Transfusion complications in thalassemia patients

A report from the Centers for Disease Control and Prevention (CME)

Elliott Vichinsky*, Lynne Neumayr, Sean Trimble, Patricia J. Giardina, Alan R. Cohen, Thomas Coates, Jeanne Boudreaux, Ellis J. Neufeld, Kristy Kenney, Althea Grant, Alexis A. Thompson

*Corresponding author for this work

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. This report summarizes the population and their previous nonimmune and immune transfusion complications. Study Design and Methods The CDC Thalassemia Blood Safety Network is a consortium of centers longitudinally following patients. Enrollment occurred from 2004 through 2012. Demographics, transfusion history, infectious exposures, and transfusion and nontransfusion complications were summarized. Logistic regression analyses of factors associated with allo- and autoimmunization were employed. Results The race/ethnicity of these 407 thalassemia patients was predominantly Asian or Caucasian. The mean ± SD age was 22.3 ± 13.2 years and patients had received a mean ± SD total number of 149 ± 103.4 units of red blood cells (RBCs). Multiorgan dysfunction was common despite chelation. Twenty-four percent of transfused patients had previous exposure to possible transfusion-associated pathogens including one case of babesia. As 27% were immigrants, the infection source cannot be unequivocally linked to transfusion. Transfusion reactions occurred in 48%, including allergic, febrile, and hemolytic; 19% were alloimmunized. Common antigens were E, Kell, and C. Years of transfusion was the strongest predictor of alloimmunization. Autoantibodies occurred in 6.5% and were associated with alloimmunization (p < 0.0001). Local institutional policies, not patient characteristics, were major determinants of blood preparation and transfusion practices. Conclusion Hemosiderosis, transfusion reactions, and infections continue to be major problems in thalassemia. New pathogens were noted. National guidelines for RBC phenotyping and preparation are needed to decrease transfusion-related morbidity.

Original languageEnglish (US)
Pages (from-to)972-981
Number of pages10
JournalTransfusion
Volume54
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Thalassemia
Centers for Disease Control and Prevention (U.S.)
Blood Safety
Erythrocytes
Organizational Policy
Hemosiderosis
Babesia
Infection
Blood Transfusion
Autoantibodies
Fever
Logistic Models
History
Regression Analysis
Demography
Guidelines
Morbidity
Antigens
Population

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Vichinsky, Elliott ; Neumayr, Lynne ; Trimble, Sean ; Giardina, Patricia J. ; Cohen, Alan R. ; Coates, Thomas ; Boudreaux, Jeanne ; Neufeld, Ellis J. ; Kenney, Kristy ; Grant, Althea ; Thompson, Alexis A. / Transfusion complications in thalassemia patients : A report from the Centers for Disease Control and Prevention (CME). In: Transfusion. 2014 ; Vol. 54, No. 4. pp. 972-981.
@article{48cd1f3edbdf4316a8d47fa6abfdbabf,
title = "Transfusion complications in thalassemia patients: A report from the Centers for Disease Control and Prevention (CME)",
abstract = "Background Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. This report summarizes the population and their previous nonimmune and immune transfusion complications. Study Design and Methods The CDC Thalassemia Blood Safety Network is a consortium of centers longitudinally following patients. Enrollment occurred from 2004 through 2012. Demographics, transfusion history, infectious exposures, and transfusion and nontransfusion complications were summarized. Logistic regression analyses of factors associated with allo- and autoimmunization were employed. Results The race/ethnicity of these 407 thalassemia patients was predominantly Asian or Caucasian. The mean ± SD age was 22.3 ± 13.2 years and patients had received a mean ± SD total number of 149 ± 103.4 units of red blood cells (RBCs). Multiorgan dysfunction was common despite chelation. Twenty-four percent of transfused patients had previous exposure to possible transfusion-associated pathogens including one case of babesia. As 27{\%} were immigrants, the infection source cannot be unequivocally linked to transfusion. Transfusion reactions occurred in 48{\%}, including allergic, febrile, and hemolytic; 19{\%} were alloimmunized. Common antigens were E, Kell, and C. Years of transfusion was the strongest predictor of alloimmunization. Autoantibodies occurred in 6.5{\%} and were associated with alloimmunization (p < 0.0001). Local institutional policies, not patient characteristics, were major determinants of blood preparation and transfusion practices. Conclusion Hemosiderosis, transfusion reactions, and infections continue to be major problems in thalassemia. New pathogens were noted. National guidelines for RBC phenotyping and preparation are needed to decrease transfusion-related morbidity.",
author = "Elliott Vichinsky and Lynne Neumayr and Sean Trimble and Giardina, {Patricia J.} and Cohen, {Alan R.} and Thomas Coates and Jeanne Boudreaux and Neufeld, {Ellis J.} and Kristy Kenney and Althea Grant and Thompson, {Alexis A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1111/trf.12348",
language = "English (US)",
volume = "54",
pages = "972--981",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "4",

}

Vichinsky, E, Neumayr, L, Trimble, S, Giardina, PJ, Cohen, AR, Coates, T, Boudreaux, J, Neufeld, EJ, Kenney, K, Grant, A & Thompson, AA 2014, 'Transfusion complications in thalassemia patients: A report from the Centers for Disease Control and Prevention (CME)', Transfusion, vol. 54, no. 4, pp. 972-981. https://doi.org/10.1111/trf.12348

Transfusion complications in thalassemia patients : A report from the Centers for Disease Control and Prevention (CME). / Vichinsky, Elliott; Neumayr, Lynne; Trimble, Sean; Giardina, Patricia J.; Cohen, Alan R.; Coates, Thomas; Boudreaux, Jeanne; Neufeld, Ellis J.; Kenney, Kristy; Grant, Althea; Thompson, Alexis A.

In: Transfusion, Vol. 54, No. 4, 01.01.2014, p. 972-981.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Transfusion complications in thalassemia patients

T2 - A report from the Centers for Disease Control and Prevention (CME)

AU - Vichinsky, Elliott

AU - Neumayr, Lynne

AU - Trimble, Sean

AU - Giardina, Patricia J.

AU - Cohen, Alan R.

AU - Coates, Thomas

AU - Boudreaux, Jeanne

AU - Neufeld, Ellis J.

AU - Kenney, Kristy

AU - Grant, Althea

AU - Thompson, Alexis A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. This report summarizes the population and their previous nonimmune and immune transfusion complications. Study Design and Methods The CDC Thalassemia Blood Safety Network is a consortium of centers longitudinally following patients. Enrollment occurred from 2004 through 2012. Demographics, transfusion history, infectious exposures, and transfusion and nontransfusion complications were summarized. Logistic regression analyses of factors associated with allo- and autoimmunization were employed. Results The race/ethnicity of these 407 thalassemia patients was predominantly Asian or Caucasian. The mean ± SD age was 22.3 ± 13.2 years and patients had received a mean ± SD total number of 149 ± 103.4 units of red blood cells (RBCs). Multiorgan dysfunction was common despite chelation. Twenty-four percent of transfused patients had previous exposure to possible transfusion-associated pathogens including one case of babesia. As 27% were immigrants, the infection source cannot be unequivocally linked to transfusion. Transfusion reactions occurred in 48%, including allergic, febrile, and hemolytic; 19% were alloimmunized. Common antigens were E, Kell, and C. Years of transfusion was the strongest predictor of alloimmunization. Autoantibodies occurred in 6.5% and were associated with alloimmunization (p < 0.0001). Local institutional policies, not patient characteristics, were major determinants of blood preparation and transfusion practices. Conclusion Hemosiderosis, transfusion reactions, and infections continue to be major problems in thalassemia. New pathogens were noted. National guidelines for RBC phenotyping and preparation are needed to decrease transfusion-related morbidity.

AB - Background Transfusions are the primary therapy for thalassemia but have significant cumulative risks. In 2004, the Centers for Disease Control and Prevention (CDC) established a national blood safety monitoring program for thalassemia. This report summarizes the population and their previous nonimmune and immune transfusion complications. Study Design and Methods The CDC Thalassemia Blood Safety Network is a consortium of centers longitudinally following patients. Enrollment occurred from 2004 through 2012. Demographics, transfusion history, infectious exposures, and transfusion and nontransfusion complications were summarized. Logistic regression analyses of factors associated with allo- and autoimmunization were employed. Results The race/ethnicity of these 407 thalassemia patients was predominantly Asian or Caucasian. The mean ± SD age was 22.3 ± 13.2 years and patients had received a mean ± SD total number of 149 ± 103.4 units of red blood cells (RBCs). Multiorgan dysfunction was common despite chelation. Twenty-four percent of transfused patients had previous exposure to possible transfusion-associated pathogens including one case of babesia. As 27% were immigrants, the infection source cannot be unequivocally linked to transfusion. Transfusion reactions occurred in 48%, including allergic, febrile, and hemolytic; 19% were alloimmunized. Common antigens were E, Kell, and C. Years of transfusion was the strongest predictor of alloimmunization. Autoantibodies occurred in 6.5% and were associated with alloimmunization (p < 0.0001). Local institutional policies, not patient characteristics, were major determinants of blood preparation and transfusion practices. Conclusion Hemosiderosis, transfusion reactions, and infections continue to be major problems in thalassemia. New pathogens were noted. National guidelines for RBC phenotyping and preparation are needed to decrease transfusion-related morbidity.

UR - http://www.scopus.com/inward/record.url?scp=84898633977&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898633977&partnerID=8YFLogxK

U2 - 10.1111/trf.12348

DO - 10.1111/trf.12348

M3 - Article

VL - 54

SP - 972

EP - 981

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 4

ER -