(P-TS-57) Group-specific red cell transfusion practice in chronically transfused patients with sickle cell disease

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

MD

Miriam Andrea Duque, MD

University Of Miami
Miami, Florida, United States

Background/Case Studies: The proportion of type O red cell used is increasing, particularly for non-type O recipients who require special phenotype blood such as in chronically transfusion-dependent conditions like sickle cell disease (SCD) and other hemoglobinopathies. In patients with SCD, the practice is to match the ABO and RhD as well as prophylactically provide antigen negative units for Rh: CE and K to prevent alloimmunization. There is a tendency to overuse type O red cells to find suitable blood that match the specific set of antigens. In this study, we retrospectively review ABO/Rh type specific transfusion practice in chronically transfused patients with SCD in our institution.

Study

Design/Methods:

We performed a retrospective chart review of patients with SCD who received a blood transfusion for a 3 month period to evaluate if ABO Rh specific matching was provided. Recipient ABO/Rh type, total number of units transfused, ABO/Rh type of donor units and historical antibody specificity were reviewed. Patients with Anti-D alloimmunization and type O RhD negative were excluded. Our transfusion policy for SCD is to provide ABO/Rh type specific units negative for C, E and K, hemoglobin S negative. The blood orders were fulfilled by our local blood supplier with the best available product and safe ABO/Rh D substitutions were allowed to meet the special requirements.

Results/Findings:

The group most often substituted was AB positive, where 56.4% requests were met with A positive, 23% with O positive and 20% with O negative. The second group most often substituted was B positive, where 35% of requests were met with B negative, 35% with O positive and 12.5% with O negative instead. Follow by A positive, where 51.6% were substituted with A negative and only 2% with type O units. Among type O positive requests, 23% were substituted with O negative units. The percentage of type O units given to a non-type O recipient was 19.1% and the percentage of O type negative units provided to a non-type O negative recipient 7.1%.

Issued group (% of requested units)
Requested Group	Total units requested	O+	O-	A+	A-	B+	B-	AB+	AB-	Provision Type specific
O+	39	76.9%	23.0%							76.9%
A+	91	1.0%	1.0%	45.0%	51.6%					45.0%
B+	40	35%	12.5%			17.5%	35%			17.5%
AB+	39	23.0%	0.0%	56.4%	20.5%					0.0%

Conclusions: Preserving type O red blood cells is the critical importance for a hospital blood bank and the community at large. Especially in the era of gene cell therapy in SCD where the red cell usage is expected to increase as a result of the strict transfusion protocols. Provision of ABO group specific blood that meet special requirements for patients with SCD remains a challenge. Blood centers should ensure a wide range of units from every blood group are phenotyped to accommodate hospitals’ demand for group specific (A, B, AB) extended phenotype red blood cells.