Children with sickle cell disease (SCD) who have had immune reactions to previous blood transfusions face significantly higher risks when undergoing a stem cell transplant, according to a recently published study in theAmerican Journal of Hematology.
This could mean that children who have previously experienced such as alloimmunization, such as those with hemolytic disease of the fetus and newborn (HDFN), may be at a higher risk of complications.
The study suggests that a history of these immune reactions after transfusion, known as red blood cell immunization, serves as a major warning sign for how a child will fare after their transplant procedure.
Learn more about HDFN causes and risk factors
Among the 229 patients studied, about 17% had experienced these immune reactions before their transplant. These children had a much harder time recovering, showing lower rates of successful, complication-free survival over a five-year period compared to those who had never had such reactions.
They also faced a higher chance of graft failure, which is when the transplant simply does not “take” in the patient’s body. While stem cell transplants are meant to be a cure for sickle cell disease, these types of complications remain the primary concern for doctors and families.
Sickle cell disease causes red blood cells to take on an abnormal shape, leading to chronic pain and the need for regular blood transfusions. However, when the body reacts to these transfusions, it may indicate that the patient’s immune system is naturally more sensitive or prone to overreacting.
The researchers believe that this pre-existing immune sensitivity is what ultimately leads to more complications during the transplant process. This study, which used data from the multicenter STAR registry, tracked children who received transplants from matching family donors over several decades.
Beyond the increased risk of rejection and disease, the study also found that patients with a history of immune reactions needed significantly more platelet transfusions after their surgery.
“We postulate that the observed associations of pre-HCT RBC alloimmunization with severe acute GVH and post-HCT platelet transfusion burden are due to inherent immunologic characteristics that render patients at increased risk of developing multiple immune-mediated complications,” the authors wrote.
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