IDEAL

Blood transfusions are a major therapy in the treatment and prevention of complications in patients with sickle cell disease (SCD) and thalassemia. However, these transfusions can cause a problem called alloimmunization, where the patient's immune system reacts to the transfused blood resulting in a severe and potentially life-threatening situation. A devastating form of alloimmunization is delayed hemolytic transfusion reaction (DHTR) which is more prevalent in patients with SCD. In some cases, having certain combinations of alloantibodies can make it almost impossible to find compatible blood for future transfusions. In order to prevent alloimmunization, the blood groups of the recipient and the donor should be optimally matched. 

In the Dutch Caucasian patient population the cumulative incidence of alloimmunization is 2-5%. Unfortunately, alloimmunization has a much higher incidence in transfusion recipients from ethnic minority groups. Especially in patients of African descent, receiving blood from Caucasian donors, as there are significant mismatches in red blood cell antigens between these two ethnic groups. Furthermore, the risk of alloimmunization in SCD patients is further increased due to the chronic proinflammatory state caused by hemolytic anemia and recurrent ischemia-reperfusion injury. 

To mitigate this risk, we need to address the ethnic mismatch between Caucasian donors and recipients of African descent. The present lack of donors from ethnic minority groups and especially donors from African descent needs to be addressed urgently.