Regular blood transfusions are a mainstay in the therapy of patients with clinically significant thalassaemias and haemoglobinopathies. The Medical Therapy Unit at Monash Medical Centre provides multi-disciplinary care for these patients. An overview of the service will be discussed.
Method and Results
The Blood Bank Laboratory at Monash Medical Centre provides transfusion support for 150 adult patients and 24 paediatric patients with thalassaemia or haemoglobinopathy. A review of the transfusion records of the patient population was performed. 86% of the regularly transfused patients have β thalassaemia major. 9% have a sickle disorder and the remainder have Hb E / β thalassaemia or HbH disease. Most of these patients have been chronically transfused for many years, and only 23 of 150 (15%) of the adult patients have a pre-transfusion extended phenotype documented. In contrast, all but 2 of the 24 paediatric patients have an extended phenotype. The literature reports that these chronically transfused patients have a high incidence of alloimmunisation. Our experience supports this, with 82 of the 150 adult patients having a history of alloantibodies. In contrast, despite an institutional policy of matching for Rh(D) and K only, just 4 of the 24 paediatric patients have been alloimmunised. Antibodies often fall to undetectable levels over time in our experience. A review of the laboratory results performed in July 2013 showed that only 10 of the 86 alloimmunised patients have currently detectable antibodies.
The Blood Bank Laboratory is an important part of the care provided by the Medical Therapy Unit. Antibody evanescence in this population highlights the importance of an accurate transfusion history and continuity of care.