A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia

Tina Noutsos; Maree A. Perry; Paul J. Secombe; David J. Roxby; Romi Sinha; Lewis T. Campbell

doi:10.3390/jcm12041606

A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia

Tina Noutsos, Maree A. Perry, Paul J. Secombe, David J. Roxby, Romi Sinha, Lewis T. Campbell

Menzies School of Health Research

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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Abstract

Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015–2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05–6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01–1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.

Original language	English
Article number	1606
Pages (from-to)	1-18
Number of pages	18
Journal	Journal of Clinical Medicine
Volume	12
Issue number	4
DOIs	https://doi.org/10.3390/jcm12041606
Publication status	Published - Feb 2023

Bibliographical note

Funding Information:
We acknowledge the traditional custodians of the lands on which this research was conducted. We acknowledge the guidance and direction provided by Maree Meredith, Director of Poche Centre for Indigenous Health, Flinders University, who provided advice during study design and National Blood Authority grant application. We thank the National Blood Authority Research and Development program, who funded the research, and the Division of Medicine, Royal Darwin Hospital, NT Health for the provision of a research grant to fund a First Nations Reference group to inform the future directions of transfusion research for the NT. We also thank David Cooper at Territory Pathology, who sourced Territory Pathology laboratory records, and the ANZICS registry for provision of all NT ICU demographic and clinical data that made this research possible.

Funding Information:
This research was funded by an Australian National Blood Authority Round 5 National Blood Sector Research and Development Program grant, ID no. 528. T.N. receives research salary support as Outstanding Future Researcher at Menzies School of Health Research, Charles Darwin University. M.A.P. received funding for her studies from an Indigenous Post Graduate Research Scholarship and top up scholarship from the Faculty of Health, Queensland University of Technology.

Publisher Copyright:
© 2023 by the authors.

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69493753-oaFinal published version, 1.23 MBLicence: CC BY

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Noutsos, T., Perry, M. A., Secombe, P. J., Roxby, D. J., Sinha, R., & Campbell, L. T. (2023). A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia. Journal of Clinical Medicine, 12(4), 1-18. Article 1606. https://doi.org/10.3390/jcm12041606

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title = "A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia",

abstract = "Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015–2019). Of 4183 total patients, 50.9\% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9\% versus 2.3\%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6\%) versus 52 (72.2\%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5\% First Nations versus 1.1\% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95\% CI 1.05–6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95\% CI 1.01–1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.",

keywords = "Aboriginal Australians, Aboriginal health, alloantibodies, blood transfusion, erythrocyte transfusion, immunohematology, transfusion medicine",

author = "Tina Noutsos and Perry, \{Maree A.\} and Secombe, \{Paul J.\} and Roxby, \{David J.\} and Romi Sinha and Campbell, \{Lewis T.\}",

note = "Funding Information: We acknowledge the traditional custodians of the lands on which this research was conducted. We acknowledge the guidance and direction provided by Maree Meredith, Director of Poche Centre for Indigenous Health, Flinders University, who provided advice during study design and National Blood Authority grant application. We thank the National Blood Authority Research and Development program, who funded the research, and the Division of Medicine, Royal Darwin Hospital, NT Health for the provision of a research grant to fund a First Nations Reference group to inform the future directions of transfusion research for the NT. We also thank David Cooper at Territory Pathology, who sourced Territory Pathology laboratory records, and the ANZICS registry for provision of all NT ICU demographic and clinical data that made this research possible. Funding Information: This research was funded by an Australian National Blood Authority Round 5 National Blood Sector Research and Development Program grant, ID no. 528. T.N. receives research salary support as Outstanding Future Researcher at Menzies School of Health Research, Charles Darwin University. M.A.P. received funding for her studies from an Indigenous Post Graduate Research Scholarship and top up scholarship from the Faculty of Health, Queensland University of Technology. Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = feb,

doi = "10.3390/jcm12041606",

language = "English",

volume = "12",

pages = "1--18",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

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A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia. / Noutsos, Tina; Perry, Maree A.; Secombe, Paul J. et al.
In: Journal of Clinical Medicine, Vol. 12, No. 4, 1606, 02.2023, p. 1-18.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia

AU - Noutsos, Tina

AU - Perry, Maree A.

AU - Secombe, Paul J.

AU - Roxby, David J.

AU - Sinha, Romi

AU - Campbell, Lewis T.

N1 - Funding Information: We acknowledge the traditional custodians of the lands on which this research was conducted. We acknowledge the guidance and direction provided by Maree Meredith, Director of Poche Centre for Indigenous Health, Flinders University, who provided advice during study design and National Blood Authority grant application. We thank the National Blood Authority Research and Development program, who funded the research, and the Division of Medicine, Royal Darwin Hospital, NT Health for the provision of a research grant to fund a First Nations Reference group to inform the future directions of transfusion research for the NT. We also thank David Cooper at Territory Pathology, who sourced Territory Pathology laboratory records, and the ANZICS registry for provision of all NT ICU demographic and clinical data that made this research possible. Funding Information: This research was funded by an Australian National Blood Authority Round 5 National Blood Sector Research and Development Program grant, ID no. 528. T.N. receives research salary support as Outstanding Future Researcher at Menzies School of Health Research, Charles Darwin University. M.A.P. received funding for her studies from an Indigenous Post Graduate Research Scholarship and top up scholarship from the Faculty of Health, Queensland University of Technology. Publisher Copyright: © 2023 by the authors.

PY - 2023/2

Y1 - 2023/2

N2 - Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015–2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05–6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01–1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.

AB - Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015–2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05–6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01–1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.

KW - Aboriginal Australians

KW - Aboriginal health

KW - alloantibodies

KW - blood transfusion

KW - erythrocyte transfusion

KW - immunohematology

KW - transfusion medicine

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DO - 10.3390/jcm12041606

M3 - Article

AN - SCOPUS:85148951193

SN - 2077-0383

VL - 12

SP - 1

EP - 18

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 4

M1 - 1606

ER -

A Retrospective Cohort Study of Red Cell Alloimmunisation in Rural, Remote, and Aboriginal and Torres Strait Islander Peoples Admitted to Intensive Care in the Northern Territory, Australia

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