Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series
Robert Sheppard Nickel
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Division of Hematology, Children's National Health System, Washington, DC
Search for more papers by this authorJeanne E. Hendrickson
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Department of Pediatrics, Yale University, New Haven, Connecticut
Department of Laboratory Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorRoss M. Fasano
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorErin K. Meyer
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Search for more papers by this authorAnne M. Winkler
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Search for more papers by this authorMarianne M. Yee
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorPeter A. Lane
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorYuritzi A. Jones
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorFarzana D. Pashankar
Department of Pediatrics, Yale University, New Haven, Connecticut
Search for more papers by this authorTamara New
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorCassandra D. Josephson
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorCorresponding Author
Sean R. Stowell
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Address reprint requests to: Sean R. Stowell, Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, GA 30322; e-mail: [email protected]; [email protected].Search for more papers by this authorRobert Sheppard Nickel
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Division of Hematology, Children's National Health System, Washington, DC
Search for more papers by this authorJeanne E. Hendrickson
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Department of Pediatrics, Yale University, New Haven, Connecticut
Department of Laboratory Medicine, Yale University, New Haven, Connecticut
Search for more papers by this authorRoss M. Fasano
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorErin K. Meyer
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Search for more papers by this authorAnne M. Winkler
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Search for more papers by this authorMarianne M. Yee
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorPeter A. Lane
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorYuritzi A. Jones
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorFarzana D. Pashankar
Department of Pediatrics, Yale University, New Haven, Connecticut
Search for more papers by this authorTamara New
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorCassandra D. Josephson
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
Search for more papers by this authorCorresponding Author
Sean R. Stowell
Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, Georgia
Address reprint requests to: Sean R. Stowell, Center for Transfusion and Cellular Therapy, Department of Pathology, Emory University, Atlanta, GA 30322; e-mail: [email protected]; [email protected].Search for more papers by this authorAbstract
BACKGROUND
Although red blood cell (RBC) transfusion represents an integral component of sickle cell disease (SCD) care, transfusion support for some patients can result in alloimmunization to RBC antigens. Alloimmunized patients with SCD appear to experience worse survival compared to nonalloimmunized patients. While this difference in mortality may in part be due to underlying immunologic differences related to disease severity, it may also reflect direct clinical consequences of RBC alloimmunization. Alloimmunized patients have an increased risk of serious hemolytic transfusion reactions (HTRs) and may not receive adequate RBC transfusion support due to lack of compatible RBC units.
CASE REPORT
This study reports on five RBC alloimmunized patients with SCD who died, to illustrate the concept that RBC alloimmunization itself contributes to premature death.
RESULTS
The clinical course for each of the reported patients provides insight into the direct and indirect consequences of RBC alloimmunization, where patients experienced delayed HTRs or did not receive needed RBC transfusions.
CONCLUSION
Future work examining the clinical impact of RBC alloimmunization should not only consider HTRs but should also address the potential consequences associated with difficulties in obtaining compatible blood.
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