Low rate of red blood cell alloimmunization among multi-transfused Beta-thalassemia major patients in Iraq: effective strategies or other reasons?

Introduction: Thalassemia, a hemoglobin disorder, represents a considerable public health challenge in Iraq. Although blood transfusion is crucial for the survival of β-thalassemia patients, it is associated with health problems, including alloimmunization. This study aimed to investigate the incidence of alloimmunization and identify the types of alloantibodies present in β-thalassemia patients in Wasit province, Iraq. Materials and Methods: This cross-sectional study was conducted on 160 Beta-thalassemia major patients in the Wasit province of Iraq in 2022. Blood samples were collected for alloantibody screening and identification using a commercial kit. The data were analyzed using SPSS-27. Results: 6 patients (3.7%) developed alloantibodies based on immunohematological tests. Of these alloantibodies, 66.6% were against Rh antigens, 33.3% were against Kell antigens, and 16.6% were against Duffy antigens. The most common alloantibodies were anti-D (50%), anti-K (33.3%), anti-C (16.6%), and anti-Fya (16.6%), with one patient developing two types of alloantibodies. Conclusion: The homogeneity between blood donors and patients is the main reason for low rate of alloimmunization. Our study suggests a potential association between the development of alloantibodies and factors such as splenectomy and gender, although the it is not statistically significant (p-value = 0.1); however, no significant association was observed between alloimmunization and the initiation of blood transfusions, ABO blood group, or RhD status (p-value= 0.6).