Red cell alloimmunisation in patients with different types of infections

Dorothea Evers, Johanna G. van der Bom, Janneke Tijmensen, Rutger A. Middelburg, Masja de Haas, Saurabh Zalpuri, Karen M.K. de Vooght, Daan van de Kerkhof, Otto Visser, Nathalie C.V. Péquériaux, Francisca Hudig, Jaap Jan Zwaginga

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29 Citations (Scopus)


Red cell alloantigen exposure can cause alloantibody-associated morbidity. Murine models have suggested that inflammation modulates red cell alloimmunisation. This study quantifies alloimmunisation risks during infectious episodes in humans. We performed a multicentre case–control study within a source population of patients receiving their first and subsequent red cell transfusions during an 8-year follow-up period. Patients developing a first transfusion-induced red cell alloantibody (N = 505) were each compared with two similarly exposed, but non-alloimmunised controls (N = 1010) during a 5-week ‘alloimmunisation risk period’ using multivariate logistic regression analysis. Transfusions during ‘severe’ bacterial (tissue-invasive) infections were associated with increased risks of alloantibody development [adjusted relative risk (RR) 1·34, 95% confidence interval (95% CI) 0·97–1·85], especially when these infections were accompanied with long-standing fever (RR 3·06, 95% CI 1·57–5·96). Disseminated viral disorders demonstrated a trend towards increased risks (RR 2·41, 95% CI 0·89–6·53), in apparent contrast to a possible protection associated with Gram-negative bacteraemia (RR 0·58, 95% CI 0·13–1·14). ‘Simple’ bacterial infections, Gram-positive bacteraemia, fungal infections, maximum C-reactive protein values and leucocytosis were not associated with red cell alloimmunisation. These findings are consistent with murine models. Confirmatory research is needed before patients likely to develop alloantibodies may be identified based on their infectious conditions at time of transfusion.

Original languageEnglish
Pages (from-to)956-966
Number of pages11
JournalBritish Journal of Haematology
Issue number5
Publication statusPublished - 1 Dec 2016


  • blood transfusion
  • humans
  • infections
  • inflammation
  • red blood cell alloimmunisation


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