Nowadays management of severe Rh ALLOIMMUNIZATION consists of serial determination of middle cerebral artery peak systolic velocity, amniocentesis, cordocentesis, and in many instances intrauterine transfusion. We present a case of severe Rh ALLOIMMUNIZATION who, for the first time in Iran, was delivered at term after several intrauterine transfusions.

Dear Editor, We read the publication on “ ALLOIMMUNIZATION in thalassemia patients” with a great interest. Davoudi‑ Kiakalayeh et al. concluded that “ blood matching for Rh and K antigens in patients with transfusion‑ dependent thalassemia could reduce the rate of red blood cell ALLOIMMUNIZATION. ” [1] We would like to share ideas and experience from our setting in Indochina where the prevalence of transfusion‑ dependent thalassemia is very high. In our setting, the blood matching for Rh and K antigens is routinely done in big blood bank centers...

Background: Regular blood transfusions to treat the patients with thalassemia major generate antibodies acting against red blood cells antigens. This immune response is called alloimmunity. This study was conducted with the purpose of determining the prevalence of alloantibodies and autoantibody, identifying the type of causative antigen, and recognizing the factors affecting ALLOIMMUNIZATION among the patients with thalassemia major receiving blood. Materials and Methods: In this cross-sectional study, 385 patients with thalassemia major participated. After recording their demographic information, serum specimens taken from the patients were screened using pooled cells obtained from Biorad Company. The positive cases were examined to identify antibodies using panel cells obtained from Iranian Blood Transfusion Organization. In this study, SPSS 16 was employed for performing statistical analysis.Results: Of the 385 patients, 69 subjects (17.9%) comprising 221 men and 164 women had alloantibody. In 57 cases, the antibody type was exactly identified. In 21 patients (5.5%) the existence of autoantibody was determined. The mean ages of the participants were within 14.3±7.5 and 13.3±7.9 years old for male and female groups, respectively. 28 patients had splenectomy and age at the onset of blood transfusion ranged from a month after birth to nine years.Conclusion: In these patients, the most significant blood group systems acted by alloantibodies were Rh and Kell. Since the results of this study show 17.9% incidence of ALLOIMMUNIZATION in these patients, it is recommended to carry out injected blood compatibility test (cross-match) after antibody screening.

Background and Objective: Repeated blood transfusion is the major treatment for patients with major thalassemia. However due to antigen encounters, it may initiate body reactions, including alloantibodies against red blood cell antigens. This study was done to determine the Prevalence of ALLOIMMUNIZATION in major beta thalassemia patients in northern Iran.Method: This descriptive - analytic study was carried out on 218 thalassemic patients (100 males and 118 females) with average age of 22.5±7 years in northern Iran during 2010. Each sample was tested for the presence of Alloantibodies including C, Cw, Lea, E, Lua, Leb, K, Jkb, N, P1, D, Jka, M, S, Xga, e, Fya, s, c, Fyb, k, Kpa, Jsb, Lub and Coa.Results: Eighty eight cases (40.4%; 95% CI: 33.9-46.9) were positive for the presence of alloantibodies. Alloantibodies against C, Cw, Lea red blood cell surface antigens were the most prevalent (40%). No significant correlation was found between emergence of alloantibody with the age of initial, frequency and duration of blood transfusion.Conclusion: ALLOIMMUNIZATION is a common observation in thalassemic patients and should be prevented by transfusing compatible blood.

Background: The prevalence of Rh ALLOIMMUNIZATION has decreased following the use of anti-D immunoglobulin. With serial amniocentesis, Doppler sonography of the middle cerebral artery and treatment of anemia with intrauterine blood transfusion, perinatal mortality has declined. However, Rh ALLOIMMUNIZATION in twin pregnancies poses a diagnostic and therapeutic challenge.Case report: We are reporting, for the first time in Iran, the successful treatment of severe Rh ALLOIMMUNIZATION in a dichorionic- diamnionic twin pregnancy leading to the live births of both neonates. Before treatment, the fetal hemoglobin levels were 3.1g/dl and 3.9g/dl, with ascites in both fetuses. The fetuses were treated with several IUTs.Results: After treatment, the neonates were delivered, weighing 2200 and 2300g, with good Apgar scores, at a gestational age of 34 weeks.Conclusion: 10% of population in Iran is Rh-negative, although Prophylaxis for Rh ALLOIMMUNIZATION is universal, as other part of the world it cannot irrigated. For the best management of these cases, we need a well-equipped referral center.