Prevalence of allo- and auto-antibodies in transfused sickle cell disease and cancer patients at Kenyatta National Hospital

Abstract

Multiple transfusions are required for certain populations such as patients with sickle cell disease (SCD), haematological malignancies (HM) and solid (SM) malignancy. However, the development of auto and alloantibody has not been considered and their prevalence remains unknown. We determined the prevalence and specificities of RBC alloantibodies and autoantibodies in patient groups (SCD, HM and SM) with recurrent transfusion demands at Kenyatta National Hospital, Nairobi, Kenya.Between February and August 2014, 300 whole blood samples from SCD, HM and SM patients were collected and screened for allo- and autoantibodies.Amongst the 228 patients with viable samples (SCD, n = 137; HM, n = 48; SM, n = 43), the median transfusion frequency was two to three events per group, 38 (16.7%) were RBC immunized and 32 (14.0%) had a positive direct antiglobulin test. Specific alloantibodies were identified in six patients (2.6%). Four of these six were SCD patients (2.9%) who had specific RBC alloantibodies (anti-Cw, anti-M, anti-Cob, anti-S); amongst HM patients one had anti-K and one had anti-Lea. RBC autoantibody prevalence was 3.1% (7/228). Amongst the healthy blood donors, the Ror, ccD.ee and R2r, ccD.Ee phenotypes accounted for 82% of the Rhesus phenotypes and all were Kell negative. The numbers of transfusions and the rates of RBC allo- and autoantibodies are low. The most important RBC allo- and autoantibody-inducing blood group antigens are relatively homogeneously distributed in this population. A general change in the Kenyatta National Hospital pre-transfusion test regimen is thus not necessary. The current transfusion practice should be reconsidered if transfusionfrequencies increase in the future.