Standard Compared With Extended Red Blood Cell Antigen Matching for Prevention of Subsequent Hemolytic Disease of the Fetus and Newborn: A Systematic Review.

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY ACS Applied Materials & Interfaces Pub Date : 2024-10-01 Epub Date: 2024-08-08 DOI:10.1097/AOG.0000000000005701

Ronan P Sugrue, Jaxon Olsen, Marie Elise Abi Antoun, Lesley A Skalla, Jennifer Cate, Andra H James, Alexandra Stonehill, Virginia Watkins, Marilyn J Telen, Jerome J Federspiel

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Abstract

Objective: To systematically review and meta-analyze alloimmunization among recipients of red blood cells (RBCs) matched for ABO blood type and Rhesus D (ABO+D) antigen compared with those also matched for c, E, and Kell (cEK).

Data sources: Four online databases (Medline, Scopus, EMBASE, ClinicalTrials.gov ) were searched from March 28, 2023, to April 1, 2024. The search protocol was peer reviewed and published on PROSPERO ( CRD42023411620 ).

Methods of study selection: Studies reporting alloimmunization as the primary outcome among recipients of RBCs matched for ABO+D or additional cEK matching were included. Patients transfused with unmatched RBCs or a mixture of matching regimens were excluded. Risk of bias was assessed with Cochrane Tool to Assess Risk of Bias in Cohort Studies and Tool for Risk of Bias. Random-effects meta-analysis was used to combine effect estimates.

Tabulation, integration, and results: Ten studies met criteria. Risk of bias was low. Overall, 91,221 patients were transfused, of whom 40,220 (44.1%) received additional cEK-matched RBCs. The overall rate of alloimmunization was 6.2% (95% CI, 2.5-14.9%) for ABO+D-only matching and 1.9% (95% CI, 0.7-5.1%) when cEK was added. Time of follow-up antibody testing ranged from 6 to 18 months after transfusion. Additional cEK match was associated with significantly less alloimmunization compared with standard ABO+D match (odds ratio [OR] 0.37, 95% CI, 0.20-0.69). This association remained when chronically transfused patients were excluded (OR 0.65, 95% CI, 0.54-0.79) and for alloimmunization to c, E, or K antigens only (OR 0.29, 95% CI, 0.18-0.47).

Conclusion: Additional cEK RBC matching protocols were associated with lower odds of recipient alloimmunization. Given severe sequelae of alloimmunization in pregnancy, routine cEK matching for transfusion in people with pregnancy potential younger than age 50 years in the United States merits consideration.

Systematic review registration: PROSPERO, CRD42023411620 .

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标准红细胞抗原配型与扩展红细胞抗原配型在预防胎儿和新生儿溶血病方面的比较：系统回顾。

目的系统回顾和荟萃分析ABO血型和恒河猴D（ABO+D）抗原匹配的红细胞（RBC）与c、E和Kell（cEK）匹配的红细胞（RBC）接受者之间的同种免疫情况：从 2023 年 3 月 28 日至 2024 年 4 月 1 日检索了四个在线数据库（Medline、Scopus、EMBASE、ClinicalTrials.gov）。检索协议经同行评审后发布在 PROSPERO (CRD42023411620)上：纳入的研究报告将同种异体免疫作为 ABO+D 或额外 cEK 匹配的 RBC 受体的主要结果。排除了输注未配型RBC或混合配型方案的患者。使用科克伦队列研究偏倚风险评估工具（Cochrane Tool to Assess Risk of Bias in Cohort Studies）和偏倚风险工具（Tool for Risk of Bias）评估偏倚风险。随机效应荟萃分析用于合并效应估计值：十项研究符合标准。偏倚风险较低。共有 91,221 名患者接受了输血，其中 40,220 人（44.1%）接受了额外的 cEK 匹配红细胞。仅 ABO+D 配型的总异体免疫率为 6.2% (95% CI, 2.5-14.9%)，加入 cEK 后为 1.9% (95% CI, 0.7-5.1%)。抗体检测的随访时间从输血后 6 个月到 18 个月不等。与标准的 ABO+D 配型相比，额外的 cEK 配型可显著降低同种异体免疫（几率比 [OR] 0.37，95% CI，0.20-0.69）。如果排除长期输血的患者（OR 0.65，95% CI，0.54-0.79）以及仅对 c、E 或 K 抗原的同种异体免疫（OR 0.29，95% CI，0.18-0.47），这种关联性依然存在：结论：额外的 cEK 红细胞匹配方案与受体发生同种异体免疫的几率较低有关。考虑到妊娠期同种免疫的严重后遗症，美国值得考虑对 50 岁以下有妊娠可能的人群输血时进行常规 cEK 配型：prospero，CRD42023411620。

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来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.