Oਉਇਉਁ Aਔਉਃਅ Acquired red blood cell alloantibodies in transfused patients of 80 years or over: a 2008-2013 national haemovigilance survey Pierre Moncharmont1, Grégory Barday1, Jean-Yves Py2, Francis Meyer1, and the National Haemovigilance Network of the French Blood Establishment 1
French Blood Establishment, Rhône Alpes Auvergne Blood Bank, Lyon; 2French Blood Establishment, Central Atlantic Blood Bank, Orléans, France
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Background. As transfusion in the elderly patients has increased over the last decades, and with the aim of improving blood policy, post-transfusion red blood cell alloimmunisation, a delayed serological transfusion reaction, was investigated in patients 80 years old or over. Materials and methods. For every adverse reaction to a transfusion, a report is sent to the French haemovigilance database. All cases of red blood cell alloimmunisation reported in the haemovigilance database were collected, and an analysis was performed on those cases in transfused patients 80 years old or over. Results. There were 11,625 reports of red blood cell alloimmunisation from 1 January, 2008 to 31 December, 2013, of which 3,617 (31.1%) occurred in patients 80 years old or over. Among this subgroup, red blood cell concentrates were the most frequently involved blood component (3,482 reports, 96.3%). Red blood cell alloimmunisation after transfusion of platelet concentrates was also notified (132 reports, 3.7%). Anti-KEL1 was the most frequent antibody (874 reports, 24.2%). The imputability of the blood component was certain in 2,340 cases (64.7%) and probable in 1,078 (29.8%). In 2013, the incidence of red blood cell alloimmunisation was 4.14 per 1,000 transfused patients aged 80 years old or over. Discussion. In a 6-year national survey in which 40,570 reports were made, there were 3,617 cases of red blood cell alloimmunisation in transfused recipients of 80 years old or over. This delayed serological transfusion reaction is not rare. Red blood cell concentrates were predominantly involved, but cases caused by platelet concentrates were also described. In order to prevent alloimmunisation in the elderly, several factors must be evaluated before transfusing matched red blood cell concentrates: the patient's age, pathology and its outcome, the type of transfusion support (chronic or not), life expectancy, and blood product availability. Keywords: alloimmunisation, red blood cell, elderly, transfusion.
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Introduction
Transfusion in elderly patients has increased over the last decades. In a first French study, conducted between March and December 1997, of 3,206 blood product recipients, 1,816 (57%) were over 65 years old (969 females and 847 males)1. Nine years later, a second study found that the mean age of transfused patients was 63.9 years (median 70.0 years), and that 23.7% of transfused patients were 80 years old or over2 (per 100,000 population, 18.9 between 70 and 79 years, 24.6 between 80 and 89 years and 38.0 over 90 years). Another 5 years later, a third study found the same median age, but that the proportion of transfused patients 80 years old or over had increased to 28.7%3. The same evolution was observed in England. From data obtained during two 14-day periods in October 1999 and June 2000, Wells et al.4 saw that the mean age
of transfused patients was 62.7 years (median 67 years), and that per 100,000 population, red blood cells (RBC) were received by 15,087 patients of 65 years or over vs 2,184 in those less than 65 years old. In a second study, with data collected during two 14-day periods in May and October 2004, Wallis et al.5 found that the mean age of transfusion recipients had increased to 63.6 years. In their study of 335 transfused patients, Dzick and Medeiros6 observed that RBC alloimmunisation did not decline with age. In military veterans, Tormey et al.7 found 577 RBC alloantibodies in 443 transfused patients, of whom 418 were male (94.4%). The prevalence of RBC alloantibodies was 2.4% (443 among 18,750 transfusion records). In these male veterans, the most frequent specificity of RBC alloantibodies was anti-KEL1 (118/540; 21.9%) followed by anti-RH3 (105/540; 19.4%). The risk of RBC alloimmunisation increased
Blood Transfus 2017; 15: 254-8 DOI 10.2450/2016.0328-15 254
All rights reserved - For personal use only No other use without premission
© SIMTI Servizi Srl
Red blood cell antibodies in elderly patients
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2008 to 2013, an increase in RBC alloimmunisation was observed, from 1,574 cases in 2008 (including 433 in recipients 80 years old or over) to 2,185 in 2013 (including 707 in recipients 80 years old or over) (Table I). Furthermore, the cases of RBC alloimmunisation increased with age (Figure 1). For year 2013, supplementary data were available and analysed. From 1 January, 2013 to 31 December, 2013, 473,886 patients were transfused in France. Between the ages of 15 and 49 years, the most transfused patients were females (Figure 2). Similar results were obtained in the 170,658 patients of 80 years old or over: 94,100 females (55.1%) vs 76,558 males (44.9%). This difference was statistically significant (p
French Blood Establishment, Rhône Alpes Auvergne Blood Bank, Lyon; 2French Blood Establishment, Central Atlantic Blood Bank, Orléans, France
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Se rv i
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Background. As transfusion in the elderly patients has increased over the last decades, and with the aim of improving blood policy, post-transfusion red blood cell alloimmunisation, a delayed serological transfusion reaction, was investigated in patients 80 years old or over. Materials and methods. For every adverse reaction to a transfusion, a report is sent to the French haemovigilance database. All cases of red blood cell alloimmunisation reported in the haemovigilance database were collected, and an analysis was performed on those cases in transfused patients 80 years old or over. Results. There were 11,625 reports of red blood cell alloimmunisation from 1 January, 2008 to 31 December, 2013, of which 3,617 (31.1%) occurred in patients 80 years old or over. Among this subgroup, red blood cell concentrates were the most frequently involved blood component (3,482 reports, 96.3%). Red blood cell alloimmunisation after transfusion of platelet concentrates was also notified (132 reports, 3.7%). Anti-KEL1 was the most frequent antibody (874 reports, 24.2%). The imputability of the blood component was certain in 2,340 cases (64.7%) and probable in 1,078 (29.8%). In 2013, the incidence of red blood cell alloimmunisation was 4.14 per 1,000 transfused patients aged 80 years old or over. Discussion. In a 6-year national survey in which 40,570 reports were made, there were 3,617 cases of red blood cell alloimmunisation in transfused recipients of 80 years old or over. This delayed serological transfusion reaction is not rare. Red blood cell concentrates were predominantly involved, but cases caused by platelet concentrates were also described. In order to prevent alloimmunisation in the elderly, several factors must be evaluated before transfusing matched red blood cell concentrates: the patient's age, pathology and its outcome, the type of transfusion support (chronic or not), life expectancy, and blood product availability. Keywords: alloimmunisation, red blood cell, elderly, transfusion.
©
Introduction
Transfusion in elderly patients has increased over the last decades. In a first French study, conducted between March and December 1997, of 3,206 blood product recipients, 1,816 (57%) were over 65 years old (969 females and 847 males)1. Nine years later, a second study found that the mean age of transfused patients was 63.9 years (median 70.0 years), and that 23.7% of transfused patients were 80 years old or over2 (per 100,000 population, 18.9 between 70 and 79 years, 24.6 between 80 and 89 years and 38.0 over 90 years). Another 5 years later, a third study found the same median age, but that the proportion of transfused patients 80 years old or over had increased to 28.7%3. The same evolution was observed in England. From data obtained during two 14-day periods in October 1999 and June 2000, Wells et al.4 saw that the mean age
of transfused patients was 62.7 years (median 67 years), and that per 100,000 population, red blood cells (RBC) were received by 15,087 patients of 65 years or over vs 2,184 in those less than 65 years old. In a second study, with data collected during two 14-day periods in May and October 2004, Wallis et al.5 found that the mean age of transfusion recipients had increased to 63.6 years. In their study of 335 transfused patients, Dzick and Medeiros6 observed that RBC alloimmunisation did not decline with age. In military veterans, Tormey et al.7 found 577 RBC alloantibodies in 443 transfused patients, of whom 418 were male (94.4%). The prevalence of RBC alloantibodies was 2.4% (443 among 18,750 transfusion records). In these male veterans, the most frequent specificity of RBC alloantibodies was anti-KEL1 (118/540; 21.9%) followed by anti-RH3 (105/540; 19.4%). The risk of RBC alloimmunisation increased
Blood Transfus 2017; 15: 254-8 DOI 10.2450/2016.0328-15 254
All rights reserved - For personal use only No other use without premission
© SIMTI Servizi Srl
Red blood cell antibodies in elderly patients
zi
Sr l
2008 to 2013, an increase in RBC alloimmunisation was observed, from 1,574 cases in 2008 (including 433 in recipients 80 years old or over) to 2,185 in 2013 (including 707 in recipients 80 years old or over) (Table I). Furthermore, the cases of RBC alloimmunisation increased with age (Figure 1). For year 2013, supplementary data were available and analysed. From 1 January, 2013 to 31 December, 2013, 473,886 patients were transfused in France. Between the ages of 15 and 49 years, the most transfused patients were females (Figure 2). Similar results were obtained in the 170,658 patients of 80 years old or over: 94,100 females (55.1%) vs 76,558 males (44.9%). This difference was statistically significant (p
