Investigating the Formation of Red Blood Cell Alloimmunization at KEMRI Wellcome Trust Research Programme (KWTRP)

Investigating the formation of red blood cell alloimmunization in sickle cell anaemia patients in Kilifi

• Sickle cell anaemia (SCA) is an inherited red blood cell disorder that results in variant haemoglobin production (HbS). HbS tends to polymerise in low oxygen levels in the human body, leading to RBC sickling. SCA is a burden, especially in Sub-Saharan Africa (SSA), where at least 240,000 children are born with the condition every year. Approximately 50% to 90% of those born with the condition die undiagnosed before their fifth birthday. In Kenya, the highest frequencies are found at the coast and areas surrounding Lake Victoria.
• SCA patients rely on blood transfusion for disease management. However, this therapy is associated with the risk of alloimmunisation, which is the formation of alloantibodies by the recipient of foreign RBC antigens
•  The WHO recommends extended matching for RBC antigens considered clinically significant (kell, Kidd, etc.) before transfusion. However, in Kenya, pre-transfusion tests are only done on the major blood groups, ABO and Rhesus D. Alloimmunisation predisposes the patients to the risk of haemolytic transfusion reactions and in pregnant mothers, haemolytic disease of the foetus and newborn which can potentially cause serious morbidity and mortality in SCA patients. The detection of the alloantibodies depends on the different evanescence rates in the patient, and without post-transfusion follow-up, some of the alloantibodies may be missed.
• This study aims to screen SCA patients for alloantibodies prior to and after transfusion. It will also determine the phenotypic profiles of both the donors and SCA patients and monitor the patients' resolution of anaemia during hospitalisation. We will hopefully identify factors that increase the risk of alloimmunization and provide evidence supporting enhanced donor-recipient matching and improved transfusion protocols for managing sickle cell anaemia (SCA).