Determination of Red Cell Antigen Alloimmunization and Specific Type of Antibody in Multi-Transfused Liver Cirrhosis Patient

Abstract

Background: In liver cirrhosis anemia occurs in up to 75 % of the patients and blood transfusion is the mainstay of treatment of anemia. Red cell alloimmunization is a common problem encountered in multi-transfused patient. Alloimmunization can make further blood transfusion troublesome as extensive matching of donor is required to provide antigen free blood to the recipient for which alloantibodies are formed. Antibodies to foreign red cell antigens in patient’s blood results in delay of transfusion because of complex pre-transfusion tests and difficulty in finding compatible red blood cell unit. Moreover, they can also cause delayed hemolytic blood transfusion reaction. Objectives: 1) To determine frequency of red blood cell alloantibodies in multi-transfused liver cirrhosis patient. 2) To determine the specific type of most common alloantibodies in multi-transfused liver cirrhosis patient. Study design: Cross-sectional study. Place of study: Pathology department of King Edward Medical University with sampling from four hospitals located in Lahore, Pakistan: Mayo Hospital, Jinnah Hospital, Services Hospital and Sir Ganga Ram Hospital. Period of study: January 2016 to March 2016. Methodology: To establish alloimmunization rate in multi-transfused liver cirrhosis patient, cross-sectional study was designed. Sample size of 90 liver cirrhosis patients of all age groups and both genders who had been transfused at least 5 times were taken with the exclusion criteria of known alloantibodies or autoimmune diseases. Patients were screened for alloantibodies using tube IAT and if found positive specific type of antibody was determined using extended red cell panel. Results: 90 patients were screened for alloantibodies of which 3 patients were positive for alloantibodies giving alloimmunization rate of 3.3% in multi-transfused liver cirrhosis patient. All three patients had antibodies of different specificities. First patient had anti-D, second patient had anti- Le(b) belonging to Lewis blood group system and third patient had Anti-Jk(a) belonging to Kidd blood group system. Conclusions: This study was conducted to explore the frequency of alloimmunization in multi-transfused liver cirrhosis patients. Due to cross-sectional study design, incidence of formation of new antibodies as well as loss of antibodies over time could not be determined. Therefore, to establish red blood cell alloimmunization rate in cirrhotic patient, a large-scale prospective study should be done in which LISS IAT or enzyme treated cell should be used and antibody detection tests should be done at defined time intervals after blood transfusion. It is suggested that antibody screening test should be done twice. Once shortly after blood transfusion (may be after one month) to detect fast appearing new antibodies or anamnestic response of undetectable antibodies. Secondly after longer interval to detect slow evolving antibodies.