التفاصيل البيبلوغرافية
| العنوان: |
Alloimmunization in sickle cell disease: changing antibody specificities and association with chronic pain and decreased survival. |
| المؤلفون: |
Telen, Marilyn J., Afenyi‐Annan, Araba, Garrett, Melanie E., Combs, Martha R., Orringer, Eugene P., Ashley‐Koch, Allison E. |
| المصدر: |
Transfusion; Jun2015, Vol. 55 Issue 6pt2, p1378-1387, 10p, 6 Charts, 4 Graphs |
| مصطلحات موضوعية: |
SICKLE cell anemia treatment, BLOOD transfusion reaction, ANTIBODY specificity, LACTATE dehydrogenase, CHRONIC pain, BLOOD sampling, GENETIC polymorphisms, PATHOLOGICAL physiology |
| مستخلص: |
Background Alloimmunization remains a significant complication of transfusion and has been associated with multiple factors, including inflammation, an important pathophysiologic mechanism in sickle cell disease ( SCD). We explored whether alloimmunization is associated with disease severity in SCD. Study Design and Methods Adult SCD patients were enrolled in a study of outcome-modifying genes in SCD. Historical records of patients with SCD at two participating institutions were reviewed for data on antigen phenotype and alloimmunization. Differences in demographic, clinical, and laboratory findings; end-organ damage; and overall disease severity were then compared between alloimmunized and nonalloimmunized patients. Results Of 319 patients, 87 (27%) were alloimmunized. Alloantibody specificities differed from those previously described, especially due to the significantly higher frequency of anti- S. Although alloimmunization was not associated with frequency of vasoocclusive episodes, a higher percentage of alloimmunized patients had chronic pain, as defined by daily use of short-acting narcotics (p = 0.006), long-acting narcotics (p = 0.013), or both (p = 0.03). Additionally, alloimmunized patients had poorer survival (hazard ratio, 1.92; p = 0.01) and were more likely to have avascular necrosis (p = 0.024), end-organ damage (p = 0.049), and red blood cell autoantibodies (p < 0.001), even after controlling for the effects of age, sex, and hemoglobin diagnosis. Alloimmunization was not associated with other SCD-related complications, such as acute chest syndrome or stroke. Conclusion Alloimmunization in SCD may be associated with chronic pain, risk of end-organ damage, and shorter survival. These novel findings suggest new directions for the investigation of immune response-mediated pathways common to alloimmunization and chronic pain. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
