The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Transfusion complications in thalassemia patients: a report from the Centers for Disease Control and Prevention (CME)
Article first published online: 25 JUL 2013
© 2013 American Association of Blood Banks
Volume 54, Issue 4, pages 972–981, April 2014
How to Cite
Vichinsky, E., Neumayr, L., Trimble, S., Giardina, P. J., Cohen, A. R., Coates, T., Boudreaux, J., Neufeld, E. J., Kenney, K., Grant, A., Thompson, A. A. and CDC Thalassemia Investigators (2014), Transfusion complications in thalassemia patients: a report from the Centers for Disease Control and Prevention (CME). Transfusion, 54: 972–981. doi: 10.1111/trf.12348
This study was supported by the Centers for Disease Control and Prevention (CDC): 5U01DD000310-05 to Children's Hospital & Research Center Oakland, U01-DD00306 to Children's Hospital Philadelphia, U01-DD00309 to Children's Hospital Los Angeles, U01-DD000308-05 to Boston Children's Hospital, U01-DD0003075 to Ann & Robert H. Lurie Children's Hospital of Chicago, and U01-DD000311-05 to Weill Medical College of Cornell University. In addition, Boston Children's Hospital was supported by NCRR Grant M01-RR02172.
- Issue published online: 11 APR 2014
- Article first published online: 25 JUL 2013
- Manuscript Accepted: 1 JUN 2013
- Manuscript Revised: 6 MAY 2013
- Manuscript Received: 13 SEP 2012
- Centers for Disease Control and Prevention (CDC). Grant Numbers: 5U01DD000310-05, U01-DD00306, U01-DD00309, U01-DD000308-05, U01-DD0003075, U01-DD000311-05
- NCRR. Grant Number: M01-RR02172
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.
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.
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.