-4+, and IL-17+ CD4+T in cell cultures under exogenous stimuli. Peripheral blood mononuclear cells (PB-MNCs) from 9 steady-state SCD patients, 15 SCD/ON patients, and 19 healthy controls had functional status of CD4+T cells analyzed. Bone marrow mononuclear cells (BM-MNCs) from 24 SCD/ON patients (SCD BM) and 18 patients with ON not related to SCD (non-SCD BM) were also analyzed. We found that PB-MNC of SCD patients with or without ON presented significantly reduced TCD4+, TCD8+, and TCD4+ naïve cell frequencies and increased frequency of circulating CD4+T cells able to simultaneously produce IFN-γ +/IL4+ and IL-17+/IL4+ compared to healthy controls. Conversely, the polyclonal stimulation of BM-MNC induced an increased frequency of CD4+IFN-γ + and CD4+IL-17+ in SCD BM compared to non-SCD BM. The increased proportion of CD4+ T cells able to produce a broad spectrum of proinflammatory cytokines after a strong stimulus indicates that the immune system in SCD/ON patients presents an expressive pool of partially differentiated cells ready to take on effector function. It is possible that this increased subpopulation may extend to inflammatory sites of target organs and may contribute to the maintenance of inflammation and the pathophysiology of osteonecrosis in sickle cell disease.
Collapse
|
21
|
Investigation of Changes in Exosomes Profile During Storage Period of Erythrocyte Suspensions. Indian J Hematol Blood Transfus 2020. [DOI: 10.1007/s12288-020-01336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
22
|
Balbuena-Merle R, Santhanakrishnan M, Devine L, Gibb DR, Tormey CA, Siddon AJ, Curtis SA, Gallagher PG, Weinstein JS, Hendrickson JE. Characterization of circulating and cultured Tfh-like cells in sickle cell disease in relation to red blood cell alloimmunization status. Transfus Apher Sci 2020; 59:102778. [PMID: 32439490 PMCID: PMC7483805 DOI: 10.1016/j.transci.2020.102778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/12/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND People living with sickle cell disease (SCD) are prone to red blood cell (RBC) alloimmunization. We hypothesized that subjects with alloantibodies (responders) would have differences in circulating T-follicular helper (Tfh)-like cells compared to subjects without alloantibodies (non-responders). MATERIALS AND METHODS Peripheral blood mononuclear cells were collected from 28 subjects, including those with SCD and controls. Circulating CD4 T-cell subsets were first evaluated at baseline. CD4 T-cell subsets were also evaluated after naïve CD4 T-cells were differentiated into Tfh-like cells following in vitro culture with CD3/CD28 beads, IL-7, IL-12, and Activin A. Transfusion and alloantibody histories were extracted from the electronic medical record. RESULTS Non-responders had a lower percentage of CD45RA negative Tmemory cells than responders or controls (p<0.05). Notably, there were no differences in circulating Tfh-like cells between any group. However, naïve CD4 T-cells from subjects with SCD were more likely to express CXCR5 after in vitro culture than cells from controls. After culture, CXCR5 expressing cells from responders were more likely to express PD1 and ICOS (16.43 %, sd. 20.23) compared to non-responders (3.69 %, s.d. 3.09) or controls (2.78 %, s.d. 2.04). DISCUSSION The tendency for naïve CD4 T-cells from responders to differentiate into Tfh-like cells after in vitro culture may suggest these cells are prepared to assist B-cells with antibody production regardless of antigen specificity. Further studies are needed, but it is possible that these results may explain why some responders form RBC alloantibodies with multiple specificities, in addition to RBC autoantibodies and HLA alloantibodies.
Collapse
Affiliation(s)
- Raisa Balbuena-Merle
- Yale University, Department of Laboratory Medicine, New Haven, CT, United States
| | | | - Lesley Devine
- Yale University, Department of Laboratory Medicine, New Haven, CT, United States
| | - David R Gibb
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, Los Angeles, CA, United States
| | - Christopher A Tormey
- Yale University, Department of Laboratory Medicine, New Haven, CT, United States; VA Connecticut, Pathology and Laboratory Medicine Service, West Haven, CT, United States
| | - Alexa J Siddon
- Yale University, Department of Laboratory Medicine, New Haven, CT, United States; VA Connecticut, Pathology and Laboratory Medicine Service, West Haven, CT, United States; Yale University, Department of Pathology, New Haven, CT, United States
| | - Susanna A Curtis
- Yale University, Division of Hematology/Oncology, New Haven, CT, United States
| | - Patrick G Gallagher
- Yale University, Department of Pathology, New Haven, CT, United States; Yale University, Department of Pediatrics, New Haven, CT, United States; Yale University, Department of Genetics, New Haven, CT, United States
| | - Jason S Weinstein
- Rutgers New Jersey Medical School, Center for Immunity and Inflammation, Newark, NJ, United States
| | - Jeanne E Hendrickson
- Yale University, Department of Laboratory Medicine, New Haven, CT, United States; Yale University, Department of Pediatrics, New Haven, CT, United States.
| |
Collapse
|
23
|
Nickel RS, Flegel WA, Adams SD, Hendrickson JE, Liang H, Tisdale JF, Hsieh MM. The impact of pre-existing HLA and red blood cell antibodies on transfusion support and engraftment in sickle cell disease after nonmyeloablative hematopoietic stem cell transplantation from HLA-matched sibling donors: A prospective, single-center, observational study. EClinicalMedicine 2020; 24:100432. [PMID: 32637902 PMCID: PMC7327930 DOI: 10.1016/j.eclinm.2020.100432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is curative for patients with sickle cell disease (SCD). Prior to HSCT, patients with SCD commonly receive RBC transfusions with some becoming RBC or HLA alloimmunized. This alloimmunization may impact post-HSCT transfusion requirements and donor engraftment. METHODS The study population included patients with SCD transplanted on a single-center nonmyeloablative, HLA-matched sibling HSCT trial at the National Heart, Lung, and Blood Institute (NHLBI) who had a pre-HSCT sample available for HLA class I antibody testing. We evaluated transfusion requirements and engraftment outcomes comparing patients with and without pre-existing HLA and RBC antibodies. FINDINGS Of 36 patients studied, 10 (28%) had HLA class I antibodies and 11 (31%) had a history of RBC alloantibodies. Up to day +45 post-HSCT, patients with HLA antibodies received more platelet transfusions (median 2.5 vs 1, p = 0.042) and those with RBC alloantibodies received more RBC units (median 7 vs 4, p = 0.0059) compared to respective non-alloimmunized patients. HLA alloimmunization was not associated with neutrophil engraftment, donor chimerism, or graft rejection. However, RBC alloimmunization correlated with a decreased donor T cell chimerism at 1 year (median 24% vs 55%, p = 0.035). INTERPRETATION Pre-existing HLA and RBC alloantibodies are clinically significant for patients undergoing HLA-matched nonmyeloablative HSCT. Testing for both HLA and RBC antibodies is important to help estimate transfusion needs peri‑HSCT. The association of lower donor T cell chimerism and pre-existing RBC alloantibodies needs further investigation. FUNDING NIH Clinical Center and NHLBI Intramural Research Program (Z99 CL999999, HL006007-11) and the Thrasher Research Fund.
Collapse
Affiliation(s)
- Robert Sheppard Nickel
- Children's National Hospital, Division of Hematology, 111 Michigan Ave NW, Washington, DC 20010, United States
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Corresponding author at: Children's National Hospital, Division of Hematology, 111 Michigan Ave NW, Washington, DC 20010, United States.
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Sharon D. Adams
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Jeanne E. Hendrickson
- Departments of Laboratory Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Hua Liang
- The George Washington University, Department of Statistics, Washington, DC, United States
| | - John F. Tisdale
- Cellular and Molecular Therapeutics Branch, National Institutes of Health, Bethesda, MD, United States
| | - Matthew M. Hsieh
- Cellular and Molecular Therapeutics Branch, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
24
|
de Azevedo JTC, Malmegrim KCR. Immune mechanisms involved in sickle cell disease pathogenesis: current knowledge and perspectives. Immunol Lett 2020; 224:1-11. [PMID: 32437728 DOI: 10.1016/j.imlet.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/02/2020] [Accepted: 04/18/2020] [Indexed: 12/18/2022]
Abstract
Sickle cell disease (SCD) is caused by a single point mutation in the β-chain of the hemoglobin gene that results in the replacement of glutamic acid with valine in the hemoglobin protein. However, recent studies have demonstrated that alterations in several other genes, especially immune related genes, may be associated with complications of SCD. In fact, higher chronic inflammatory status is related to more severe clinical symptoms in SCD patients, suggesting crucial roles of the immune system in SCD physiopathology. Nevertheless, although participation of innate immune cells in SCD pathogenesis has been broadly and extensively described, little is known about the roles of the adaptive immune system in this disease. In addition, the influence of treatments on the immune system of SCD patients and their complications (such as alloimmunization) are not yet completely understood. Thus, we reviewed the current knowledge about the immune mechanisms involved in SCD pathogenesis. We suggest recommendations for future studies to allow for a broader understanding of SCD pathogenesis, helping in the development of new therapies and improvement in the life quality and expectancy of patients.
Collapse
Affiliation(s)
- Júlia Teixeira Cottas de Azevedo
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kelen Cristina Ribeiro Malmegrim
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Clinical, Toxicological and Bromatological Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
| |
Collapse
|
25
|
Garcia NP, Júnior ALS, Soares GAS, Costa TCC, dos Santos APC, Costa AG, Tarragô AM, Martins RN, do Carmo Leão Pontes F, de Almeida EG, de Paula EV, Martins-Filho OA, Malheiro A. Sickle Cell Anemia Patients Display an Intricate Cellular and Serum Biomarker Network Highlighted by TCD4+CD69+ Lymphocytes, IL-17/MIP-1 β, IL-12/VEGF, and IL-10/IP-10 Axis. J Immunol Res 2020; 2020:4585704. [PMID: 32411797 PMCID: PMC7199620 DOI: 10.1155/2020/4585704] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/14/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is associated with a chronic proinflammatory state characterized by elevated leukocyte count, mortality from severe recurrent infections, and subsequent vasoocclusive complications with leukocyte adhesion to the endothelium and increased plasma levels of inflammatory cytokines. The immune system has a close connection with morbidity in SCA, but further studies are needed to uncover the involvement of innate and adaptive immunities in modulating the SCA physiopathology. We performed measurements of the frequency of innate and adaptive immunity cells, cytokines, chemokines, and growth factors and immunophenotyping of Toll-like receptor and adhesion molecule expression in the blood of SCA patients and healthy donors to evaluate the different profiles of these biomarkers, the relationship among them, and their correlation to laboratory records and death risk. Material and Methods. Immunophenotyping of cells, Toll-like receptors, and adhesion molecules were performed from peripheral blood samples of SCA patients and healthy donors by flow cytometry and cytokine/chemokine/growth factor measurement by the Luminex technique performed from the serum of the same subjects. RESULTS Cells of adaptive immunity such as IL-12, IL-17, and IL-10 cytokines; IL-8, IP-10, MIP-1α, MIP-1β, and RANTES chemokines; and VEGF, FGF-basic, and GM-CSF growth factors were higher in SCA patients than healthy donors regardless of any laboratorial and clinical condition. However, high death risk appears to have relevant biomarkers. CONCLUSION In the SCA pathophysiology at steady state, there is a broad immunological biomarker crosstalk highlighted by TCD4+CD69+ lymphocytes, IL-12 and IL-17 inflammatory and IL-10 regulatory cytokines, MIP-1α, MIP-1β, and IP-10 chemokines, and VEGF growth factor. High expression of TLR2 in monocytes and VLA-4 in TCD8+ lymphocytes and high levels of MIP-1β and RANTES appear to be relevant in high death risk conditions. The high reticulocytosis and high death risk conditions present common correlations, and there seems to be a balance by the Th2 profile.
Collapse
Affiliation(s)
- Nadja Pinto Garcia
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), 69077-000 Manaus, AM, Brazil
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Alexander Leonardo S. Júnior
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
| | - Geyse Adriana S. Soares
- Programa de Apoio a Iniciação Científica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Thainá Cristina C. Costa
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
| | - Alicia Patrine C. dos Santos
- Programa de Apoio a Iniciação Científica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Allyson Guimarães Costa
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), 69077-000 Manaus, AM, Brazil
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
| | - Andréa Monteiro Tarragô
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Rejane Nina Martins
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Flávia do Carmo Leão Pontes
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
| | - Emerson Garcia de Almeida
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
| | - Erich Vinícius de Paula
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
- Departamento de Clínica Médica da Faculdade de Ciências Médicas da UNICAMP, 13083-970 Campinas, SP, Brazil
| | - Olindo Assis Martins-Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou/Fiocruz Minas, 30190-002 Belo Horizonte, MG, Brazil
| | - Adriana Malheiro
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Universidade Federal do Amazonas (UFAM), 69077-000 Manaus, AM, Brazil
- Laboratório de Genômica, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), 69050-001 Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade Estadual do Amazonas (PPCAH/UEA), 69065-001 Manaus, AM, Brazil
| |
Collapse
|
26
|
|
27
|
Nickel RS, Horan JT, Abraham A, Qayed M, Haight A, Ngwube A, Liang H, Luban NLC, Hendrickson JE. Human leukocyte antigen (HLA) class I antibodies and transfusion support in paediatric HLA‐matched haematopoietic cell transplant for sickle cell disease. Br J Haematol 2019; 189:162-170. [DOI: 10.1111/bjh.16298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Robert S. Nickel
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
| | - John T. Horan
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Allistair Abraham
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Ann Haight
- Aflac Cancer and Blood Disorders Center Emory University Atlanta GAUSA
| | - Alexander Ngwube
- Center for Cancer and Blood Disorders Phoenix Children's Hospital Phoenix AZUSA
| | - Hua Liang
- Department of Statistics The George Washington University Washington DCUSA
| | - Naomi L. C. Luban
- Division of Hematology Children's National Hospital WashingtonDCUSA
- The George Washington University School of Medicine and Health Sciences Washington DCUSA
| | | |
Collapse
|
28
|
Balbuena-Merle R, Curtis SA, Devine L, Gibb DR, Karafin MS, Luckey CJ, Tormey CA, Siddon AJ, Roberts JD, Hendrickson JE. Red blood cell alloimmunization is associated with lower expression of FcγR1 on monocyte subsets in patients with sickle cell disease. Transfusion 2019; 59:3219-3227. [PMID: 31355970 PMCID: PMC7075520 DOI: 10.1111/trf.15463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/25/2019] [Accepted: 07/05/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the clinical significance of red blood cell (RBC) alloantibodies, there are currently no laboratory tests available to predict which patients may be at risk of antibody formation after transfusion exposure. Given their phagocytic and inflammatory functions, we hypothesized that differences in circulating monocytes may play a role in alloimmunization. STUDY DESIGN AND METHODS Forty-two adults with sickle cell disease (SCD) were recruited, with data extracted from the electronic medical record and peripheral blood analyzed by flow cytometry for total monocytes, monocyte subsets (CD14 high/CD16 low+ classical monocytes, CD14 high/CD16 high+ intermediate monocytes, and CD14 intermediate/CD16 high+ non-classical/inflammatory monocytes), and FcγR1 (CD64) expression. Thirteen "non-responder" patients (non-alloimmunized patients with documented RBC transfusion at the study institution) were compared to 20 alloimmunized "responder" patients, who had a total of 44 RBC alloantibodies identified. RESULTS There were no significant differences in the percentages of total monocytes, monocyte subsets, or measured cytokines between non-responders and responders. However, non-responders had higher CD64 expression on classical monocytes (MFI mean 3424 ± standard deviation 1141) compared to responders (MFI mean 2285 ± 1501), p = 0.029, and on intermediate monocytes (MFI mean 3720 ± 1191) compared to responders (MFI mean 2497 ± 1640), p = 0.033. CONCLUSIONS Monocytes and the inflammatory milieu increasingly are being appreciated to play a role in some complications of SCD. The differences in FcγR1 expression on monocyte subsets noted between responders and non-responders, which cannot be directly explained by the serum cytokines evaluated, warrant further investigation.
Collapse
Affiliation(s)
| | | | - Lesley Devine
- Department of Laboratory Medicine, Yale University, New Haven
| | - David R. Gibb
- Department of Laboratory Medicine, Yale University, New Haven
| | - Matthew S. Karafin
- Medical Sciences Institute, Blood Center of Wisconsin, part of Versiti, Milwaukee, WI
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Chance John Luckey
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Christopher A. Tormey
- Department of Laboratory Medicine, Yale University, New Haven
- VA Connecticut, Pathology and Laboratory Medicine Service, West Haven, Connecticut
| | - Alexa J. Siddon
- Department of Laboratory Medicine, Yale University, New Haven
- VA Connecticut, Pathology and Laboratory Medicine Service, West Haven, Connecticut
- Department of Pathology, Yale University, New Haven
| | | | - Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven
- Department of Pediatrics, Yale University, New Haven
| |
Collapse
|
29
|
Moncharmont P. Adverse transfusion reactions in transfused children. Transfus Clin Biol 2019; 26:329-335. [PMID: 31563446 DOI: 10.1016/j.tracli.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/06/2019] [Indexed: 01/28/2023]
Abstract
Transfusion in paediatrics requires specific guidelines, because child physiology and pathology differ significantly as compared to adults. Adverse transfusion reactions in transfused children also vary in type and frequency, but there is a better understanding of these reactions in adults than in children. However, for the most frequent adverse transfusion reactions, the overall prevalence is higher in children than in adults, with the exception of post-transfusion red blood cell alloimmunisation, which is lower, excluding patients with haemoglobinopathies. In several studies, allergic reactions were the most frequently reported adverse transfusion reaction in paediatrics, and the platelet concentrate the most frequently implicated blood product. Early diagnosis of certain adverse transfusion reactions such as haemosiderosis, is essential in order to initiate the best therapy and obtain a good clinical outcome. The prevention of adverse transfusion reactions in children is required, but needs further clinical studies in paediatrics. Lastly, changes in technology, policy and clinical practices will improve transfusion safety in children.
Collapse
Affiliation(s)
- P Moncharmont
- Département des vigilances, hémovigilance, établissement français du sang Auvergne Rhône-Alpes, site de Lyon-Décines, 111, rue Élisée-Reclus, CS 20617, 69153 Décines-Charpieu cedex, France.
| |
Collapse
|
30
|
El Kababi S, Benajiba M, El Khalfi B, Hachim J, Soukri A. Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors. Transfus Clin Biol 2019; 26:240-248. [PMID: 31279519 DOI: 10.1016/j.tracli.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/09/2019] [Indexed: 01/26/2023]
Abstract
Red blood cell alloimmunization is one of the major challenges to regular transfusions in β-thalassemic patients. In Morocco, rare studies have focused on this hemoglobinopathy. OBJECTIVE We aimed to study the prevalence and risk factors of red cell alloimmunization in β-thalassemic patients. PATIENTS AND METHODS Retrospective study during 9 years (2009-2018) was conducted on 160 β-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. RESULTS The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. CONCLUSION This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.
Collapse
Affiliation(s)
- S El Kababi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - M Benajiba
- National Blood Transfusion Center, Immuno-hematology, Bab-El-Irfane, rue m'fadel-Cherka, 10000 Rabat, Morocco
| | - B El Khalfi
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco
| | - J Hachim
- Hematology-Oncology pediatric department, Children's Hospital Abderrahim Harouchi, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University, Tarik bnou ziad street, 20360 Casablanca, Morocco
| | - A Soukri
- Laboratory of Physiopathology, Genetics Molecular and Biotechnology (PGMB), Faculty of Sciences Ain Chock, Research Center Health and Biotechnology, University Hassan II of Casablanca, Km 8 Route El jadida, BP 5366, Mearif, 20100 Casablanca, Morocco.
| |
Collapse
|
31
|
MicroRNA Profiling of Exosomes Derived from Red Blood Cell Units: Implications in Transfusion-Related Immunomodulation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2045915. [PMID: 31312654 PMCID: PMC6595350 DOI: 10.1155/2019/2045915] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/27/2019] [Indexed: 12/21/2022]
Abstract
Purpose To elucidate the microRNAs existent in exosomes derived from stored red blood cell (RBC) unit and their potential function. Materials and Methods Exosomes were isolated from the supernatant derived from stored RBC units by sequential centrifugation. Isolated exosomes were characterized by TEM (transmission electron microscopy), western blotting, and DLS (dynamic light scattering). MicroRNA (miRNA) microarray was performed to detect the expression of miRNAs in 3 exosome samples. Results revealed miRNAs that were simultaneously expressed in the 3 exosome samples and were previously reported to exist in mature RBCs. Functions and potential pathways of some detected miRNAs were illustrated by bioinformatic analysis. Validation of the top 3 abundant miRNAs was carried out by qRT-PCR (quantitative reverse transcription‐polymerase chain reaction). Results TEM and DLS revealed the mean size of the exosomes (RBC-derived) as 64.08 nm. These exosomes exhibited higher abundance of short RNA than the long RNA. 78 miRNAs were simultaneously detected in 3 exosome samples and mature RBCs. Several biological processes might be impacted by these miRNAs, through their target gene(s) enriched in a particular signalling pathway. The top 3 (abundant) miRNAs detected were as follows: miR-125b-5p, miR-4454, and miR-451a. qRT-PCR revealed higher abundance of miR-451a than others. Only miR-4454 and miR-451a abundance tended to increase with increasing storage time. Conclusion Exosomes derived from stored RBC units possessed multiple miRNAs and, hence, could serve various functions. The function of exosomes (RBC-derived) might be implemented partly by the predominantly enriched miR-451a.
Collapse
|
32
|
Torres-Acosta MA, Harrison RP, Csaszar E, Rito-Palomares M, Brunck MEG. Ex vivo Manufactured Neutrophils for Treatment of Neutropenia-A Process Economic Evaluation. Front Med (Lausanne) 2019; 6:21. [PMID: 30881955 PMCID: PMC6405517 DOI: 10.3389/fmed.2019.00021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/23/2019] [Indexed: 01/11/2023] Open
Abstract
Neutropenia is a common side-effect of acute myeloid leukemia (AML) chemotherapy characterized by a critical drop in neutrophil blood concentration. Neutropenic patients are prone to infections, experience poorer clinical outcomes, and require expensive medical care. Although transfusions of donor neutrophils are a logical solution to neutropenia, this approach has not gained clinical traction, primarily due to challenges associated with obtaining sufficiently large numbers of neutrophils from donors whilst logistically managing their extremely short shelf-life. A protocol has been developed that produces clinical-scale quantities of neutrophils from hematopoietic stem and progenitor cells (HSPC) in 10 L single-use bioreactors (1). This strategy could be used to mass produce neutrophils and generate sufficient cell numbers to allow decisive clinical trials of neutrophil transfusion. We present a bioprocess model for neutrophil production at relevant clinical-scale. We evaluated two production scenarios, and the impact on cost of goods (COG) of multiple model parameters including cell yield, materials costs, and process duration. The most significant contributors to cost were consumables and raw materials, including the cost of procuring HSPC-containing umbilical cord blood. The model indicates that the most cost-efficient culture volume (batch size) is ~100 L in a single bioreactor. This study serves as a framework for decision-making and optimization strategies when contemplating the production of clinical quantities of cells for allogeneic therapy.
Collapse
Affiliation(s)
| | - Richard P Harrison
- Centre for Biological Engineering, Holywell Park, Loughborough University, Loughborough, United Kingdom.,Wolfson Centre for Stem Cells, Tissue Engineering and Modelling (STEM), School of Medicine, Nottingham, United Kingdom
| | - Elizabeth Csaszar
- Centre for Commercialization of Regenerative Medicine, Toronto, ON, Canada
| | - Marco Rito-Palomares
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Marion E G Brunck
- Centro de Biotecnología FEMSA, Tecnológico de Monterrey, Monterrey, Mexico
| |
Collapse
|
33
|
Transfusion-related red blood cell alloantibodies: induction and consequences. Blood 2019; 133:1821-1830. [PMID: 30808636 DOI: 10.1182/blood-2018-08-833962] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 01/19/2023] Open
Abstract
Blood transfusion is the most common procedure completed during a given hospitalization in the United States. Although often life-saving, transfusions are not risk-free. One sequela that occurs in a subset of red blood cell (RBC) transfusion recipients is the development of alloantibodies. It is estimated that only 30% of induced RBC alloantibodies are detected, given alloantibody induction and evanescence patterns, missed opportunities for alloantibody detection, and record fragmentation. Alloantibodies may be clinically significant in future transfusion scenarios, potentially resulting in acute or delayed hemolytic transfusion reactions or in difficulty locating compatible RBC units for future transfusion. Alloantibodies can also be clinically significant in future pregnancies, potentially resulting in hemolytic disease of the fetus and newborn. A better understanding of factors that impact RBC alloantibody formation may allow general or targeted preventative strategies to be developed. Animal and human studies suggest that blood donor, blood product, and transfusion recipient variables potentially influence which transfusion recipients will become alloimmunized, with genetic as well as innate/adaptive immune factors also playing a role. At present, judicious transfusion of RBCs is the primary strategy invoked in alloimmunization prevention. Other mitigation strategies include matching RBC antigens of blood donors to those of transfusion recipients or providing immunomodulatory therapies prior to blood product exposure in select recipients with a history of life-threatening alloimmunization. Multidisciplinary collaborations between providers with expertise in transfusion medicine, hematology, oncology, transplantation, obstetrics, and immunology, among other areas, are needed to better understand RBC alloimmunization and refine preventative strategies.
Collapse
|
34
|
Balbuena-Merle R, Hendrickson JE. Red blood cell alloimmunization and delayed hemolytic transfusion reactions in patients with sickle cell disease. Transfus Clin Biol 2019; 26:112-115. [PMID: 30857806 DOI: 10.1016/j.tracli.2019.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Red blood cell (RBC) alloimmunization is more common in patients with sickle cell disease (SCD) than in any other studied patient population. The high prevalence of RBC alloimmunization is multi-factorial, likely involving the chronic hemolysis and inflammatory status of SCD itself, the transfusion burden of patients, and the RH genetic diversity of patients and blood donors, among other reasons. Antibody evanescence, or the decrease of RBC alloantibodies below levels detectable by blood bank testing, occurs frequently with fewer than 30% of alloantibodies estimated to be detected by current screening practices. Evanescence increases the likelihood that a patient with SCD will have a delayed hemolytic transfusion reaction upon future RBC exposure, with previously undetected alloantibodies coming roaring back in an anamnestic manner after exposure to the cognate RBC antigen. A subset of patients having delayed hemolytic transfusion reactions go on to experience hyperhemolysis; some but not all cases of hyperhemolysis are associated with previously evanescent RBC alloantibodies. There is an increasing appreciation of the association between RBC alloantibodies and RBC autoantibodies, as well as involvement of the alternative complement pathway in some instances of hyperhemolysis. A case report in this manuscript describes a highly alloimmunized patient with SCD who experiences a delayed hemolytic transfusion reaction with bystander hemolysis due to a previously evanescent, complement binding anti-M RBC alloantibody. Additional studies, including those involving multiple centers and countries, are needed to further understand RBC alloimmunization in patients with SCD and to develop strategies to prevent or mitigate potentially life-threatening hemolytic transfusion reactions.
Collapse
Affiliation(s)
- R Balbuena-Merle
- Department of Laboratory Medicine, 330 Cedar Street, CB 405, New Haven, CT 06520-8035, United States
| | - J E Hendrickson
- Department of Laboratory Medicine, 330 Cedar Street, CB 405, New Haven, CT 06520-8035, United States.
| |
Collapse
|
35
|
Complement activation during intravascular hemolysis: Implication for sickle cell disease and hemolytic transfusion reactions. Transfus Clin Biol 2019; 26:116-124. [PMID: 30879901 DOI: 10.1016/j.tracli.2019.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intravascular hemolysis is a hallmark of a large spectrum of diseases, including the sickle cell disease (SCD), and is characterized by liberation of red blood cell (RBC) degradation products in the circulation. Released Hb, heme, RBC fragments and microvesicles (MVs) exert pro-inflammatory, pro-oxidative and cytotoxic effects and contribute to vascular and tissue damage. The innate immune complement system not only contributes to the RBC lysis, but it is also itself activated by heme, RBC MVs and the hypoxia-altered endothelium, amplifying thus the cell and tissue damage. This review focuses on the implication of the complement system in hemolysis and hemolysis-mediated injuries in SCD and in cases of delayed hemolytic transfusion reactions (DHTR). We summarize the evidences for presence of biomarkers of complement activation in patients with SCD and the mechanisms of complement activation in DHTR. We discuss the role of antibodies-dependent activation of the classical complement pathway as well as the heme-dependent activation of the alternative pathway. Finally, we describe the available evidences for the efficacy of therapeutic blockade of complement in cases of DHTR. In conclusion, complement blockade is holding promises but future prospective studies are required to introduce Eculizumab or another upcoming complement therapeutic for DHTR and even in SCD.
Collapse
|
36
|
Richards AL, Sheldon K, Wu X, Gruber DR, Hudson KE. The Role of the Immunological Synapse in Differential Effects of APC Subsets in Alloimmunization to Fresh, Non-stored RBCs. Front Immunol 2018; 9:2200. [PMID: 30344520 PMCID: PMC6182098 DOI: 10.3389/fimmu.2018.02200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Each year, over 5 million red blood cell (RBC) transfusions are administered to patients in the USA. Despite the therapeutic benefits of RBC transfusions, there are associated risks. RBC-specific alloantibodies may form in response to antigenic differences between RBC donors and recipients; these alloantibodies can be a problem as they may mediate hemolysis or pose barriers to future transfusion support. While there is currently no reliable way to predict which RBC recipients will make an alloantibody response, risk factors such as inflammation have been shown to correlate with increased rates of RBC alloimmunization. The underlying mechanisms behind how inflammation mediates alloantibody production are incompletely defined. Methods: To assess erythrophagocytosis, mice were treated with PBS or inflammatory stimuli followed by a transfusion of allogeneic RBCs labeled with a lipophilic dye. At multiple time points, RBC consumption and expression of activation makers by leukocytes was evaluated. To determine which antigen presenting cell (APC) subset(s) were capable of promoting allogeneic T cell activation, sorted leukocyte populations (which had participated in erythrophagocytosis) were co-cultured in vitro with allogeneic CD4+ T cells; T cell proliferation and ability to form immunological synapses with APCs were determined. Results: Upon transfusion of fresh allogeneic RBCs, multiple APCs consumed transfused RBCs. However, only CD8+ and CD11b+ dendritic cells formed productive immunological synapses with allogeneic T cells and stimulated proliferation. Importantly, allogeneic T cell activation and RBC alloantibody production occurred in response to RBC transfusion alone, and transfusion in the context of inflammation enhanced RBC consumption, the number of immune synapses, allogeneic T cell proliferation, and the rate and magnitude of alloantibody production. Conclusions: These data demonstrate that regardless of the ability to participate in RBC consumption, only a subset of APCs are capable of forming an immune synapse with T cells thereby initiating an alloantibody response. Additionally, these data provide mechanistic insight into RBC alloantibody generation.
Collapse
Affiliation(s)
| | - Kathryn Sheldon
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Xiaoping Wu
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - David R Gruber
- Bloodworks Northwest Research Institute, Seattle, WA, United States
| | - Krystalyn E Hudson
- Bloodworks Northwest Research Institute, Seattle, WA, United States.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
37
|
Tzounakas VL, Valsami SI, Kriebardis AG, Papassideri IS, Seghatchian J, Antonelou MH. Red cell transfusion in paediatric patients with thalassaemia and sickle cell disease: Current status, challenges and perspectives. Transfus Apher Sci 2018; 57:347-357. [PMID: 29880248 DOI: 10.1016/j.transci.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Notwithstanding the high safety level of the currently available blood for transfusion and the decreasing frequency of transfusion-related complications, administration of labile blood products to paediatric patients still poses unique challenges and considerations. The incidence of thalassaemia and sickle cell disease in the paediatric population may be high enough under specific racial and geographical contexts. Red cell transfusion is the cornerstone of β-thalassaemia treatment and one of the most effective ways to prevent or correct specific acute and chronic complications of sickle cell disease. However, this life-saving strategy comes with its own complications, such as additional iron overload, alloimmunization and haemolytic reactions, among others. In paediatrics, the dependency of the transfusion outcome upon disease and other recipient characteristics is more prominent compared with the adults, owing to differences in developmental maturity and physiology that render them more susceptible to common risks, exacerbate the host response to transfused cells, and modify the type or the clinical severity of the transfusion-related morbidity. The adverse branch of red cell transfusion is likely the overall effect of several factors acting synergistically to shape the clinical phenotype of this therapy, including inherent donor/blood unit variables, like antigenicity, red cell deformability and extracellular vesicles, as well as recipient variables, such as history of alloimmunization and inflammation level at time of transfusion. This review focuses on paediatric patients with β-thalassaemia and sickle cell disease as a recipient group with distinct transfusion-related characteristics, and introduces new concepts for consideration, not adequately studied and elucidated so far.
Collapse
Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Serena I Valsami
- Department of Blood Transfusion, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Technological and Educational Institute of Athens, Athens, Greece
| | - Issidora S Papassideri
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
| |
Collapse
|
38
|
da Cunha Gomes EG, Machado LAF, de Oliveira LC, Neto JFN. The erythrocyte alloimmunisation in patients with sickle cell anaemia: a systematic review. Transfus Med 2018; 29:149-161. [PMID: 29845661 DOI: 10.1111/tme.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
Transfusion therapy is a common practice in the treatment of anaemia and can cause erythrocyte alloimmunisation. To systematise data related to erythrocyte alloimmunisation in patients with sickle cell disease (SCD), a bibliographic search was carried out in September 2017 to search for studies in four electronic databases. (i) Referring to the original work, (ii) being cohort or case-control, (iii) having been developed with individuals with SCD and (iv) having evaluated the erythrocyte alloimmunisation. Two reviewers identified the articles for inclusion in the study, extracted the predetermined data and carried out the evaluation of the methodological quality of the work. 21 studies were selected; the studies included data on 20 636 individuals (children and adults), were mostly published in the last 10 years, were developed in the United States and had high methodological quality. The occurrence of erythrocyte alloimmunisation ranged from 4·4 to 76%, and there was a higher rate of alloimmunisation against antigens of the Rh system. The risk factors for alloimmunisation were age; gender (female); red blood cell (RBC) units received; presence of ≥1 autoantibodies, TNF-α, interleukin (IL1B), human leukocyte antigens (HLA)-DRB1 gene polymorphisms; first blood transfusion (BT) after 5 years of age, transfusion episodic, multiple or during inflammatory events, acute chest syndrome (ACS) and vase-occlusive crisis (VOC); increased percentage of CD41 T memory cells; and positive direct antiglobulin test. Transfusion policies should be developed to protect the patient and his or her health based on the main factors associated with its incidence.
Collapse
Affiliation(s)
- E G da Cunha Gomes
- Professional Master's in Health, Laboratory Medicine and Forensic Technology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - L A F Machado
- Professional Master's in Health, Laboratory Medicine and Forensic Technology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - L C de Oliveira
- Search Group NutriPali, Nutritionist Palliative Care Unit, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - J F N Neto
- Lipids Laboratory-LabLip, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
39
|
Chonat S, Quarmyne MO, Bennett CM, Dean CL, Joiner CH, Fasano RM, Stowell SR. Contribution of alternative complement pathway to delayed hemolytic transfusion reaction in sickle cell disease. Haematologica 2018; 103:e483-e485. [PMID: 29794144 DOI: 10.3324/haematol.2018.194670] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Satheesh Chonat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA .,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Maa-Ohui Quarmyne
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Caroline M Bennett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Christina L Dean
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Clinton H Joiner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ross M Fasano
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean R Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
40
|
Floch A, Gien D, Tournamille C, Chami B, Habibi A, Galactéros F, Bierling P, Djoudi R, Pondarré C, Peyrard T, Pirenne F. High immunogenicity of red blood cell antigens restricted to the population of African descent in a cohort of sickle cell disease patients. Transfusion 2018; 58:1527-1535. [PMID: 29707783 DOI: 10.1111/trf.14633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) patients undergo multiple red blood cell (RBC) transfusions and are regularly exposed to low-prevalence (LP) antigens specific to individuals of African descent. This study evaluated the prevalence of antibodies against LP antigens in SCD patients and the need to identify these antibodies in everyday practice. STUDY DESIGN AND METHODS Plasma from 211 SCD patients was tested with RBCs expressing the following LP antigens: RH10 (V), RH20 (VS), RH23 (DW ), RH30 (Goa ), KEL6 (Jsa ), and MNS6 (He). RESULTS Nine LP antibodies were found in eight patients (3.8%): five anti-RH23, two anti-RH30, and two anti-MNS6. The exposure risk, calculated for each LP antigen, was below 3% per RBC unit, for all antigens tested. Thus, in this cohort of transfused SCD patients, the prevalence of LP antibodies was similar to that of antibodies against antigens of the FY, JK, and MNS blood group systems. These findings also reveal the occurrence of anti-RH23 in SCD patients. No anti-RH20 or anti-KEL6 were found, despite the high frequency of mismatch situations. CONCLUSION These results highlight the immunogenicity of these LP antigens, and the evanescence of antibodies against LP antigens. They also highlight the importance of appropriate pretransfusion testing for patients frequently transfused, who are likely to be exposed to multiple types of blood group antigens.
Collapse
Affiliation(s)
- Aline Floch
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil
| | - Dominique Gien
- Laboratory of Excellence GR-Ex, Créteil, France.,Département Centre National de Référence pour les Groupes Sanguins, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - Christophe Tournamille
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France
| | - Btissam Chami
- Etablissement Français du Sang (EFS)-Ile de France, Créteil
| | - Anoosha Habibi
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Centre de Référence de la Drépanocytose, Unité des Maladies du Globule Rouge, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Frédéric Galactéros
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Centre de Référence de la Drépanocytose, Unité des Maladies du Globule Rouge, Hôpitaux Universitaires Henri Mondor, Créteil
| | - Philippe Bierling
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil.,Service de Pédiatrie et Drépanocytose, Centre Intercommunal de Créteil, Créteil, France
| | - Rachid Djoudi
- Etablissement Français du Sang (EFS)-Ile de France, Créteil
| | - Corinne Pondarré
- INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Service de Pédiatrie et Drépanocytose, Centre Intercommunal de Créteil, Créteil, France
| | - Thierry Peyrard
- Laboratory of Excellence GR-Ex, Créteil, France.,Département Centre National de Référence pour les Groupes Sanguins, Institut National de la Transfusion Sanguine (INTS), Paris, France
| | - France Pirenne
- Etablissement Français du Sang (EFS)-Ile de France, Créteil.,INSERM U955, Equipe 2 "Transfusion et maladies du globule rouge", Créteil.,Laboratory of Excellence GR-Ex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil
| |
Collapse
|
41
|
Karafin MS, Westlake M, Hauser RG, Tormey CA, Norris PJ, Roubinian NH, Wu Y, Triulzi DJ, Kleinman S, Hendrickson JE. Risk factors for red blood cell alloimmunization in the Recipient Epidemiology and Donor Evaluation Study (REDS-III) database. Br J Haematol 2018; 181:672-681. [PMID: 29675950 DOI: 10.1111/bjh.15182] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/29/2018] [Indexed: 12/22/2022]
Abstract
Despite the significance of red blood cell (RBC) alloimmunization, the lack of standardized registries in the US has prevented the completion of large studies. Data from 3·5 years of the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) recipient database, containing information from 12 hospitals, were studied. A RBC alloantibody responder had an antibody identified at any point during the study, and a non-responder had a negative antibody screen at least 15 days post-RBC transfusion. Demographics, blood type, ICD9/10 codes, and other potential correlates were evaluated. Of 319 177 (2·07%) screened patients, 6597 had a total of 8892 clinically significant RBC alloantibodies identified, with 75% being in the Rh or Kell families. Alloimmunization was more common in females (2·38%) than males (1·68%), and in RhD negative (2·82%) than RhD positive (1·94%) patients. Age, sex, RhD status and race were associated with being a responder, and certain diagnoses (including sickle cell disease or trait, systemic lupus erythematosus, rheumatoid arthritis and myelodysplastic syndrome) were more common among responders than non-responders. Data collected in this multi-centre recipient database provide the largest RBC alloimmunized patient cohort studied in the US, with previously known demographic and disease associations of responder status confirmed, and new associations identified.
Collapse
Affiliation(s)
| | | | - Ronald G Hauser
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,VA CT, West Haven, CT, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,VA CT, West Haven, CT, USA
| | - Philip J Norris
- University of California, San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| | - Nareg H Roubinian
- University of California, San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| | - Yanyun Wu
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,Bloodworks Northwest, Seattle, WA, USA
| | - Darrell J Triulzi
- University of Pittsburgh and Institute of Transfusion Medicine, Pittsburgh, PA, USA
| | - Steve Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University, New Haven, CT, USA.,Department of Pediatrics, Yale University, New Haven, CT, USA
| | | |
Collapse
|
42
|
Giudice V, Feng X, Lin Z, Hu W, Zhang F, Qiao W, Ibanez MDPF, Rios O, Young NS. Deep sequencing and flow cytometric characterization of expanded effector memory CD8 +CD57 + T cells frequently reveals T-cell receptor Vβ oligoclonality and CDR3 homology in acquired aplastic anemia. Haematologica 2018; 103:759-769. [PMID: 29419434 PMCID: PMC5927970 DOI: 10.3324/haematol.2017.176701] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/30/2017] [Indexed: 11/24/2022] Open
Abstract
Oligoclonal expansion of CD8+ CD28− lymphocytes has been considered indirect evidence for a pathogenic immune response in acquired aplastic anemia. A subset of CD8+ CD28− cells with CD57 expression, termed effector memory cells, is expanded in several immune-mediated diseases and may have a role in immune surveillance. We hypothesized that effector memory CD8+CD28−CD57+ cells may drive aberrant oligoclonal expansion in aplastic anemia. We found CD8+CD57+ cells frequently expanded in the blood of aplastic anemia patients, with oligoclonal characteristics by flow cytometric Vβ usage analysis: skewing in 1–5 Vβ families and frequencies of immunodominant clones ranging from 1.98% to 66.5%. Oligoclonal characteristics were also observed in total CD8+ cells from aplastic anemia patients with CD8+CD57+ cell expansion by T-cell receptor deep sequencing, as well as the presence of 1–3 immunodominant clones. Oligoclonality was confirmed by T-cell receptor repertoire deep sequencing of enriched CD8+CD57+ cells, which also showed decreased diversity compared to total CD4+ and CD8+ cell pools. From analysis of complementarity-determining region 3 sequences in the CD8+ cell pool, a total of 29 sequences were shared between patients and controls, but these sequences were highly expressed in aplastic anemia subjects and also present in their immunodominant clones. In summary, expansion of effector memory CD8+ T cells is frequent in aplastic anemia and mirrors Vβ oligoclonal expansion. Flow cytometric Vβ usage analysis combined with deep sequencing technologies allows high resolution characterization of the T-cell receptor repertoire, and might represent a useful tool in the diagnosis and periodic evaluation of aplastic anemia patients. (Registered at clinicaltrials.gov identifiers: 00001620, 01623167, 00001397, 00071045, 00081523, 00961064)
Collapse
Affiliation(s)
- Valentina Giudice
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Zenghua Lin
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA.,Department of Hematology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Wei Hu
- BGI Genomics, BGI-Shenzhen, China
| | | | | | | | - Olga Rios
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD, USA
| |
Collapse
|
43
|
Red blood cell alloimmunization: new findings at the bench and new recommendations for the bedside. Curr Opin Hematol 2017; 23:543-549. [PMID: 27454234 DOI: 10.1097/moh.0000000000000277] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To summarize recent discoveries from clinical studies and animal models that contribute to understanding the alloimmune response to non-ABO blood group antigens. RECENT FINDINGS Several studies have confirmed high rates of alloimmunization among patients requiring chronic red blood cell (RBC) transfusion. Moreover, 'triggers' for alloantibody development in the transfusion setting have been identified, with a number of investigations linking recipient inflammation to a higher likelihood of alloimmunization. Additional associations between human leukocyte antigen expression and CD4 T-cell markers in 'responder' or 'nonresponder' humans have been revealed. Recent animal studies have described novel mechanistic properties by which the alloimmune response is governed, including the critical role played by dendritic cells in transfusion-associated alloimmunization. New light has also been shed on the properties of alloantibodies developed as a result of pregnancy, as well as mechanisms through which such alloimmunization may be prevented. SUMMARY Many of the clinical/biological factors that contribute to the RBC alloimmune response have been further elucidated. This knowledge will be applied to identify individuals most likely to mount an immune response to RBC antigens, such that appropriate resources and strategies for preventing alloimmunization (or mitigating its harmful effects) can be implemented.
Collapse
|
44
|
Nonclassical FCGR2C haplotype is associated with protection from red blood cell alloimmunization in sickle cell disease. Blood 2017; 130:2121-2130. [PMID: 28899854 DOI: 10.1182/blood-2017-05-784876] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/06/2017] [Indexed: 01/21/2023] Open
Abstract
Red blood cell (RBC) transfusions are of vital importance in patients with sickle cell disease (SCD). However, a major complication of transfusion therapy is alloimmunization. The low-affinity Fcγ receptors, expressed on immune cells, are important regulators of antibody responses. Genetic variation in FCGR genes has been associated with various auto- and alloimmune diseases. The aim of this study was to evaluate the association between genetic variation of FCGR and RBC alloimmunization in SCD. In this case-control study, DNA samples from 2 cohorts of transfused SCD patients were combined (France and The Netherlands). Cases had a positive history of alloimmunization, having received ≥1 RBC unit. Controls had a negative history of alloimmunization, having received ≥20 RBC units. Single nucleotide polymorphisms and copy number variation of the FCGR2/3 gene cluster were studied in a FCGR-specific multiplex ligation-dependent probe amplification assay. Frequencies were compared using logistic regression. Two hundred seventy-two patients were included (130 controls, 142 cases). The nonclassical open reading frame in the FCGR2C gene (FCGR2C.nc-ORF) was strongly associated with a decreased alloimmunization risk (odds ratio [OR] 0.26, 95% confidence [CI] 0.11-0.64). This association persisted when only including controls with exposure to ≥100 units (OR 0.30, CI 0.11-0.85) and appeared even stronger when excluding cases with Rh or K antibodies only (OR 0.19, CI 0.06-0.59). In conclusion, SCD patients with the FCGR2Cnc-ORF polymorphism have over a 3-fold lower risk for RBC alloimmunization in comparison with patients without this mutation. This protective effect was strongest for exposure to antigens other than the immunogenic Rh or K antigens.
Collapse
|
45
|
Chou ST, Westhoff CM. Application of genomics for transfusion therapy in sickle cell anemia. Blood Cells Mol Dis 2017; 67:148-154. [DOI: 10.1016/j.bcmd.2017.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/07/2017] [Indexed: 12/23/2022]
|
46
|
Hendrickson JE. Red blood cell alloimmunisation: induction of immunity and potential mitigation strategies. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- J. E. Hendrickson
- Department of Laboratory Medicine; Yale University School of Medicine; New Haven CT USA
- Department of Pediatrics; Yale University School of Medicine; New Haven CT USA
| |
Collapse
|
47
|
Evers D, van der Bom JG, Tijmensen J, de Haas M, Middelburg RA, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, Zwaginga JJ. Absence of the spleen and the occurrence of primary red cell alloimmunization in humans. Haematologica 2017; 102:e289-e292. [PMID: 28411255 DOI: 10.3324/haematol.2016.162685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dorothea Evers
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Deptartment of Clinical Epidemiology, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands
| | - Janneke Tijmensen
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands
| | - Masja de Haas
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands.,Department of Immunohematology Diagnostics, Sanquin, Amsterdam, the Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Deptartment of Clinical Epidemiology, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Eindhoven, the Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Hematology, Catharina Hospital, Eindhoven, the Netherlands
| | - Otto Visser
- Department of Hematology, VU Medical Center, Amsterdam, the Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | | | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands .,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Sanquin, Amsterdam, the Netherlands
| |
Collapse
|
48
|
Allali S, Peyrard T, Amiranoff D, Cohen JF, Chalumeau M, Brousse V, de Montalembert M. Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre. Br J Haematol 2017; 177:641-647. [PMID: 28402005 DOI: 10.1111/bjh.14609] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 12/27/2016] [Indexed: 12/27/2022]
Abstract
Patients with sickle cell disease (SCD) show a high prevalence of red blood cell (RBC) alloimmunization, but few studies have focused on children. We aimed to study the prevalence and risk factors of RBC alloimmunization in SCD children. We retrospectively analysed the medical and transfusion files for 245 SCD children hospitalized in our centre in 2014 and included 175 patients who had received at least one RBC unit in their lifetime. The main clinical and immuno-haematological characteristics of alloimmunized and non-alloimmunized patients were compared. The prevalence of alloimmunization was 13·7% [95% confidence interval (CI) (8·6-18·6)], and 7·4% [95% CI (3·5-11·3)] after excluding the probable irregular natural antibodies (anti-M, anti-Lea , anti-Leb , anti-Lex ). Main risk factors for alloimmunization were increased number of RBC units received (median of 65 vs. 10 units per patient; P = 0·01) and the presence of one or more red cell autoantibodies (46·2% vs. 4·7%; P < 0·0001). The alloimmunization rate was higher for episodically transfused than chronically transfused patients (1·43 vs. 0·24/100 units received; P < 0·001). The presence of red cell autoantibodies appears to be a major risk factor for alloimmunization in SCD children and could justify specific transfusion guidelines.
Collapse
Affiliation(s)
- Slimane Allali
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Thierry Peyrard
- Laboratory of Excellence GR-Ex, Paris, France.,Département Centre National de Référence pour les Groupes Sanguins (CNRGS), Institut National de la Transfusion Sanguine (INTS), Paris, France.,Inserm UMR_S1134, Paris Diderot University, Paris, France
| | - Denise Amiranoff
- Etablissement Français du Sang (EFS), Necker Hospital for Sick Children, Paris, France
| | - Jérémie F Cohen
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France
| | - Martin Chalumeau
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France.,Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm UMR1153, Paris, France
| | - Valentine Brousse
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| | - Mariane de Montalembert
- Department of Paediatrics, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
| |
Collapse
|
49
|
Mekontso Dessap A, Pirenne F, Razazi K, Moutereau S, Abid S, Brun‐Buisson C, Maitre B, Michel M, Galacteros F, Bartolucci P, Habibi A. A diagnostic nomogram for delayed hemolytic transfusion reaction in sickle cell disease. Am J Hematol 2016; 91:1181-1184. [PMID: 27538126 DOI: 10.1002/ajh.24537] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022]
Abstract
Diagnosis of delayed hemolytic transfusion reactions (DHTR), one of the most dreaded complications of transfusion in patients with sickle cell disease (SCD), is challenging and not straightforward. Current diagnostic approaches are complex and not consensual; they are based on assessment of hemoglobin (Hb) drop and enhanced hemolysis, features also seen during classical vaso-occlusive events. In this observational study, we tested the hypothesis that the rate of decline in HbA after an index transfusion is a surrogate marker for the destruction of transfused RBC, which could be used diagnostically. We examined 421 transfusion episodes (in 128 patients of a French referral center for SCD) for which an Hb electrophoresis was obtained within 1 week following an index transfusion and repeated within 2 months (before a subsequent scheduled transfusion or during an acute complication). Chart review found DHTR to be present in 26 cases (6.2%), absent in 389 cases (92.4%), and possible in six cases (1.4%). As expected, DHTR was associated with accelerated hemolysis (increased serum bilirubin and lactic dehydrogenase concentrations) and a decline in total Hb as compared to the early post-transfusion value. However, the decline in HbA concentration appeared more effective in segregating between patients without DHTR and others. We propose a diagnostic nomogram for DHTR based on Hb A as a biologic marker of the survival of transfused RBCs. Am. J. Hematol. 91:1181-1184, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Armand Mekontso Dessap
- AP‐HP, Hôpitaux Universitaires Henri Mondor, DHU A‐TVB, Service de Réanimation MédicaleCréteil France
- Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMASCréteil France
| | - France Pirenne
- Établissement Français du sang (EFS) Île‐de‐France, Université Paris Est Créteil, Faculté de Médecine Créteil France
- Laboratory of Excellence GRexINSERM U955, Equipe 2Créteil France
| | - Keyvan Razazi
- AP‐HP, Hôpitaux Universitaires Henri Mondor, DHU A‐TVB, Service de Réanimation MédicaleCréteil France
- Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMASCréteil France
| | - Stéphane Moutereau
- Service de BiochimieAP‐HP, Hôpitaux Universitaires Henri MondorCréteil France
| | - Shariq Abid
- AP‐HP, Hôpitaux Universitaires Henri Mondor, DHU A‐TVB, Service de Réanimation MédicaleCréteil France
| | - Christian Brun‐Buisson
- AP‐HP, Hôpitaux Universitaires Henri Mondor, DHU A‐TVB, Service de Réanimation MédicaleCréteil France
- Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMASCréteil France
| | - Bernard Maitre
- AP‐HP, Hôpitaux Universitaires Henri Mondor, DHU A‐TVB, Service de Réanimation MédicaleCréteil France
- Unité de PneumologieAP‐HP, Hôpitaux Universitaires Henri MondorCréteil France
| | - Marc Michel
- Service de Médecine InterneAP‐HP, Universitaires Henri MondorCréteil France
| | - Frederic Galacteros
- Laboratory of Excellence GRexINSERM U955, Equipe 2Créteil France
- Unité des Maladies du Globule RougeAP‐HP, Hôpitaux Universitaires Henri MondorCréteil France
| | - Pablo Bartolucci
- Laboratory of Excellence GRexINSERM U955, Equipe 2Créteil France
- Unité des Maladies du Globule RougeAP‐HP, Hôpitaux Universitaires Henri MondorCréteil France
| | - Anoosha Habibi
- Laboratory of Excellence GRexINSERM U955, Equipe 2Créteil France
- Unité des Maladies du Globule RougeAP‐HP, Hôpitaux Universitaires Henri MondorCréteil France
| |
Collapse
|
50
|
Sippert EÂ, Visentainer JEL, Alves HV, Rodrigues C, Gilli SCO, Addas-Carvalho M, Saad STO, Costa FF, Castilho L. Red blood cell alloimmunization in patients with sickle cell disease: correlation with HLA and cytokine gene polymorphisms. Transfusion 2016; 57:379-389. [PMID: 27873324 DOI: 10.1111/trf.13920] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The reason for the difference in susceptibility to red blood cell (RBC) alloimmunization among patients with sickle cell disease (SCD) is not clearly understood and is probably the result of multiple factors. Our hypothesis is that genetic polymorphisms are associated with RBC alloimmunization. STUDY DESIGN AND METHODS We investigated the possible association of susceptibility to RBC alloimmunization with polymorphisms of HLA and cytokines genes in 161 SCD patients prior exposed to RBC transfusion. Cytokine gene polymorphisms were analyzed by polymerase chain reaction (PCR) and TaqMan assays. HLA Class I genotyping was performed using PCR-specific sequence of oligonucleotides. Polymorphism frequencies were compared using the Fisher's exact test. RESULTS Our results revealed increased percentage of the A allele and the GA genotype of the TNFA -308G/A cytokine among alloimmunized patients when compared to nonalloimmunized patients (A allele, 16.4% vs. 6.8%, p = 0.004; GA genotype, 32.8% vs. 11.7%, p = 0.0021). In addition, the IL1B -511T allele and the IL1B -511TT and CT genotype frequencies were overrepresented among alloimmunized patients (T allele, 53.0% vs. 37.5%, p = 0.0085; CT + TT genotypes, 81.82% vs. 60.87%, p = 0.0071). In relation to HLA Class I, we found a higher frequency of HLA-DRB1*15 among patients alloimmunized to Rh antigens when compared to nonalloimmunized patients (15.63% vs. 6.98%, p = 0.044). CONCLUSION Brazilian SCD patients with the TNFA, IL1B, and HLA-DRB1 gene polymorphisms were at increased risk of becoming alloimmunized by RBC transfusions. These findings may contribute to the development of future therapeutic strategies for patients with SCD with higher susceptibility of alloimmunization.
Collapse
Affiliation(s)
- Emilia Ângela Sippert
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Hugo Vicentin Alves
- Basic Health Sciences Department, State University of Maringa, Maringá, Paraná, Brazil
| | - Camila Rodrigues
- Basic Health Sciences Department, State University of Maringa, Maringá, Paraná, Brazil
| | | | - Marcelo Addas-Carvalho
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | | | - Fernando Ferreira Costa
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Lilian Castilho
- Hematology and Hemotherapy Center, State University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| |
Collapse
|