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How do I incorporate red cell genotyping to improve chronic transfusion therapy?
Author(s) -
Van Buren Nancy L.,
Gorlin Jed B.,
Corby Susan M.,
Cassidy Sandra,
FritchLilla Stephanie,
Nelson Stephen C.,
Westhoff Connie M.
Publication year - 2020
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.15599
Subject(s) - genotyping , medicine , thalassemia , transfusion therapy , blood transfusion , immunology , red blood cell , antigen , blood type (non human) , hematology , allele , antibody , sickle cell anemia , population , abo blood group system , disease , genotype , biology , genetics , gene , environmental health
BACKGROUND Children with transfusion dependent anemia, such as sickle cell disease (SCD) and thalassemia, are at an increased risk for developing red blood cell (RBC) alloantibodies due to their lifelong need for transfusion therapy. With the advent of genotyping, extended RBC antigen typing can be incorporated into chronic transfusion therapy programs (CTTPs) to improve patient care and provide antigen matched blood for this population of patients. STUDY DESIGN AND METHODS The hospital, blood center (BC), and hematology clinic caring for children requiring long‐term transfusion support developed a CTTP. Genotyping was performed at entry to determine patient RBC antigen type. Limited versus extended antigen matching of transfusions was provided based on known RBC antibodies. RESULTS Fifty patients with the following disorders were enrolled: 20 with SCD, 23 with thalassemia, and 7 with other disorders. At enrollment, nine (18%) had RBC alloantibodies, including six (30%) of patients with SCD and three (13%) with thalassemia. Two children developed antibodies after enrollment; one warm autoantibody following limited “CEK” matched RBCs and one patient with a hemizygous variant RHD allele developed anti‐D. Six (30%) patients with SCD had variant RHCE alleles; two had homozygous variant alleles and four had a variant present along with a wild type allele. CONCLUSION We demonstrate how a CTTP can be developed in a community hospital through collaboration with the blood supplier, hospital, and clinical care team. A model of incorporating RBC genotyping informs risk for alloimmunization and allows consideration of transfusion strategy for providing prophylactic antigen matched blood.