Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
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Original Article

Volume 000, Number 000, January 2025, pages 000-000

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

Tables

Table 1. General Characteristic and Outcome of the Eligible Studies
 
StudyStudy designSample sizeGender male, n (%)Age (years), mean ± SDBlood transfusion interval (days)Number of transfusionsDuration of transfusionFirst transfusion agePopulationMethodTotal number of patients with alloantibodyTotal number of patients with Rhesus alloantibodyBlood component
N/A: not available; yr: years; RBC: red blood cell; IgG: immunoglobulin G.
Almorish et al, 2024 [15]Cross-sectional10050 (50)Range 1 - > 20N/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 - Yemen11 cell identification panel62Leukoreduced
Chao et al, 2013 [16]Retrospective cohort6431 (48)19.2 ± 6.7N/AN/A17.8 ± 4.3 years5.7 ± 2.2 monthChinaLISS65Leukodepleted
Chaudhari et al, 2011 [17]Cross-sectional3222 (68.75)12.0 ± 3.821 - 352 units (1), 15-19 units (2), > 20 units (29)8.5 ± 4.0 year2.7 ± 1.3 yearsIndia11 cell identification panel64Non leukodepleted whole blood or packed RBC
Davari et al, 2016 [18]Cross-sectional4925 (51)18.59 ± 8.1614 - 35> 50 unitsN/AN/AIran10 cell identification panel82Leukoreduced and non leukoreduced
Dhawan et al, 2014 [19]Cross-sectional319235 (73.66)15.1814 - 28235.74 unitsN/A14.93 monthsIndia11 cell identification panel1810Non leukodepleted
Dogra et al, 2015 [20]Descriptive study59N/A9.27 ± 4.5814 - 28Mean ± SD: 132 ± 38.44 unitsN/A4.7 (3.8) yearsIndia11 cell identification panel64Non leukodepleted
Ebrahimisadr et al, 2021 [21]Descriptive study18466 (35.86)Range 0 - > 3021 - 35N/AN/AN/AIran11 cell identification panel11673Non leukodepleted
El Danasoury, et al, 2012 [22]Prospective cohort235126 (53.61)12 ± 6.114 - 28N/AN/A2 ± 1.2 yearsEgypt11 cell identification panel4629Non leukodepleted
Gholami et al, 2021 [23]Cross-sectional1147N/A14 ± 6N/A> 20 unitsN/AN/AIranIBTO homemade 11-cell panel in LISS solution9747Non leukodepleted
Guirat-Dhouib et al, 2011 [24]Prospective cohort13073 (56.15)9.9N/AN/AN/AN/ATunisianGel filtration test109Non leukodepleted
Iqbal et al, 2014 [25]Cross-sectional13076 (58.5)6.28 ± 3.185 - 20N/AN/AN/APakistan3 cell panel followed by 11 cell panel118Non leukodepleted
Jariwala et al, 2019 [26]Retrospective cohort333188(56.45)11.3 (4 - 26)N/A17.6 units/yearN/AN/AIndia11 cell identification panel44Non leukodepleted
Davoudi-Kiakalayeh et al, 2017 [27]Retrospective cohort190N/A26 ± 5.9N/AN/AN/AN/AIranIBTO home-made, 3 RBC cells) and antibody identification panels4730Leukodepleted
Minhas et al, 2022 [28]Retrospective cross-sectional8451 (59.5)Median 7 (4 - 11)N/AMedian 64 (26 - 127) unitsN/AN/APakistanDia clon3 cell antigen panel2217Non leukodepleted
Pazgal et al, 2020 [29]Retrospective cohort4021 (52.5)31.8 ± 6.914 - 21Mean 828.5 ± 239.3 unitsN/A0.71 ± 0.93 yearsIsraelAutomated systems and LISS-IgG cards1710Before 2004 non leukoreduced 2004: leukoreduced
Seferi et al, 2015 [30]Retrospective study and prospective follow up11859 (50)1710 - 90N/AN/AN/AAlbaniaDiaPanel, Diamed-Biorad1410Pre- and post-storage leukoreduced red cell
Senavirathna et al, 2021 [31]Retrospective descriptive study398188 (47.24)18.41 ± 11.67N/AN/AN/AN/AColomboTube technique64Non leukodepleted
Usman et al, 2011 [32]Cross-sectional800350 (43.75)11.5N/AN/AN/AN/APakistanDiaMed3026Non leukodepleted
Zaidi et al, 2015 [33]Cross-sectional16297 (60)Median 6.7 (range: 0·5 - 25)14.2 - 31.8N/AN/A0.98 ± 0.93 yearsPakistan3 cell antigen panel1411Non leukodepleted
Zarrabian et al, 2023 [34]Retrospective cohort7644 (58)12.83 (5.48)N/AMean (range) 145.5 (5 - 598)95.6 (63.3) monthsN/ACanada11 cell identification panel44Non leukodepleted

 

Table 2. Specificity of Red Blood Cell Antibodies in Rhesus Blood Group
 
Rhesus bloood group system specificityAlmorish 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%
E14212310112135011N/A81374410134.581012.21
D000021116012062008104013.69400.87
C01001017830220005003010.27300.66
c10110000110120000600237.87230.50
D + C0000107001003030010165.47160.35
Cw0000102530000010000124.10120.26
Kell + E000000400000200001072.3970.15
e000000102000001002062.0560.12
C + E000000500000100000062.0560.12
c + E001000000000002000031.3730.08
Cw + E000010200000000000031.0230.06
E + Jkb000010200000000000031.0230.06
C + e000000300000000000031.0230.06
C + K000010000000001000020.6820.04
E + K000000002000000000020.6820.04
Kell + C + E000000000000200000020.6820.04
Kell + C + D000000000000200000020.6820.04
C + Kell000000200000000000020.6820.04
Kell + Cw + Kpa000000200000000000020.6820.04
E + C- + kell000000200000000000020.6820.04
E + S000000000100000000010.3410.02
Kpa + D000000000000100000010.3410.02
D + K000000000000001000010.3410.02
D + E + C000000000000000001010.3410.02
E + K + C + M + Kpa000000000000000001010.3410.02
C + S000000100000000000010.3410.02
D + S000000100000000000010.3410.02
D + Kell000000100000000000010.3410.02
D + E000000100000000000010.3410.02
E + Jka000000100000000000010.3410.02
Rhesus bloood group system specificityAlmorish 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 + Kell000000100000000000010.3410.02
Cw + Kpa000000100000000000010.3410.02
E + C + Jka000000100000000000010.3410.02
E + Kell + Jkb000000100000000000010.3410.02
E + C- + Jkb000000100000000000010.3410.02
D + C + S000000100000000000010.3410.02
C- + kell + Cw000000100000000000010.3410.02
D + C + kell000000100000000000010.3410.02
E + S + Jkb000000100000000000010.3410.02
D + C + E + K + S + Jkb000000000000000100010.3410.02
E + C- + kell + M000000100000000000010.3410.02
E + kell + Fyb + S000000100000000000010.3410.02
D + kell + S + Jkb000000100000000000010.3410.02
C + D + E + kell000000100000000000010.3410.02
E + C + Fyb + Jka + S000000100000000000010.3410.02