Prevalence of Red Blood Cell Alloimmunization among Children with Sickle Cell Disease in Southern Region of Saudi Arabia: A Single-Center Experience

Abstract: Background: Sickle cell disease (SCD), carrying a varied worldwide prevalence, is a commonly encountered entity in Kingdom of Saudi Arabia and Mediterranean. It is characterized by a range of complications. Blood transfusion is essentially required for both episodic and chronic indications. These blood transfusions inherently imply various risks including alloimmunization. Objective: To ascertain the incidence of red blood cell alloimmunization in children having sickle cell disease (SCD). Materials and Methods: Retrospective cross-sectional study was conducted at the Department of Pediatric Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia, after obtaining permission from Research Ethics Committee (REC certificate number AFHS-RMREC/2024/Pediatrics/745). The data was collected for last three years 1st July 2021 to 30th June 2024, regarding pediatric patients having sickle cell disease while aged one to fourteen years. Result: 188 patients of sickle cell disease - all with Saudi ethnicity - were selected with 81 (43%) patients being female and 107 (57%) male. The mean age was 6 years 2 months. Each patient had an average of 2.3 admissions during the course of the disease. Out of these 188 patients, 14 (7.4%) patients were found to have alloimmunization. Mean age at which they developed alloimmunization was 6 years 8 months. 12 patients were on hydroxyurea and 7 patients (50%) underwent splenectomy. On average these cases received 13 transfusions. In contrast, only three (21.4%) patients had undergone exchange transfusion. The most commonly identified single alloantibody was anti-E as seen in 3 patients (21.4%), followed by anti-M in two cases (14.3%). In 4 cases (28.6%), there was an indeterminate antibody (with no specific pattern). Two (14.3%) children were having combination of alloantibodies. Conclusion: Among the children from southern region of Kingdom of Saudi Arabia, the incidence of alloimmunization in SCD was 7.4%. Keywords: Alloimmunization, Anemia, Complications of sickle cell anaemia, Hemoglobin, Red blood cell transfusion, Sickle cell disease.