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Incidence of alloantibody formation after ABO‐D or extended matched red blood cell transfusions: a randomized trial (MATCH study)
Author(s) -
Schonewille Henk,
Honohan Áine,
van der Watering Leo M.G.,
Hudig Francisca,
te Boekhorst Peter A.,
Koopmanvan Gemert Ankie W.M.M.,
Brand Anneke
Publication year - 2016
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13347
Subject(s) - medicine , abo blood group system , incidence (geometry) , confidence interval , red blood cell , randomized controlled trial , blood transfusion , relative risk , antibody , surgery , gastroenterology , immunology , physics , optics
BACKGROUND Most incidentally transfused patients receive only ABO‐D–compatible transfusions and antibodies are formed in up to 8%. The effect of extended (c, C, E, K, Fy a , Jk a , and S antigens) matched (EM) and ABO‐D–matched red blood cell (RBC) transfusions on the incidence of new clinically relevant RBC antibody formation after a first elective transfusion event in surgical patients was studied. STUDY DESIGN AND METHODS A multicenter randomized trial was performed in nontransfused patients who were scheduled to experience a single elective transfusion event of maximal 4 RBC units. The primary outcome was the incidence of newly formed warm reacting clinically relevant RBC alloantibodies measured in three follow‐up (FU) samples taken at 7 to 10 days, 4 to 6 weeks, and 4 to 6 months posttransfusion. RESULTS A total of 853 patients were randomized, and of these, 333 patients were transfused with a total of 1035 RBC units. At least one FU sample was available from 97% of transfused patients. In intention‐to‐treat analysis, new antibodies were detected in 10 of 155 ABO‐D and seven of 178 EM patients, respectively. Per‐protocol analysis including 190 patients showed a nonsignificant absolute risk difference (ARD) of 5.3% (95% confidence interval [CI], −1.4% to 12%) in alloimmunization between study arms. In a post hoc analysis of 138 patients who received RBCs but no platelet (PLT) transfusions the ARD increased to significance, 8.0% (95% CI, 0.4‐16.0). CONCLUSION Extended matching for selected antigens reduced the alloimmunization risk by 64% in surgical patients. Extended matching seems successful only if the patient did not receive accompanying nonmatched PLT transfusions.