Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 2, February 2025, pages 106-118

Prevalence of Alloimmunization Events in Thalassemia Patients With Repeated Transfusions in the Rhesus Blood Group System: A Systematic Review and Meta Analysis

Figures

↓  Figure 1. Study selection according to PRISMA flowchart. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 1.
↓  Figure 2. Forest plot of proportion estimate of alloimmunization in rhesus blood group. CI: confidence interval.
Figure 2.

Tables

↓  Table 1. General Characteristic and Outcome of the Eligible Studies
 
Study Study design Sample size Gender male, n (%) Age (years), mean ± SD Blood transfusion interval (days) Number of transfusions Duration of transfusion First transfusion age Population Method Total number of patients with alloantibody Total number of patients with Rhesus alloantibody Blood component
N/A: not available; yr: years; RBC: red blood cell; IgG: immunoglobulin G.
Almorish et al, 2024 [15] Cross-sectional 100 50 (50) Range 1 - > 20 N/A > 12 units/year (88), ≥ 12 units/year (12) < 160 month (71), ≥ 160 months (30) < 1 yr (42), 1 - 10 yr (53), > 10 yr (5) Sana’a City - Yemen 11 cell identification panel 6 2 Leukoreduced
Chao et al, 2013 [16] Retrospective cohort 64 31 (48) 19.2 ± 6.7 N/A N/A 17.8 ± 4.3 years 5.7 ± 2.2 month China LISS 6 5 Leukodepleted
Chaudhari et al, 2011 [17] Cross-sectional 32 22 (68.75) 12.0 ± 3.8 21 - 35 2 units (1), 15-19 units (2), > 20 units (29) 8.5 ± 4.0 year 2.7 ± 1.3 years India 11 cell identification panel 6 4 Non leukodepleted whole blood or packed RBC
Davari et al, 2016 [18] Cross-sectional 49 25 (51) 18.59 ± 8.16 14 - 35 > 50 units N/A N/A Iran 10 cell identification panel 8 2 Leukoreduced and non leukoreduced
Dhawan et al, 2014 [19] Cross-sectional 319 235 (73.66) 15.18 14 - 28 235.74 units N/A 14.93 months India 11 cell identification panel 18 10 Non leukodepleted
Dogra et al, 2015 [20] Descriptive study 59 N/A 9.27 ± 4.58 14 - 28 Mean ± SD: 132 ± 38.44 units N/A 4.7 (3.8) years India 11 cell identification panel 6 4 Non leukodepleted
Ebrahimisadr et al, 2021 [21] Descriptive study 184 66 (35.86) Range 0 - > 30 21 - 35 N/A N/A N/A Iran 11 cell identification panel 116 73 Non leukodepleted
El Danasoury, et al, 2012 [22] Prospective cohort 235 126 (53.61) 12 ± 6.1 14 - 28 N/A N/A 2 ± 1.2 years Egypt 11 cell identification panel 46 29 Non leukodepleted
Gholami et al, 2021 [23] Cross-sectional 1147 N/A 14 ± 6 N/A > 20 units N/A N/A Iran IBTO homemade 11-cell panel in LISS solution 97 47 Non leukodepleted
Guirat-Dhouib et al, 2011 [24] Prospective cohort 130 73 (56.15) 9.9 N/A N/A N/A N/A Tunisian Gel filtration test 10 9 Non leukodepleted
Iqbal et al, 2014 [25] Cross-sectional 130 76 (58.5) 6.28 ± 3.18 5 - 20 N/A N/A N/A Pakistan 3 cell panel followed by 11 cell panel 11 8 Non leukodepleted
Jariwala et al, 2019 [26] Retrospective cohort 333 188(56.45) 11.3 (4 - 26) N/A 17.6 units/year N/A N/A India 11 cell identification panel 4 4 Non leukodepleted
Davoudi-Kiakalayeh et al, 2017 [27] Retrospective cohort 190 N/A 26 ± 5.9 N/A N/A N/A N/A Iran IBTO home-made, 3 RBC cells) and antibody identification panels 47 30 Leukodepleted
Minhas et al, 2022 [28] Retrospective cross-sectional 84 51 (59.5) Median 7 (4 - 11) N/A Median 64 (26 - 127) units N/A N/A Pakistan Dia clon3 cell antigen panel 22 17 Non leukodepleted
Pazgal et al, 2020 [29] Retrospective cohort 40 21 (52.5) 31.8 ± 6.9 14 - 21 Mean 828.5 ± 239.3 units N/A 0.71 ± 0.93 years Israel Automated systems and LISS-IgG cards 17 10 Before 2004 non leukoreduced 2004: leukoreduced
Seferi et al, 2015 [30] Retrospective study and prospective follow up 118 59 (50) 17 10 - 90 N/A N/A N/A Albania DiaPanel, Diamed-Biorad 14 10 Pre- and post-storage leukoreduced red cell
Senavirathna et al, 2021 [31] Retrospective descriptive study 398 188 (47.24) 18.41 ± 11.67 N/A N/A N/A N/A Colombo Tube technique 6 4 Non leukodepleted
Usman et al, 2011 [32] Cross-sectional 800 350 (43.75) 11.5 N/A N/A N/A N/A Pakistan DiaMed 30 26 Non leukodepleted
Zaidi et al, 2015 [33] Cross-sectional 162 97 (60) Median 6.7 (range: 0·5 - 25) 14.2 - 31.8 N/A N/A 0.98 ± 0.93 years Pakistan 3 cell antigen panel 14 11 Non leukodepleted
Zarrabian et al, 2023 [34] Retrospective cohort 76 44 (58) 12.83 (5.48) N/A Mean (range) 145.5 (5 - 598) 95.6 (63.3) months N/A Canada 11 cell identification panel 4 4 Non leukodepleted

 

↓  Table 2. Specificity of Red Blood Cell Antibodies in Rhesus Blood Group
 
Rhesus bloood group system specificity Almorish et al, 2024 [15] Chao et al, 2013 [16] Chaudhari et al, 2011 [17] Davari et al, 2016 [18] Dhawan et al, 2014 [19] Dogra et al, 2015 [20] Ebrahimisadr et al, 2021 [21] El Danasoury et al, 2012 [22] Gholami et al, 2021 [23] Guirat-Dhouib et al, 2011 [24] Iqbal et al, 2014 [25] Jariwala et al, 2019 [26] Davoudi-Kiakalayeh et al, 2017 [27] Minhas et al, 2022 [28] Pazgal et al, 2020 [29] Seferi et al, 2015 [30] Senavirathna et al, 2021 [31] Usman et al, 2011 [32] Zaidi et al, 2015 [33] Zarrabian et al, 2023 [34] Number of alloimmunized patients (total 292) Antibody specificity among all studies (total 4,566)
N % N %
E 1 4 2 1 2 3 10 11 21 3 5 0 11 N/A 8 1 3 7 4 4 101 34.58 101 2.21
D 0 0 0 0 2 1 11 6 0 1 2 0 6 2 0 0 8 1 0 40 13.69 40 0.87
C 0 1 0 0 1 0 1 7 8 3 0 2 2 0 0 0 5 0 0 30 10.27 30 0.66
c 1 0 1 1 0 0 0 0 11 0 1 2 0 0 0 0 6 0 0 23 7.87 23 0.50
D + C 0 0 0 0 1 0 7 0 0 1 0 0 3 0 3 0 0 1 0 16 5.47 16 0.35
Cw 0 0 0 0 1 0 2 5 3 0 0 0 0 0 1 0 0 0 0 12 4.10 12 0.26
Kell + E 0 0 0 0 0 0 4 0 0 0 0 0 2 0 0 0 0 1 0 7 2.39 7 0.15
e 0 0 0 0 0 0 1 0 2 0 0 0 0 0 1 0 0 2 0 6 2.05 6 0.12
C + E 0 0 0 0 0 0 5 0 0 0 0 0 1 0 0 0 0 0 0 6 2.05 6 0.12
c + E 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 3 1.37 3 0.08
Cw + E 0 0 0 0 1 0 2 0 0 0 0 0 0 0 0 0 0 0 0 3 1.02 3 0.06
E + Jkb 0 0 0 0 1 0 2 0 0 0 0 0 0 0 0 0 0 0 0 3 1.02 3 0.06
C + e 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 3 1.02 3 0.06
C + K 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 2 0.68 2 0.04
E + K 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 2 0.68 2 0.04
Kell + C + E 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0.68 2 0.04
Kell + C + D 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0.68 2 0.04
C + Kell 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0.68 2 0.04
Kell + Cw + Kpa 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0.68 2 0.04
E + C- + kell 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0.68 2 0.04
E + S 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
Kpa + D 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0.34 1 0.02
D + K 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0.34 1 0.02
D + E + C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0.34 1 0.02
E + K + C + M + Kpa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0.34 1 0.02
C + S 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + S 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + Kell 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + E 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + Jka 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
Rhesus bloood group system specificity Almorish et al, 2024 [15] Chao et al, 2013 [16] Chaudhari et al, 2011 [17] Davari et al, 2016 [18] Dhawan et al, 2014 [19] Dogra et al, 2015 [20] Ebrahimisadr et al, 2021 [21] El Danasoury et al, 2012 [22] Gholami et al, 2021 [23] Guirat-Dhouib et al, 2011 [24] Iqbal et al, 2014 [25] Jariwala et al, 2019 [26] Davoudi-Kiakalayeh et al, 2017 [27] Minhas et al, 2022 [28] Pazgal et al, 2020 [29] Seferi et al, 2015 [30] Senavirathna et al, 2021 [31] Usman et al, 2011 [32] Zaidi et al, 2015 [33] Zarrabian et al, 2023 [34] Number of alloimmunized patients (total 293) Antibody specificity among all studies (total 4,650)
N % N %
Cw + Kell 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
Cw + Kpa 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + C + Jka 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + Kell + Jkb 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + C- + Jkb 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + C + S 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
C- + kell + Cw 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + C + kell 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + S + Jkb 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + C + E + K + S + Jkb 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0.34 1 0.02
E + C- + kell + M 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + kell + Fyb + S 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
D + kell + S + Jkb 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
C + D + E + kell 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02
E + C + Fyb + Jka + S 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0.34 1 0.02