IBD, inflammation may mediate transfusion immune response
MedWire News: Patients with inflammatory bowel disease (IBD) have a high risk for alloimmunization after red blood cell (RBC) transfusion, which may affect future surgeries, report researchers in the American Journal of Medicine.
"Most immunized [IBD] patients are young, which determines a high lifetime risk for alloantibody-associated hemolytic complications," caution Günther Körmöczi (Medical University of Vienna, Austria) and co-workers.
The researchers investigated the production of alloantibodies against RBCs in IBD patients who received RBC transfusion for anemia. Both transfusion and pregnancy may result in alloimmunization, and inflammation is believed to also promote the response, they explain.
RBC alloantibody status was determined for 193 IBD patients with a history of RBC transfusion (n=73), pregnancy (n=74), or both (n=46), and 357 patients with noninflammatory disease who had received a RBC transfusion.
Overall, IBD patients were significantly more likely to have antibodies against RBCs than gender-matched controls (5.7 vs 3.4%), rising to 8.4% of transfused IBD patients who made up 10 of the 11 alloimmunized IBD patients.
Patients with IBD had received fewer transfusions than controls (average 3.0 vs 4.2), but had significantly higher levels of the inflammatory marker C-reactive protein during the transfusion (average 8.4 vs 5.4 mg/dL).
Finding that IBD patients produced antibodies against well-characterized RBC antigen systems, Körmöczi et al suggest: "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."
The researchers expand: "In particular, young women with active disease may have a high antibody response risk and could benefit from extended matching, as preventing transfusion-driven alloimmunization also would effectively diminish the fetal risk in later pregnancies."
Preoperative autologous blood donation may also be helpful, they add.
By Lynda Williams