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 alloimmunization (p ≤ 0.05). Conclusion: RBC alloimmunization prevalence was 5.9% and associated with clinical and transfusion-related factors. Alloantibodies to Rh, Kell, MNS, Duffy, Kidd and Lewis blood group systems were detected, underscoring the need for improved pre transfusion testing in Uganda.