Keywords
extended phenotyping
erythrocyte antigens
alloimmunization
Lubumbashi
cannabis use, academic performance, adolescents, prevention, educational context, Democratic Republic of the Congo
How to Cite
Abstract
Introduction
In the Democratic Republic of Congo (DRC), transfusion management for patients with sickle cell disease (SCD) is traditionally limited to ABO and RH1 (D) compatibility screening. This practice exposes multi-transfused pediatric populations to a high hidden risk of red blood cell (RBC) alloimmunization due to unmonitored minor blood group polymorphisms.
Purpose
To establish extended immunohematological mapping of the Rh, Kell, Duffy, Kidd, and MNS systems in a pediatric SCD cohort in Lubumbashi, DRC.
Methods
A cross-sectional study was conducted involving 98 pediatric SCD patients managed across specialized urban medical facilities in Lubumbashi. Extended erythrocyte antigen phenotyping was performed using standard hemagglutination techniques. Statistical analyses were executed using IBM SPSS Statistics (Version 20.0).
Results
The cohort had a mean age of 4.26 ± 3.07 years and a high clinical transfusion burden, with 40.8% of subjects having received three or more transfusions. Complete antigenic invariance (100.0% prevalence) was observed for D, c, e, and s antigens. Conversely, phenotypic variations were identified in antigens C (11.2%) and E (7.1%). The ABO system is dominated by group O (57.14%). The protective Duffy-null phenotype Fy(a−b−) predominated (89.8%), whereas the Kidd system revealed a high proportion of the Jk(b−) variant (66.3%). Bivariate analyses confirmed that the distribution of these blood group variations was statistically independent of sex and geographic origin (p > .05).
Conclusion
Current national transfusion guidelines expose multi-transfused children to significant, unaddressed immunological risk. Implementing extended phenotyping and regional donor-matching registries is necessary to mitigate clinical alloimmunization complications in the DRC.
References
Aygun, B., Padmanabhan, S., Paley, C., & Chandrasekaran, V. (2002). Clinical significance of RBC alloantibodies and autoantibodies in sickle cell patients who received transfusions. Transfusion, 42(1), 37–43. https://doi.org/10.1046/j.1537-2995.2002.00007.x
Barro, L., Drew, V. J., Poda, G. G., Tagny, C. T., El-Ekiaby, M., Owusu-Ofori, S., & Burnouf, T. (2018). Blood transfusion in sub-Saharan Africa: Understanding the missing gap and responding to present and future challenges. Vox Sanguinis, 113(8), 726–736. https://doi.org/10.1111/vox.12705
Chiaroni, J., Peyrard, T., & Pirenne, F. (2024). Erythrocyte blood groups (2nd ed.). John Libbey Eurotext.
Chou, S. T., Alsawas, M., Fasano, R. M., Field, J. J., Hendrickson, J. E., Howard, J., Kameka, M., Kwiatkowski, J. L., Pirenne, F., Shi, P. A., Stowell, S. R., Thein, S. L., Westhoff, C. M., Wong, T. E., & Akl, E. A. (2020). American Society of Hematology 2020 guidelines for sickle cell disease: Transfusion support. Blood Advances, 4(2), 327–355. https://doi.org/10.1182/bloodadvances.2019001143
Cohn, C. S., Delaney, M., Johnson, S. T., Katz, L. M., & Schwartz, J. (Eds.). (2023). Technical manual (21st ed.). AABB.
Diallo, D. A. (2008). Sickle cell disease in Africa: Issues, strategies for improving survival and quality of life for sickle cell patients. Bulletin de l'Académie Nationale de Médecine, 192(7), 1361–1373. https://doi.org/10.1016/S0001-4079(19)32686-X
Flegel, W. A. (2006). Molecular genetics of RH and its clinical application. Transfusion Clinique et Biologique, 13(1–2), 4–12. https://doi.org/10.1016/j.tracli.2006.02.011
Gadji, M., Cobar, G., Thiongane, A., Senghor, A. B., Seck, R., Faye, B. F., Seck, M., Guéye, Y. B., Sy, D., Sall, A., Touré, A. O., Diéye, T. N., & Diop, S. (2023). Red blood cell alloantibodies in pediatric transfusion in sub-Saharan Africa: A new cohort and literature review. EJHaem, 4(2), 315–323. https://doi.org/10.1002/jha2.645
Harmening, D. M. (2018). Modern blood banking and transfusion practices (7th ed.). F. A. Davis Company.
Howes, R. E., Patil, A. P., Piel, F. B., Nyangiri, O. A., Gething, P. W., Dewi, M., Hogg, M. M., Battle, K. E., Padilla, C. D., Baird, J. K., & Hay, S. I. (2011). The global distribution of the Duffy blood group. Nature Communications, 2, Article 266. https://doi.org/10.1038/ncomms1265
Italian, R. (2021). Immunohematology. College Centre for the Development of Teaching Materials (CCDMD).
Katamea, T. (2024). Neonatal screening for sickle cell disease in Lubumbashi. European University Editions.
Novelli, E. M., & Gladwin, M. T. (2016). Crises in sickle cell disease: Pathophysiology and management. The Lancet, 387(10037), 2545–2556. https://doi.org/10.1016/S0140-6736(15)00941-7
O'Suoji, C., Liem, R. I., Mack, A. K., Kingsberry, P., Ramsey, G., & Thompson, A. A. (2013). Alloimmunization in sickle cell anemia in the era of extended red cell typing. Pediatric Blood & Cancer, 60(9), 1487–1491. https://doi.org/10.1002/pbc.24530
Pirenne, F., Floch, A., & Diop, S. (2023). Alloimmunization against red blood cells in sickle cell disease: Transfusion challenges in high-income and low-income countries. The Lancet Haematology, 10(6), e468–e476. https://doi.org/10.1016/S2352-3026(23)00066-2
Reid, M. E., Lomas-Francis, C., & Olsson, M. L. (2012). The blood group antigen factsbook (3rd ed.). Academic Press. https://doi.org/10.1016/B978-0-12-415849-8.00001-6
Sawadogo, S., Nebie, K., Kima, D., Ouedraogo, S. K. A., Nagnon, P. A., Koulidiati, J., Traore, C., Sawadogo, S., Kafando, E., & Deneys, V. (2023). Feasibility and performance of in-house red blood cell reagents to detect unexpected antibodies in immunized patients in Burkina Faso. Immunohematology, 39(4), 172–180. https://doi.org/10.2478/immunohematology-2023-025
Seck, M., Diarra, A., Touré, M., & Fofana, T. (2019). Erythrocyte antigen polymorphism and post-transfusion alloimmunization in sickle cell patients in Bamako, Mali. DOAJ Medical Journal, 8(1), 44–51.
Tariq, F., Ahmed, R., Ashfaq, J., Thakur, W., Ashique, A., & Borhany, M. (2022). Frequency of extended red cell antigen phenotype among patients of hematological diseases: A single center study. Cureus, 14(7), Article e27215. https://doi.org/10.7759/cureus.27215
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2026 Fazili, O. A., Mudogo, V., Ngbolua, K. N.