Red blood cell alloantibodies in transfused patients with haematological malignancies at Mbarara Regional Referral Hospital and the Uganda Cancer Institute: Prevalence, specificities and associated factors

Abstract

Background and Objectives: Patients with haematological malignancies often require blood transfusion support. Multiple allogeneic blood transfusions may result in alloimmunization, complicating future transfusions. This study determined alloantibody prevalence, specificities and factors associated with the presence of red blood cell (RBC) alloantibodies among transfused patients with haematological malignancies at Mbarara Regional Referral Hospital (MRRH) and the Uganda Cancer Institute (UCI). Materials and Methods: This was a cross-sectional study among patients with haematological malignancies who had been multiply transfused and were seeking cancer care at MRRH and the UCI, in Uganda. Patient plasma was screened for the presence of RBC alloantibodies using haemagglutination testing with a 3-cell commercial reagent RBC and antibody identification with 11-cell antibody panels. Results: A total of 427 patients with a median age of 36 (inter-quartile range: 26– 56 years) were investigated. Twenty-five participants (5.9%) possessed RBC alloantibodies whose specificities were as follows: anti-C, two; anti-D, four; anti-E, six; anti-K, four; and anti-c, anti-Fya , anti-Jka , anti-Lea and anti-M, one each. Four patients possessed pan-reactive antibodies. Patients with chronic cancer (adjusted odds ratio [AOR] = 2.62, 95% confidence interval [CI]: 1.16–7.21), leukaemia (AOR = 2.71, 95% CI: 1.81–4.03), human immunodeficiency virus (HIV) infection (AOR = 4.34, 95% CI: 1.69–5.11), antibiotic use (AOR = 5.08, 95% CI: 2.11–7.41)and a history of ≥5 transfusions were significantly associated with RBC alloimmuniza-tion (p ≤ 0.05).Conclusion: RBC alloimmunization prevalence was 5.9% and associated with clinicaland transfusion-related factors. Alloantibodies to Rh, Kell, MNS, Duffy, Kidd andLewis blood group systems were detected, underscoring the need for improved pre-transfusion testing in Uganda. Keywords; blood transfusion, chemotherapy naïve, haematological malignancies, RBC alloimmunization,UgandaHighlights• The study found a 5.9% prevalence of red blood cell (RBC) alloantibodies among patientswith haematological malignancies who received repeated transfusions.• The study identified alloantibodies against Rh, Kell, MNS, Duffy, Kidd and Lewis blood groupsystem antigens, with four cases showing pan-reactivity. The diversity of alloantibodiesincreases the risk of haemolytic transfusion reactions and the risk of haemolytic disease ofthe foetus and newborn and complicates donor matching for transfusion.• RBC alloimmunization was associated with chronic cancer, diagnosis of leukaemia, humanimmunodeficiency virus (HIV) infection, antibiotic use, ≥5 transfusion episodes and need for≥5 donor units, emphasizing the need for improved strategies for preventing alloimmuniza-tion in multi-transfused patients