See beyond the limits of routine red blood cell (RBC) testing to support multiply transfused patients
Article written in collaboration between Immucor and Dr. L Castilho of the University of
Campinas/Hemocentro, Campinas, Brazil
There are 118.5 million blood donations collected annually to treat patients who need blood transfusions globally. In the general population, the rate of alloimmunisation to red cell antigens is approximately 1%.1 However, the populations who undergo multiple blood transfusions like sickle cell disease and thalassaemia patients have an alloimmunisation rate as high as 50%.1 Global research by immunohaematology experts has shown that extended red blood cell (RBC) antigen matching is recommended to limit alloimmunisation in chronically transfused patients. This was published in the 2017 AABB abstract by Dr Castilho et al2 entitled “Clinical Outcomes of Molecular Matching in
Transfusion-Dependent Patients with Sickle Cell Disease (SCD) and Thalassemia”. They quote that molecular matching has shown clinical benefits to patients with SCD and thalassaemia, contributing significantly to reduce the rates of alloimmunisation to 5-10% with C E K matching and <1% with extended matching.
Improvements in the clinical outcomes of patients have also been observed as shown by an increase in their haemoglobin (Hb) levels and reduction in the % of HbS in SCD patients, better in vivo RBC survival and diminished frequency of transfusions. Sickle cell disease patients are among those who benefit most from molecular typing as it allows for more extended antigen matching, identifies patients who lack high prevalence antigens and helps to differentiate between auto and alloantibodies especially in patients
who make Rh antibodies despite D, C, and E antigen matching by serology. Also, the use of better-matched blood units can reduce transfusion requirements, decreasing the risk of other adverse
reactions like transfusion-related acute lung injury and potential exposure to infectious diseases.
Immucor provides a broad portfolio of solutions to support your laboratory in managing these complex patients both to prevent red blood cell alloimmunisation but also to manage alloimmunisation in chronically transfused patients.
Preventing RBC Alloimmunisation
Immucor’s PreciseType®* is an industry-leading molecular immunohaematology test and the first in vitro diagnostic test approved by the FDA for molecular typing of RBC. The test identifies the most relevant 35 red blood cell antigens plus 3 phenotypic variants from 11 blood groups simultaneously. It has enabled the implementation of blood group genotyping in clinical laboratories, changing work practices and revolutionising the way transfusion is managed.
Once chronically transfused patients are alloimmunised it is just as important to manage these patients and attempt to match them to prevent further antibody development and haemolytic transfusion reactions.
Managing RBC Alloimmunisation
Immucor’s Capture® technology has best in class sensitivity for RBC antibody screening and identification: low titre, IgG specific antibodies can be detected hence allowing early and specific
detection of multiply transfused patient alloantibodies. Our manual Panocell®-16 and 20 panels, as well as our specialty products offer a supplementary, cost effective and efficient method to resolve complex antibody workups.
For RBC typing, Immucor offers an extensive menu of quality monoclonal reagents to ensure accurate serological typing for critical patient populations.
And finally, Immucor offers a tool that helps with finding the most compatible match for a patient: ImmuLINK®. ImmuLINK is a software suite designed as a centralised data management solution that enables laboratories to consolidate all donor and patient serological and molecular typing and antibody identification testing. The software provides functionality to search for a donor antigen profile to find a compatible match for a patient with alloantibodies.
Patients with blood disorders bring unique challenges to the transfusion laboratory. As a global expert in immunohaematology, Immucor offers a complete portfolio of products to support laboratories in preventing alloimmunisation, managing compatibility testing for multiply transfused patients, and supporting more complex workflow requirements for blood disorder management.
*The BioArray HEA assay carries the CE Mark for sale in EU. Please contact your local distributor for your country's regulatory status.
1 Fung, M. K., et al. American Association of Blood Banks. (2017). Technical Manual 19th Edition
2 Castilho, L. et al. Clinical Outcomes of Molecular Matching in Transfusion-Dependent Patients, with Sickle Cell Disease (SCD) and Thalassemia. AABB Abstract. 2017