Sickle Cell Disease (SCD) and Blood Transfusion: Prevalence of Alloantibodies and Red Cell Antigens among Multiply Transfused Individuals with SCD in Selected Tertiary Health Institutions in Abuja, Nigeria

Abstract

Background and Objectives: Most individuals with Sickle cell disease (SCD) are candidates for frequent blood transfusions, and the chances of alloantibodies production are very high. SCD is associated with severe morbidity, impaired quality of life, and premature mortality. Some SCD individuals are relatively stable and rarely require a blood transfusion; others often require multiple blood transfusions. This study aimed to determine the patterns of alloantibodies and red cell antigen phenotype frequencies among multiple-transfused SCD individuals at tertiary health institutions in Abuja. The study objectives include determining the distribution of minor red cell antigens in sickle cell individuals, relative to control subjects and to determine the presence and type of alloantibodies in sickle cell individuals and control subjects.

Methods: The study population consisted of 100 SCD individuals who had at least three transfusions and 100 non-SCD individuals who had not been transfused before as controls. An antibody screening panel (3 cells) and an identification panel (10 cells) from the national health service (NHS) (UK) were used to screen and identify alloantibodies through the tube method in low-ionic-strength solution, albumin, and the anti-human globulin (AHG) phase according to the manufacturer’s instructions. Red cell antigen typing was determined using standard tube techniques for ABO, RH, MNSs, Duffy, and Kidd.

Results: According to the results obtained from the alloantibody assay, out of the 100 SCD individuals, 16% (4) developed anti-D antibodies, 32% (8) developed anti-E, and 24% (6) developed anti-Fya. Only 4% each developed JKb, Lua, M, Lea, and C. Two percent of the individuals developed anti-S antibodies, while all the control samples were negative. The sociodemographic characteristics revealed that the age range of the subjects was between 1 and 46 years, and the majority were aged >1–10 years (38%). The distribution of the ABO blood groups revealed that 55% were in group O, 15% were in group A, and 19% were in group B. 92%, 50%, 41%, 63%, and 87% of the study population were found to be composed of RhD, RhC, RhE, Rhc, and Rhe, respectively. The incidences of M, Leb, K, and K positivity were 58%, 36%, 39% and 41%, respectively.

Conclusion and Implication for Translation: Identifying alloantibodies in SCD individuals is crucial, as it can have implications for future transfusions and impact the overall management of the disease. Implementing extended RBC phenotyping for all SCD individuals, especially those receiving regular transfusions, could allow for a more individualized and targeted approach to blood transfusion management.