Red Cell Alloimmunization Among Transfused Chronic Kidney Disease Patients: A Hospital-Based Study in Southwestern Uganda

Abstract

Purpose: This study determined the prevalence, types of red cell alloantibodies and factors associated with red cell alloimmunization among transfused patients with CKD at Mbarara Regional Referral Hospital. Patients and Methods: A cross-sectional study was conducted among 141 consented, transfused patients with CKD from March to May 2025. Sociodemographic characteristics and clinical data were collected using a structured questionnaire. Four millilitres of EDTA anticoagulated blood were collected and tested for ABO/Rh blood group, direct antihuman globulin test, and red cell alloantibodies screening and identification by using the Echo Lumena machine (Immucor USA). Data were analyzed using STATA version 17. Logistic regression was used to determine factors associated with alloimmunization, and a p-value of ≤0.05 was considered statistically significant. Results: Out of 141 patients with CKD, 97 (67.8%) were male, and the mean age was 54.4 ± 17.12. The overall prevalence of red cell alloimmunization was 10 (7.1%). A total of 4 study patients were alloimmunized with a single type of antibody; 2 had multiple antibodies, while 4 had undetermined types. Anti-K was the commonest identified alloantibody. Blood group A had significantly lower odd of alloimmunization (aOR 0.01, 95% CI: 0.0005–0.229, p = 0.004), similar to blood group O (aOR 0.01, 95% CI: 0.0007–0.163, p = 0.001). Conclusion: The study reveals a slightly higher prevalence of red cell alloimmunization compared to global prevalence, with Anti-K being the most frequent antibody. Only ABO blood group was significantly associated with red cell alloimmunization. Therefore, more studies are needed to evaluate the complex nature of this phenomenon.