Transfusions in autoimmune hemolytic anemias: Frequency and clinical significance of alloimmunization

IF 9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2023-11-27 DOI:10.1111/joim.13753

Francesco Versino, Nicoletta Revelli, Stefania Villa, Loredana Pettine, Anna Zaninoni, Daniele Prati, Francesco Passamonti, Wilma Barcellini, Bruno Fattizzo

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Abstract

Background

Autoimmune hemolytic anemia (AIHA) may be associated with transfusion reactions and risk of alloimmunization.

Objectives

To evaluate the transfusion policy and rate of alloimmunization and its clinical significance in AIHA.

Methods

Data from 305 AIHA patients followed at a reference hematologic Center in Milan, Italy from 1997 to 2022 were retrospectively/prospectively collected (NCT05931718).

Results

Overall, 33% patients required transfusions with a response rate of 83% and eight transfusion reactions (7%), none hemolytic. Alloantibodies were detected in 19% of patients, being associated with higher transfusion burden (p = 0.01), lower Hb increase post-transfusion (p = 0.05), and transfusion reactions (p = 0.04). Along decades, the rate of RBC transfusions decreased from 53% to 20% and that of alloimmunization dropped from 30% to 6% likely due to the adoption of prestorage leukoreduction, the use of more restrictive Hb thresholds, and the implementation of molecular typing.

Conclusions

Severe symptomatic AIHA may be safely transfused provided appropriate matching of patients and donors.

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自身免疫性溶血性贫血的输血:同种免疫的频率和临床意义。

背景:自身免疫性溶血性贫血(AIHA)可能与输血反应和同种异体免疫风险有关。目的:评价AIHA患者输血政策、异体免疫率及其临床意义。方法:回顾性/前瞻性收集1997年至2022年在意大利米兰一家参考血液学中心随访的305例AIHA患者的数据(NCT05931718)。结果:总体而言，33%的患者需要输血，反应率为83%，8例输血反应(7%)，无溶血。19%的患者检测到同种异体抗体，与较高的输血负担(p = 0.01)、较低的输血后Hb升高(p = 0.05)和输血反应(p = 0.04)相关。几十年来，红细胞输注率从53%下降到20%，同种异体免疫率从30%下降到6%，这可能是由于采用了储存前白细胞诱导、使用更严格的Hb阈值以及分子分型的实施。结论:如果患者和供体匹配得当，严重症状AIHA是可以安全输血的。

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来源期刊

Journal of Internal Medicine 医学-医学：内科

CiteScore

22.00

自引率

0.90%

发文量

176

审稿时长

4-8 weeks

期刊介绍： JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.