Immunohematologic tolerance of chronic transfusion exchanges with erythrocytapheresis in sickle cell disease

Background Sickle cell disease (SCD) has become a major public health issue. Hydroxyurea and red blood cell (RBC) transfusion are the cornerstone treatments. Erythrocytapheresis (ECP) is an automated method for transfusion exchange. Given that ECP requires more blood than conventional transfusion, t...

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Published in:Transfusion (Philadelphia, Pa.) Pa.), 2015-02, Vol.55 (2), p.357-363
Main Authors: Michot, Jean-Marie, Driss, Françoise, Guitton, Corinne, Moh Klaren, Julia, Lefebvre, François, Chamillard, Xavier, Gallon, Philippe, Fourn, Erwan, Pela, Alain M., Tertian, Gérard, Le Bras, Philippe, Chantalat-Auger, Christelle, Delfraissy, Jean-François, Goujard, Cécile, Lambotte, Olivier
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anemia, Sickle Cell - therapy
Child
Cytapheresis
Erythrocyte Transfusion
Female
Hemolysis
Humans
Immune Tolerance
Immunology
Incidence
Life Sciences
Male
Santé publique et épidémiologie
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Summary:Background Sickle cell disease (SCD) has become a major public health issue. Hydroxyurea and red blood cell (RBC) transfusion are the cornerstone treatments. Erythrocytapheresis (ECP) is an automated method for transfusion exchange. Given that ECP requires more blood than conventional transfusion, there is concern about alloimmunization and hemolytic transfusion reactions. We evaluate the incidence of hemolytic transfusion reactions and alloimmunization rates in patients receiving conventional blood transfusions and in patients participating in long‐term blood exchange programs with ECP. Study Design and Methods All hemolytic transfusion reactions and alloimmunizations in SCD patients were recorded over the period 2006 to 2011. Conventional transfusions and ECP were compared. Results The cohort consisted of 188 SCD patients. The median (±SD) age was 23 (±14) years. The ECP and conventional transfusion groups comprised 49 and 139 patients, respectively. The prevalence of alloimmunization was 33% in the ECP group and 22% in the conventional transfusion group (p = 0.1797). The alloimmunization/RBC unit (RBCU) ratio was lower in the ECP group than in the conventional transfusion group (1.6 and 11.6 per 1000, respectively; p 
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.12875