High Risk of Transfusion-induced Alloimmunization of Patients with Inflammatory Bowel Disease
American Journal of Medicine, 06/26/2012
Papay P et al. – Patients with inflammatory bowel disease exhibited a very high risk of transfusion–induced red cell alloimmunization, possibly potentiated by inflammation. Aside from a restrictive transfusion strategy, the implementation of prophylactic blood group phenotype matching of red cell concentrates (not only for ABO and RhD but also RhCcEe, Kell, Kidd, Duffy) could prevent antibody induction and associated complications in these patients.Methods
- Red cell alloantibody status and clinical data were analyzed in 193 inflammatory bowel disease patients with a history of transfusion or pregnancy, and compared with transfused controls with noninflammatory diseases (n=357).
- In transfused patients with inflammatory bowel disease, a 2.5–fold–increased red cell antibody prevalence was found (10/119, 8.4%), compared with transfused sex–matched controls with noninflammatory diseases (12/357, 3.4%; P=.023).
- Patients with inflammatory bowel disease had fewer transfusions (mean 3.0 vs 4.2, P=.003) but higher C–reactive protein levels during transfusion than controls (mean 8.4 vs 5.4 mg/dL, P <.001).
- The red cell antibodies of inflammatory bowel disease patients were clinically significant, directed against different Rh, Kell, Duffy, or Lutheran blood group antigens, and associated with higher number of transfusions (odds ratio 1.57; 95% confidence interval, 1.03–2.39).
- Conversely, immunomodulatory therapy during transfusion showed negative association (odds ratio 0.12; 95% confidence interval, 0.02–0.61). Only 1.4% of inflammatory bowel disease patients with pregnancy alone had antibodies.