AI Article Synopsis
- A systematic review and meta-analysis were conducted to assess alloimmunization rates in patients receiving red blood cells (RBCs) matched for standard ABO+D blood type versus those additionally matched for c, E, and Kell antigens (cEK).
- Among the 10 studies analyzed, involving 91,221 transfused patients, those receiving cEK-matched RBCs had a significantly lower alloimmunization rate of 1.9% compared to 6.2% for ABO+D-only matching.
- The findings suggest that implementing cEK matching protocols could reduce alloimmunization risks, particularly important for patients with reproductive potential under the age of 50, highlighting a need for routine testing in this demographic.
Article Abstract
Objective: To systematically review and meta-analyze alloimmunization among recipients of red blood cells (RBCs) matched for ABO blood type and Rhesus D (ABO+D) antigen compared with those also matched for c, E, and Kell (cEK).
Data Sources: Four online databases (Medline, Scopus, EMBASE, ClinicalTrials.gov ) were searched from March 28, 2023, to April 1, 2024. The search protocol was peer reviewed and published on PROSPERO ( CRD42023411620 ).
Methods Of Study Selection: Studies reporting alloimmunization as the primary outcome among recipients of RBCs matched for ABO+D or additional cEK matching were included. Patients transfused with unmatched RBCs or a mixture of matching regimens were excluded. Risk of bias was assessed with Cochrane Tool to Assess Risk of Bias in Cohort Studies and Tool for Risk of Bias. Random-effects meta-analysis was used to combine effect estimates.
Tabulation, Integration, And Results: Ten studies met criteria. Risk of bias was low. Overall, 91,221 patients were transfused, of whom 40,220 (44.1%) received additional cEK-matched RBCs. The overall rate of alloimmunization was 6.2% (95% CI, 2.5-14.9%) for ABO+D-only matching and 1.9% (95% CI, 0.7-5.1%) when cEK was added. Time of follow-up antibody testing ranged from 6 to 18 months after transfusion. Additional cEK match was associated with significantly less alloimmunization compared with standard ABO+D match (odds ratio [OR] 0.37, 95% CI, 0.20-0.69). This association remained when chronically transfused patients were excluded (OR 0.65, 95% CI, 0.54-0.79) and for alloimmunization to c, E, or K antigens only (OR 0.29, 95% CI, 0.18-0.47).
Conclusion: Additional cEK RBC matching protocols were associated with lower odds of recipient alloimmunization. Given severe sequelae of alloimmunization in pregnancy, routine cEK matching for transfusion in people with pregnancy potential younger than age 50 years in the United States merits consideration.
Systematic Review Registration: PROSPERO, CRD42023411620 .
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499014 | PMC |
| http://dx.doi.org/10.1097/AOG.0000000000005701 | DOI Listing |
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