Red Blood Cell Transfusions Are Associated with HLA Class I but not H-Y Alloantibodies in Children with Sickle Cell Disease Open Access

Nickel, Robert Sheppard (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/8p58pd430?locale=en
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Abstract

Blood transfusions can induce alloantibodies to antigens on red blood cells (RBCs), white blood cells, and platelets, with these alloantibodies having importance in transfusion and transplantation. While transfusion-related alloimmunization against RBC antigens and human leukocyte antigens (HLA) have been studied, transfusion-related alloimmunization to minor histocompatibility antigens (mHA) such as H-Y antigens has not been clinically characterized. We thus conducted a cross-sectional study of 114 children with sickle cell disease (SCD) and measured antibodies to 5 H-Y antigens and to HLA class I and class II. Few patients had H-Y antibodies, with no significant differences in the prevalence of any H-Y antibody observed among transfused females (7%), transfused males (6%), and never transfused females (4%). In contrast, HLA class I, but not HLA class II, antibodies were more prevalent among transfused than never transfused patients (class I: 33% vs 13%, p=0.046; class II: 7% vs 8%, p=0.67). After adjustment for age, splenectomy, and hydroxyurea this association between RBC transfusion and HLA class I alloimmunization remained significant.(p=0.042). Among transfused patients, RBC alloantibody history but not the amount of RBC transfusion exposure was associated with a high (>25%) HLA class I panel reactive antibody (PRA) on both univariate (OR 6.8, 95% CI 2.1-22.3) and multivariable analysis (OR 6.3, 95% CI 1.7-22.6). These results are consistent with immunologic responder and non-responder phenotypes, wherein a subset of patients with SCD may be at higher risk for transfusion-related alloimmunization.

Table of Contents

Introduction, 1-2. Background, 3-7. Methods, 8-12. Results, 13-16. Discussion, 17-20. References, 21-27. Tables and Figures, 28-40.

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