Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması
Öz
Amaç: Orak hücre hastalığının sık görüldüğü bölgemizde eritrosit alloimmmünizasyon sıklığını ve ilişkili durumları araştırmayı amaçladık.
Gereç ve Yöntem: bu çalışma tek merkezli, zamansal kesitli ve geriye dönük kohort çalşıması olarak planlanmıştır. Toplamda 216 orak hücre hastalığı [Hemoglobin (Hb) SS, Hb S-β talasemi, Hb S-α talasemi] tanısı olan hasta çalışmaya dahil edilmiştir. Hastalar transfüzyon miktarına gore iki gruba ayrılmıştır. Yılda 6’dan daha az transfüzyon alan ya da eritroferez öyküsü olmayan hastalar Grup 1’e, yılda 6 ve daha fazla basit transfüzyon alan ya da eritroferez işlemine alınan hastalar Grup 2’ye dahil edilmiştir.
Bulgular: Çalışmamıza 216 hasta dahil edilmiştir. Transfüzyon tedavisi alan toplam 216 hastanın 67 (%31.0)’sinde, Grup 1’deki 56 hastanın 17’sinde (%30.4), Grup 2’deki 160 hastanın 50’sinde (%31.3) tespit edilmiştir. Hastalar alloimmünizasyon gelişimi açısından analiz edildiğinde, çalışmamız ne orak hücre komplikasyonlarının alloimmünizasyon gelişimi için ne de alloimmünizasyonun ölüm için bir risk faktörü olmadığını göstermiştir.
Sonuç: Çalışmamamızda bulunan yüksek alloimmünizasyon sıklığı, tecrübeli merkezler dışında yapılan transfüzyonlarda alloimmünizasyonu önleyici politikalara yeteri kadar uyulmadığı konusunda fikir vermektedir. Bu nedenle orak hücre anemili hastalarda alloimmünizasyon, ayrıntılı eritrosit antijen tanımlama işlemi yapılarak azaltılabilir veya önlenebilir.
Anahtar Kelimeler
Kaynakça
- REFERENCES
- 1. Desai PC, Deal AM, Pfaff ER, Qaqish B, Hebden LM, Park YA et al. Alloimmunization is associated with older age of transfused red blood cells in sickle cell disease. Am J Hematol. 2015;90:691-5.
- 2. Yazdanbakhsh K, Ware RE, Noizat-Pirenne F. Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management. Blood. 2012;120:528-37.
- 3. Chou ST, Jackson T, Vege S, Smith-Whitley K, Friedman DF, Westhoff CM. High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood. 2013;122:1062-71.
- 4. Telen MJ, Afenyi-Annan A, Garrett ME, Combs MR, Orringer EP, Ashley-Koch AE. Alloimmunization in sickle cell disease: changing antibody specificities and association with chronic pain and decreased survival. Transfusion. 2015;55:1378-87.
- 5. Kangiwa U, Ibegbulam O, Ocheni S, Madu A, Mohammed N. Pattern and prevelence of alloimmunization in multiply transfused patients with sickle cell disease in Nigeria. Biomark Res. 2015;3:26.:
- 6. Natukunda B, Schonewille H, Ndugwa C, Brand A. Red blood cell alloimmunization in sickle cell disease patients in Uganda. Transfusion. 2010;50:20-5.
- 7. Denbow CE, Chung EE, Serjeant GR. Pulmonary artery pressure and the acute chest syndrome in homozygous sickle cell disease. Br Heart J. 1993;69:536-8.
- 8. Guler E, Garipardic M, Dalkiran T, Davutoglu M. Premarital screening test results for β-thalassemia and sickle cell anemia trait in east Mediterranean region of Turkey. Pediatr Hematol Oncol. 2010;27:608-13.
- 9. Asma S, Kozanoglu I, Tarım E, Sarıturk C, Gereklioglu C, Akdeniz A et al. Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy. Transfusion. 2015;55:36-44.
Red blood cell alloimmunization in patients with sickle cell disease in Turkey: a single center retrospective cohort study
Öz
Purpose: We aimed to investigate erythrocyte alloimmunization frequency and related factors in our region where SCD is common.
Material and Methods: This study was planned as a single center, cross-sectional and retrospective cohort study. A total of 216 patients who had been followed up due to SCD [Hemoglobin (Hb) SS, Hb S-β thalassemia, Hb S-α thalassemia] were included in this study. Patients were divided to two groups according to amount of transfusion. The patients who had received less than 6 transfusions per year and who did not have the history of erythropheresis were allocated to Group 1, and the patients who had received 6 or more simple transfusion per year or who had undergone erythrocyte exchange were allocated to Group 2.
Results: Of 216 SCD patients included in the study. Alloimmunization was detected in 67 (31.0%) out of 216 patients who underwent transfusion, and in 17 (30.4%) out of 56 patients in Group 1 and in 50 (31.3%) out of 160 patients in Group 2. When the patients were analyzed according to alloimmunization development, our study revealed that neither SCD complications are a risk factor for alloimmunization nor alloimmunization increases mortality rates.
Conclusion: High alloimmunization frequency found in our study suggests the insufficient adherence of alloimmunization-prevention policies in RBC transfusions performed except experienced institutions. Therefore alloimmunization may be reduced or prevented through performing extended red cell typing among SCD patients
Anahtar Kelimeler
Kaynakça
- REFERENCES
- 1. Desai PC, Deal AM, Pfaff ER, Qaqish B, Hebden LM, Park YA et al. Alloimmunization is associated with older age of transfused red blood cells in sickle cell disease. Am J Hematol. 2015;90:691-5.
- 2. Yazdanbakhsh K, Ware RE, Noizat-Pirenne F. Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management. Blood. 2012;120:528-37.
- 3. Chou ST, Jackson T, Vege S, Smith-Whitley K, Friedman DF, Westhoff CM. High prevalence of red blood cell alloimmunization in sickle cell disease despite transfusion from Rh-matched minority donors. Blood. 2013;122:1062-71.
- 4. Telen MJ, Afenyi-Annan A, Garrett ME, Combs MR, Orringer EP, Ashley-Koch AE. Alloimmunization in sickle cell disease: changing antibody specificities and association with chronic pain and decreased survival. Transfusion. 2015;55:1378-87.
- 5. Kangiwa U, Ibegbulam O, Ocheni S, Madu A, Mohammed N. Pattern and prevelence of alloimmunization in multiply transfused patients with sickle cell disease in Nigeria. Biomark Res. 2015;3:26.:
- 6. Natukunda B, Schonewille H, Ndugwa C, Brand A. Red blood cell alloimmunization in sickle cell disease patients in Uganda. Transfusion. 2010;50:20-5.
- 7. Denbow CE, Chung EE, Serjeant GR. Pulmonary artery pressure and the acute chest syndrome in homozygous sickle cell disease. Br Heart J. 1993;69:536-8.
- 8. Guler E, Garipardic M, Dalkiran T, Davutoglu M. Premarital screening test results for β-thalassemia and sickle cell anemia trait in east Mediterranean region of Turkey. Pediatr Hematol Oncol. 2010;27:608-13.
- 9. Asma S, Kozanoglu I, Tarım E, Sarıturk C, Gereklioglu C, Akdeniz A et al. Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy. Transfusion. 2015;55:36-44.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2016 |
| Kabul Tarihi | 27 Nisan 2016 |
| Yayımlandığı Sayı | Yıl 2016 Cilt: 41 Sayı: 4 |
