Mon, Sep 29, 2025
Volume 19, Issue 4 (Jul-Aug 2025)
mljgoums 2025, 19(4): 27-29 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Baniaghil S S, Balochi F, Kazzak E. Red blood cell alloantibodies in patients with thalassemia major referred to the blood transfusion center of Golestan province, Iran. mljgoums 2025; 19 (4) :27-29
URL: http://mlj.goums.ac.ir/article-1-1726-en.html
URL: http://mlj.goums.ac.ir/article-1-1726-en.html
1- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Gorgan, Iran , baniaghil1344@yahoo.com
2- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Iranian Blood Transfusion Organization, Tehran, Iran
3- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Gorgan, Iran; Golestan Blood Transfusion Center, Iranian Blood Transfusion Organization, Gorgan, Iran
2- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Iranian Blood Transfusion Organization, Tehran, Iran
3- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Gorgan, Iran; Golestan Blood Transfusion Center, Iranian Blood Transfusion Organization, Gorgan, Iran
Full-Text [PDF 331 kb]
(328 Downloads)
| Abstract (HTML) (878 Views)
Discussion
Repeated blood transfusion is a life-saving intervention to improve health in patients with thalassemia major. Alloimmunization is one of the important complications of transfusion in these patients. It is the response of the immune system to foreign RBC antigens and is therefore called an alloantibody. It occurs following transfusion, pregnancy, and transplantation. In patients who are transfused regularly, such as thalassemia and sickle cell anemia patients the frequency of alloantibodies is high (13). The factors responsible for alloimmunization are complex, including at least three major reasons: the RBC antigenic differences between the blood donor and the recipient, the recipient's immune status, and the immunomodulatory effects of the allogeneic blood transfusions on the recipient's immune system (12). In thalassemia patients, the main cause of the development of RBC alloimmunization is repeated blood transfusion. This may reduce the survival of transfused RBCs and reduce the efficacy of blood transfusion, leading to increased transfusion requirements. The frequency of alloimmunization in patients with repeated transfusions varies in different studies. In thalassemia patients, the alloimmunization frequency is 4-50%, in hemato-oncological patients, 1.9-13% patients are alloimmunized, and in kidney disease patients, the alloimmunization frequency is 1.27-13.1% (14).
Several studies have evaluated the prevalence of alloantibodies in thalassemia patients. According to some studies conducted in Iran, the prevalence of alloantibodies is different in various regions, i.e., 7.4% (Tehran), 5.34% (Fars Province), 18.7% (Southwest of Iran), 2.87% (northeast of Iran), 17.9% (southeast of Iran),5% (Shiraz),1.53% (Lorestan), 40% (Mazandaran) (15-22). In the Azarkivan’s study, 835 patients with thalassemia were screened for unexpected RBC alloantibodies. They reported an alloimmunization rate of 12.1% (23). In this study, 5.05% of patients with thalassemia major were alloimmunized to RBC antigens. The most common clinically significant alloantibodies detected in our study were anti-E, anti-D, anti-c in the Rh system, and anti-K in the Kell system. In another study conducted in 2016, the rate of alloimmunization in Iran was reported to be 10%. In this study, most alloantibodies were related to anti-E, anti-D, and anti-K (24). In Rostamian’s study, it was shown that 13% of transfused thalassemia patients in Iran had clinically significant RBC alloantibodies, and anti-D and anti-K antibodies were the most common antibodies (25). Shaiegan’s study showed that the most common alloantibodies were anti-E, anti-D, anti-E, and anti-c (26). One main reason for anti-D alloimmunization may be the transfusion of Rh (D)-incompatible blood due to human or technical errors or Rh (D) variants in serologically Rh (D)-negative blood units. Transfusion of Rh (D)-positive blood units to patients with weak D and partial D may also explain anti-D immunization (27).
The prevalence of alloimmunization and the type of antibody detected are different in different regions of the country. One of the reasons for the production of alloantibodies is the antigenic difference between the donor and the recipient such as pre-transfusion testing and phenotype determination, which is mainly attributed to racial-ethnic diversity and genetic effects in response to this antigenic stimulation. The greater the antigenic similarity between the recipient and the donor, the less likely it is to stimulate the immune system. In the present study, considering the racial and ethnic diversity in the provincial population, the difference in the prevalence of alloantibody and the type of antibody in thalassemia patients is quite expected. Appropriate preventive strategies, such as RBC phenotyping before initiating transfusion and using extended RBC donor and recipient matching, especially for Rh and Kell antigen systems, could be implemented to avoid complications in these patients. According to the results of this study and other conducted studies, accurate ABO and Rh antigen typing, and knowledge of the abundance of alloantibodies can provide this possibility for treatment centers and blood product storage centers to allocate reserves for special patients with constant need to prepare blood injection, which can significantly reduce alloimmunization in future transfusions in these patients.
Conclusion
Alloimmunization is a common consequence in patients who need persistent blood transfusions (For example, thalassemia patients). Some of these antibodies are clinically significant and may compromise the safety of further blood transfusions and cause hemolytic transfusion reactions. Determination of RBCs phenotype donor and recipient before beginning chronic blood transfusion, especially Kell and Rh blood group antigens (C, c, E, and e) and careful cross-matching with thorough evaluation of the donor unit's blood group may help reduce the alloimmunization rate and delayed hemolytic transfusion reactions and enhancing the lifespan in chronic transfusion patients.
Acknowledgement
We sincerely thank the colleagues of the immunohematology department of the Central Headquarters of the Blood Transfusion Organization who helped us in this study.
Funding sources
This study did not receive any grants from funding agencies, whether public, commercial, or non-profit.
Ethical statement
The study was approved by the Ethics Committee of the Golestan University of Medical Sciences, Iran (Code: IR.GOUMS.REC.1402.375).
Conflicts of interest
The authors declare that there are no conflicts of interest.
Author contributions
All authors contributed to one or more aspects of the study.
Data availability statement
All data generated or analyzed during this study are published in this article.
Full-Text: (105 Views)
Introduction
Thalassemia is the most common genetic disorder worldwide, affecting the synthesis of one or more of the globin subunits of hemoglobin leading to ineffective erythropoiesis (1). Geographically, thalassemia is a Mediterranean disease and more prevalent in West Asian and Central Asian countries such as Turkey, Iran, Burma, it is also found in Thailand, Vietnam and Colombia. Also, it is very common in Africa, Greece, and Italy (2). It can be found in more than 60 countries with a carrier (heterozygote) population of up to 150-200 million people or 4.5% of the world population, and at least 300,000 lethally affected homozygotes are born annually (3).
In Iran, more than two million thalassemia carriers and more than twenty thousand patients with thalassemia major have been identified (4). Provinces around the Persian Gulf and the Caspian Sea with a gene frequency of more than 10% are considered the thalassemia major zones in Iran (5). Patients with this hemoglobinopathy need regular transfusions. Repeated blood transfusions can stimulate the immune system and result in the formation of anti-erythrocyte antibodies. This can cause a problem in the identification process of compatible blood in these patients and cause a delay in the process of supplying and injecting compatible blood (6). The possibility of creating antibodies after injecting a bag of blood is 1% to 1.6%; the reported worldwide alloimmunization prevalence among thalassemia patients varies from 1.13% to 40.4% (7,8). Blood transfusion is the main method of treatment for these patients. However, regular blood transfusion leads to organ damage due to iron overload and immunization to RBC antigens. In Iran, routine blood group typing of thalassemia patients identifies ABO and Rh (D) antigens only before blood transfusion for thalassemia patients. Most alloantibodies are formed against them, which causes an increase in the need for blood transfusions. On the other hand, it makes it difficult to identify compatible blood units for subsequent blood transfusions.
Several studies have shown that, in most cases, responsible antibodies are related to the subgroups of the Rh system, including E, e, C, and c as well as secondary groups such as Kell, Duffy, and Kidd (9-12).
Antigenic differences in blood group systems between the donor and recipients, as well as the immunomodulatory effect of the allogenic blood transfusion on the immune system, are effective factors in alloimmunization. Due to receiving repeated blood transfusions in thalassemia patients from different people, the preparation of compatible blood is not easily possible for these patients. Therefore, the purpose of this study was to determine the prevalence of alloimmunization in thalassemia patients who received regular transfusions and help avoid hemolytic transfusion reactions that may occur during future blood transfusions.
Methods
This descriptive, cross-sectional study investigated alloantibodies in patients with thalassemia major receiving regular blood transfusions at the Blood Transfusion Center of Golestan Province, Iran. Demographic and clinical data, including age, gender, blood group (ABO/Rh), and spleen status, were collected from patients' medical records using a standardized checklist. For laboratory analysis, five milliliters of venous blood were collected from each patient in EDTA-containing vacutainer tubes before transfusion. Samples were centrifuged one hour after collection, with serum aliquoted into two tubes for antibody screening and identification. Antibody screening was performed two hours post-sampling using three screening cells (R1R1, R2R2, rr) through standard blood bank techniques, including testing phases in saline, albumin (22%), and indirect antiglobulin (Coombs) to detect RBC alloantibodies. Samples showing positive screening results underwent further analysis using 11-cell panels provided by the Immunohematology Department of Iran Blood Transfusion Organization, with confirmation through the standard tube method. All positive results were referred to the Immunohematology Laboratory of the Blood Transfusion Organization for validation. Statistical analysis was performed using SPSS version 16.0. Chi-square test was used to assess associations between variables at a 95% confidence interval (CI). P-values < 0.05 were considered statistically significant.
Results
Among 99 patients with thalassemia major receiving routine blood transfusions at 3-5 week intervals, 53% were female and 46% were male, with a mean age of 29.22 ± 10.46 years (Range: 2-61 years). The ABO blood group distribution showed that 37% of patients were type O, 23% type B, 25% type A, and 14% type AB, while 82% were Rh(D)-positive. Alloantibodies were detected in five patients (5.05%), with the remaining 94 (94.95%) showing no evidence of alloimmunization. Of the five alloimmunized patients, three (60%) were female and two (40%) were male. Two patients (40%) developed two alloantibodies each (Anti-c and anti-E in one case, anti-D and anti-K in the other), while the remaining three (60%) had single antibodies-two with anti-E and one with anti-D. Overall, anti-E and anti-D were the most common alloantibodies (Each 33.3%), followed by anti-c and anti-K (Each 16.7%), (Table 1 and 2). The majority of detected antibodies targeted Rh system antigens (85.7%), with Kell system antibodies accounted for the remaining 13.4%. Statistical analysis indicated no significant association (P > 0.05) between alloantibody formation and age, sex, blood type, or spleen status.
Thalassemia is the most common genetic disorder worldwide, affecting the synthesis of one or more of the globin subunits of hemoglobin leading to ineffective erythropoiesis (1). Geographically, thalassemia is a Mediterranean disease and more prevalent in West Asian and Central Asian countries such as Turkey, Iran, Burma, it is also found in Thailand, Vietnam and Colombia. Also, it is very common in Africa, Greece, and Italy (2). It can be found in more than 60 countries with a carrier (heterozygote) population of up to 150-200 million people or 4.5% of the world population, and at least 300,000 lethally affected homozygotes are born annually (3).
In Iran, more than two million thalassemia carriers and more than twenty thousand patients with thalassemia major have been identified (4). Provinces around the Persian Gulf and the Caspian Sea with a gene frequency of more than 10% are considered the thalassemia major zones in Iran (5). Patients with this hemoglobinopathy need regular transfusions. Repeated blood transfusions can stimulate the immune system and result in the formation of anti-erythrocyte antibodies. This can cause a problem in the identification process of compatible blood in these patients and cause a delay in the process of supplying and injecting compatible blood (6). The possibility of creating antibodies after injecting a bag of blood is 1% to 1.6%; the reported worldwide alloimmunization prevalence among thalassemia patients varies from 1.13% to 40.4% (7,8). Blood transfusion is the main method of treatment for these patients. However, regular blood transfusion leads to organ damage due to iron overload and immunization to RBC antigens. In Iran, routine blood group typing of thalassemia patients identifies ABO and Rh (D) antigens only before blood transfusion for thalassemia patients. Most alloantibodies are formed against them, which causes an increase in the need for blood transfusions. On the other hand, it makes it difficult to identify compatible blood units for subsequent blood transfusions.
Several studies have shown that, in most cases, responsible antibodies are related to the subgroups of the Rh system, including E, e, C, and c as well as secondary groups such as Kell, Duffy, and Kidd (9-12).
Antigenic differences in blood group systems between the donor and recipients, as well as the immunomodulatory effect of the allogenic blood transfusion on the immune system, are effective factors in alloimmunization. Due to receiving repeated blood transfusions in thalassemia patients from different people, the preparation of compatible blood is not easily possible for these patients. Therefore, the purpose of this study was to determine the prevalence of alloimmunization in thalassemia patients who received regular transfusions and help avoid hemolytic transfusion reactions that may occur during future blood transfusions.
Methods
This descriptive, cross-sectional study investigated alloantibodies in patients with thalassemia major receiving regular blood transfusions at the Blood Transfusion Center of Golestan Province, Iran. Demographic and clinical data, including age, gender, blood group (ABO/Rh), and spleen status, were collected from patients' medical records using a standardized checklist. For laboratory analysis, five milliliters of venous blood were collected from each patient in EDTA-containing vacutainer tubes before transfusion. Samples were centrifuged one hour after collection, with serum aliquoted into two tubes for antibody screening and identification. Antibody screening was performed two hours post-sampling using three screening cells (R1R1, R2R2, rr) through standard blood bank techniques, including testing phases in saline, albumin (22%), and indirect antiglobulin (Coombs) to detect RBC alloantibodies. Samples showing positive screening results underwent further analysis using 11-cell panels provided by the Immunohematology Department of Iran Blood Transfusion Organization, with confirmation through the standard tube method. All positive results were referred to the Immunohematology Laboratory of the Blood Transfusion Organization for validation. Statistical analysis was performed using SPSS version 16.0. Chi-square test was used to assess associations between variables at a 95% confidence interval (CI). P-values < 0.05 were considered statistically significant.
Results
Among 99 patients with thalassemia major receiving routine blood transfusions at 3-5 week intervals, 53% were female and 46% were male, with a mean age of 29.22 ± 10.46 years (Range: 2-61 years). The ABO blood group distribution showed that 37% of patients were type O, 23% type B, 25% type A, and 14% type AB, while 82% were Rh(D)-positive. Alloantibodies were detected in five patients (5.05%), with the remaining 94 (94.95%) showing no evidence of alloimmunization. Of the five alloimmunized patients, three (60%) were female and two (40%) were male. Two patients (40%) developed two alloantibodies each (Anti-c and anti-E in one case, anti-D and anti-K in the other), while the remaining three (60%) had single antibodies-two with anti-E and one with anti-D. Overall, anti-E and anti-D were the most common alloantibodies (Each 33.3%), followed by anti-c and anti-K (Each 16.7%), (Table 1 and 2). The majority of detected antibodies targeted Rh system antigens (85.7%), with Kell system antibodies accounted for the remaining 13.4%. Statistical analysis indicated no significant association (P > 0.05) between alloantibody formation and age, sex, blood type, or spleen status.
Discussion
Repeated blood transfusion is a life-saving intervention to improve health in patients with thalassemia major. Alloimmunization is one of the important complications of transfusion in these patients. It is the response of the immune system to foreign RBC antigens and is therefore called an alloantibody. It occurs following transfusion, pregnancy, and transplantation. In patients who are transfused regularly, such as thalassemia and sickle cell anemia patients the frequency of alloantibodies is high (13). The factors responsible for alloimmunization are complex, including at least three major reasons: the RBC antigenic differences between the blood donor and the recipient, the recipient's immune status, and the immunomodulatory effects of the allogeneic blood transfusions on the recipient's immune system (12). In thalassemia patients, the main cause of the development of RBC alloimmunization is repeated blood transfusion. This may reduce the survival of transfused RBCs and reduce the efficacy of blood transfusion, leading to increased transfusion requirements. The frequency of alloimmunization in patients with repeated transfusions varies in different studies. In thalassemia patients, the alloimmunization frequency is 4-50%, in hemato-oncological patients, 1.9-13% patients are alloimmunized, and in kidney disease patients, the alloimmunization frequency is 1.27-13.1% (14).
Several studies have evaluated the prevalence of alloantibodies in thalassemia patients. According to some studies conducted in Iran, the prevalence of alloantibodies is different in various regions, i.e., 7.4% (Tehran), 5.34% (Fars Province), 18.7% (Southwest of Iran), 2.87% (northeast of Iran), 17.9% (southeast of Iran),5% (Shiraz),1.53% (Lorestan), 40% (Mazandaran) (15-22). In the Azarkivan’s study, 835 patients with thalassemia were screened for unexpected RBC alloantibodies. They reported an alloimmunization rate of 12.1% (23). In this study, 5.05% of patients with thalassemia major were alloimmunized to RBC antigens. The most common clinically significant alloantibodies detected in our study were anti-E, anti-D, anti-c in the Rh system, and anti-K in the Kell system. In another study conducted in 2016, the rate of alloimmunization in Iran was reported to be 10%. In this study, most alloantibodies were related to anti-E, anti-D, and anti-K (24). In Rostamian’s study, it was shown that 13% of transfused thalassemia patients in Iran had clinically significant RBC alloantibodies, and anti-D and anti-K antibodies were the most common antibodies (25). Shaiegan’s study showed that the most common alloantibodies were anti-E, anti-D, anti-E, and anti-c (26). One main reason for anti-D alloimmunization may be the transfusion of Rh (D)-incompatible blood due to human or technical errors or Rh (D) variants in serologically Rh (D)-negative blood units. Transfusion of Rh (D)-positive blood units to patients with weak D and partial D may also explain anti-D immunization (27).
The prevalence of alloimmunization and the type of antibody detected are different in different regions of the country. One of the reasons for the production of alloantibodies is the antigenic difference between the donor and the recipient such as pre-transfusion testing and phenotype determination, which is mainly attributed to racial-ethnic diversity and genetic effects in response to this antigenic stimulation. The greater the antigenic similarity between the recipient and the donor, the less likely it is to stimulate the immune system. In the present study, considering the racial and ethnic diversity in the provincial population, the difference in the prevalence of alloantibody and the type of antibody in thalassemia patients is quite expected. Appropriate preventive strategies, such as RBC phenotyping before initiating transfusion and using extended RBC donor and recipient matching, especially for Rh and Kell antigen systems, could be implemented to avoid complications in these patients. According to the results of this study and other conducted studies, accurate ABO and Rh antigen typing, and knowledge of the abundance of alloantibodies can provide this possibility for treatment centers and blood product storage centers to allocate reserves for special patients with constant need to prepare blood injection, which can significantly reduce alloimmunization in future transfusions in these patients.
Conclusion
Alloimmunization is a common consequence in patients who need persistent blood transfusions (For example, thalassemia patients). Some of these antibodies are clinically significant and may compromise the safety of further blood transfusions and cause hemolytic transfusion reactions. Determination of RBCs phenotype donor and recipient before beginning chronic blood transfusion, especially Kell and Rh blood group antigens (C, c, E, and e) and careful cross-matching with thorough evaluation of the donor unit's blood group may help reduce the alloimmunization rate and delayed hemolytic transfusion reactions and enhancing the lifespan in chronic transfusion patients.
Acknowledgement
We sincerely thank the colleagues of the immunohematology department of the Central Headquarters of the Blood Transfusion Organization who helped us in this study.
Funding sources
This study did not receive any grants from funding agencies, whether public, commercial, or non-profit.
Ethical statement
The study was approved by the Ethics Committee of the Golestan University of Medical Sciences, Iran (Code: IR.GOUMS.REC.1402.375).
Conflicts of interest
The authors declare that there are no conflicts of interest.
Author contributions
All authors contributed to one or more aspects of the study.
Data availability statement
All data generated or analyzed during this study are published in this article.
Research Article: Research Article |
Subject:
Laboratory Sciences
Received: 2023/09/27 | Accepted: 2024/01/2 | Published: 2025/09/17 | ePublished: 2025/09/17
Received: 2023/09/27 | Accepted: 2024/01/2 | Published: 2025/09/17 | ePublished: 2025/09/17
References
1. Sahu A, Parida P, Mahapatra S, Sahoo BB. Detection of red cell alloantibodies in thalassaemia patients. Int J Contemp Pediatr. 2020;7(2):419-23. [View at Publisher] [DOI] [Google Scholar]
2. Fergus N. An overview of thalassemia for parent adapting international health and medicine. Available at: www.comeunity.com/adoption/health /thalassemia. Html. 2002. [View at Publisher]
3. Sarookhani MR, Ahmadi MH. Rare and unexpected beta thalassemic mutations in Qazvin province of Iran. Afr J Biotechnol. 2010;9(1):95-101. [View at Publisher] [Google Scholar]
4. Najmabadi H, Teimorian Sh, Khatibi T, Neishabory M,Pourfarzad F, Jalil S,et al. Amplification refractorysystem (ARMS) and reverse hybridization the detection of beta thalassemia mutation. Arch Iran Med. 2001;4(4):165-70. [View at Publisher] [Google Scholar]
5. Derakhshandeh-Peykar P, Akhavan-Niaki H, Tamaddoni A, Ghawidel-Parsa S, Holakouie Naieni K, Rahmani M, et al. Distribution of beta-thalassemia mutations in the northern provinces of Iran. Hemoglobin. 2007;31(3):351-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Van Buren NL, Gorlin JB, Corby SM, Cassidy S, FritchLilla S, Nelson SC, et al. How do I incorporate red cell genotyping to improve chronic transfusion therapy? Transfusion. 2020;60(1):16-25. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Taher A, Isma'eel H, Cappellini MD. Thalassemia intermedia: revisited. Blood Cells Mol Dis. 2006; 37(1):12-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Vaziri M, JavadzadehShahshahani H, Moghaddam M, Taghvaee N. Prevalence and specificities of red cell alloantibodies in transfusion-dependent beta thalassemia patients in Yazd. Iran J Ped Hematol Oncol. 2015;5(2):93-9. [View at Publisher] [PMID] [Google Scholar]
9. Prati D. Benefits and complications of regular blood transfusion in patients with beta-thalassaemia major. Vox Sang. 2000;79(3):129-37. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Ye Z, Zhang D, Boral L, Liz C, May J. Comparison of blood group molecular genotyping to traditional serological phenotyping in patients with chronic or recent blood transfusion. JBM. 2016;4(03):1-8. [View at Publisher] [DOI] [Google Scholar]
11. Dunbar NM, Szczepiorkowski ZM. How do we utilize a transfusion safety officer? Transfusion. 2015;55(9):2064-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
12. Singer ST, Wu V, Mignacca R, Kuypers FA, Morel P, Vichinsky EP. Alloimmunization and erythrocyte autoimmunization in transfusiondependent thalassemia patients of predominantly Asian descent. Blood. 2000;96(10):3369-73. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Keikhaei B, Hirad Far A, Abolghasemi H, et al. Red Blood Cell Alloimmunization in Patients with Thalassemia Major and Intermediate in Southwest Iran. Iranian Journal of Blood and Cancer. 2013;6(1):41-6. [View at Publisher] [Google Scholar]
14. Das SS, Biswas RN, Safi M, Zaman RU. Alloimmunization to erythrocyte antigens in patients receiving multiple blood transfusions: Clinico-immunohematological and demographic risk factors and impact of extended red cell phenotyping. Glob J Transfus Med. 2021;6(2):171-7. [View at Publisher] [DOI] [Google Scholar]
15. Shamsian BS, Arzanian MT, Shamshiri AR, Alavi S, Khojasteh O. Frequency of red cell alloimmunization in patients with-major thalassemia in an Iranian Referral Hospital. Iran J Pediatr. 2008;18(2):149-53. [View at Publisher] [Google Scholar]
16. Karimi M, Nikrooz P, Kashef S, Jamalian N, Davatolhagh Z. RBC alloimmunization in blood transfusion-dependent betathalassemia patients in southern Iran. Int J Lab Hematol. 2007;29(5):321-6. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Keikhaei B, Hirad Far A, Abolghasemi H, Mousakhani H, Ghanavat M, Moghadam M, et al. Red blood cell alloimmunization in patients with thalassemia major and intermediate in southwest Iran. IJBC. 2013;6(1):41-6 [View at Publisher] [Google Scholar]
18. Sadeghian MH, Keramati MR, Badiei Z, Ravarian M, Ayatollahi H, Rafatpanah H, et al. Alloimmunization among transfusion-dependent thalassemia patients. Asian J Transfus Sci. 2009;3(2):95-8. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Mirzaeian A, Tamaddon G, Naderi M, Hosseinpour M, Sargolzaie N, Dorgalaleh A, et al. Prevalence of alloimmunization against RBC antigens in thalassemia major patients in south east of Iran. J Blood Disorders Transf. 2013;4(4):1-4 [View at Publisher] [DOI] [Google Scholar]
20. Ghorbani AA E, Tavassoli AR, Gharehbaghian A, Kasraian L, Khademi R, Taleie A. Evaluation of frequency and specificity of RBC alloantibodies in Namazi Hospital patients in Shiraz, 2010. Sci J Iranian Blood Trans Organ. 2013;10(3):239-45. [View at Publisher] [Google Scholar]
21. Kiani A, Abdi J, Shirkhani Y, Kashi M. Prevalence of alloimmunization against RBC antigens in thalassemia major patients of Lorestan province in 2004. Sci J Iran Blood Transfus Organ. 2006;3(3):265-71. [View at Publisher] [Google Scholar]
22. Kosaryan M, Mahdavi MR, Roshan P, Hojjati MT. Prevalence of alloimmunisation in patients with beta thalassemia major. Blood Transfus. 2012;10(3):396-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Azarkeivan A, Ansari S, Ahmadi MH, Hajibeigy B, Maghsudlu M, Nasizadeh S, et al. Blood transfusion and alloimmunization in patients with thalassemia: Multicenter study. Pediatr Hematol Oncol. 2011;28(6):479-85. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Darvishi P, Azami M, Sayehmiri K, Sayehmiri F, Goodarzi A, Azarkeivan A, et al. Red blood cell alloimmunization in Iranian beta thalassemia patients: a systematic review and meta-analysis. ISBT Science Series. 2016;11(3):163-73. [View at Publisher] [DOI] [Google Scholar]
25. Rostamian H, Javandoost E, Mohammadian M, Alipour A. Prevalence and specificity of red blood cell alloantibodies and autoantibodies in transfused Iranian β thalassemia patients: A systematic review and meta analysis. Asian J Transfus Sci. 2022;16(1):111-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
26. Shaiegan M, Moghaddam M, Maghsudlu M, Azarkeivan A, Zolfaghari S, Pourfatollah AA, et al. Red Blood Cell Immunization and Contributing Factors in 685 Thalassemia Patients. Int J Hematol Oncol Stem Cell Res. 2022;16(1):9-14. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Dean L. Blood groups and red cell antigens. Bethesda (MD): National Center for Biotechnology Information (US); 2005. [View at Publisher] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Enamad
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.