Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review

Blood Transfus. 2019 Jan;17(1):4-15. doi: 10.2450/2019.0229-18.


Background: Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation.

Materials and methods: We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients.

Results: The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%).

Discussion: Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.

Publication types

  • Systematic Review

MeSH terms

  • Erythrocyte Transfusion / adverse effects*
  • Erythrocytes / immunology*
  • Humans
  • Prevalence
  • Rh Isoimmunization* / epidemiology
  • Rh Isoimmunization* / immunology
  • Rh Isoimmunization* / prevention & control
  • Rh-Hr Blood-Group System / immunology*
  • Thalassemia* / epidemiology
  • Thalassemia* / immunology
  • Thalassemia* / therapy
  • Transfusion Reaction* / epidemiology
  • Transfusion Reaction* / immunology
  • Transfusion Reaction* / prevention & control


  • Rh-Hr Blood-Group System