Alloimmunization and red cell autoimmunization in multitransfused thalassemics of Indian origin

Transfusion therapy in thalassemia is a double edged sword, on the one hand, it is a major life saving modality, while on the other hand, it can lead to complications such as alloimmunization. The rates of alloimmunization have been variably reported across the world; however, there is a paucity of such literature among Indian thalassemics. We studied the frequency of alloimmunization and autoimmunization among 211 multitransfused thalassemics of Indian origin. All the patients have been receiving blood matched for ABO and Rh(D) antigens only. Direct antiglobulin test was performed on all patients to detect autoantibody while antibody screening (using 3-cell panel) and antibody identification (11-cell panel) were carried out to detect the presence of alloantibody. The frequency of alloimmunization was 3.79% and that of autoimmunization was 0.47%. The alloantibodies identified were anti-E, anti-K, anti-D, anti-Kp(a), anti-C-w, anti-c and anti-Jk(a). In the present study, no significant association was observed between splenectomy and the development of alloantibodies as well as between age at initiation of transfusion and alloimmunization. To conclude, there is a need to formulate a balanced and cost-effective approach for transfusion management of thalassemics to minimize alloimmunization and autoimmunization.