Red-blood-cell alloimmunization in myelodysplastic syndromes - Associations with sex, DAT-positivity, and increased transfusion needs

Sep 17, 2026

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Many individuals with myelodysplastic syndromes (MDS) require repeated red blood cell transfusions, creating risk for immunization and development of alloantibodies. Reported links between alloantibodies, autoantibodies, and transfusion requirements remain incompletely understood. This retrospective cohort study examined factors associated with red blood cell alloimmunization and evaluated changes in transfusion intensity and post-transfusion hemoglobin increments.

LanguageEnglish

CategoryResearch & Report

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Pages12

Reading Time30 min

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Abstract

Background

Methods

Results

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Rationale and clinical context

Received: 29 April 2023 Revised: 10 August 2023 Accepted: 15 August 2023 DOI: 10.1111/trf.17562 TRANSFUSION C OMPLICATIONS Red blood cell alloimmunization in myelodysplastic syndromes: Associations with sex, DAT-positivity, and increased transfusion needs Jenny Rydén 1,2 | Mark Clements 3 | Agneta Wikman 4,5 | Eva Hellström-Lindberg 1,2 | Gustaf Edgren 6,7 | Petter Höglund 1,4 1Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden 2Department of Hematology, Karolinska University Hospital, Stockholm, Sweden 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden 4Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden 5Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden 6Department of Cardiology, Södersjukhuset, Stockholm, Sweden 7Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden Correspondence Jenny Rydén and Petter Höglund, Center for Hematology and Regenerative Medicine (HERM), Karolinska Institutet, Department of Medicine Huddinge, Neo research building, S-141 83, Stockholm, Sweden. Email: [jenny.ryden@ki.se](jenny.ryden@ki.se) and [petter.hoglund@ki.se](petter.hoglund@ki.se) Funding information Cancerfonden, Grant/Award Numbers: 2015/727, 2016/451, CAN 21 1512; European Commission, Grant/Award Number: 874662; Kommunfullmäktige, Stockholms Stad, Grant/Award Numbers: 20160060, 20170287; Radiumhemmets Forskningsfonder, Grant/Award Number: 181133; Swedish Research Council, Grant/Award Numbers: 2011-03152, 2017-01129, 2017-01954, 2018-02526 Abstract Background: Many patients with myelodysplastic syndromes (MDS) need repeated red blood cell transfusions which entails a risk of immunization and antibody formation. Associations between alloantibodies, autoantibodies and increased transfusion requirements have been reported, but their relationship remains unclear. In this study, we analyzed factors potentially associated with red blood cell alloimmunization, as well as changes in transfusion intensity and post-transfusion hemoglobin increments. Methods: In a retrospective cohort study, we linked Swedish MDS patients diagnosed between 2003 and 2017 to transfusion and immunohematology data. Potentially associated factors were analyzed using Cox proportional hazards regression. The transfusion rate after detected alloimmunization was analyzed using a fixed effects Poisson regression. Post-transfusion hemoglobin increments before and after alloimmunization were compared using a mixed effects regression. Results: Alloantibodies following MDS diagnosis were detected in 50 out of 429 patients (11.7%) . Female sex and a positive direct antiglobulin test (DAT) were independently associated with alloimmunization, with hazard ratios of Abbreviations: DAT, direct antiglobulin test; FE, fixed effect; IPSS‐R, international prognostic scoring system revised; IRR, incidence rate ratio; IQR, interquartile range; MDS, myelodysplastic syndrome; MDS‐EB, myelodysplastic syndromes with excess of blasts; MDS‐MLD, myelodysplastic syndromes with multilineage dysplasia; MDS‐RS, myelodysplastic syndrome with ring sideroblasts; MDS‐SLD, myelodysplastic syndromes with single lineage dysplasia; MPN, myeloproliferative neoplasm; RBC, red blood cell; Rh, Rhesus; WHO, World Health Organization. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB. RYDN ET AL. 2041 2.02 (95% confidence interval [CI] 1.08–3.78) and 9.72 (95% CI, 5.31–17.74), respecti

FAQs

What was the study’s main goal regarding MDS and red blood cell transfusions?

To analyze factors potentially associated with red blood cell alloimmunization and to assess how transfusion intensity and post-transfusion hemoglobin increments change after alloimmunization.

Which factors were independently associated with alloimmunization in the results?

Female sex and a positive direct antiglobulin test (DAT) were independently associated with alloimmunization.

How did alloimmunization affect transfusion needs and hemoglobin increment?

After alloimmunization, transfusion rate increased, and the post-transfusion hemoglobin increment was lower per red blood cell unit compared with the period before alloimmunization.

Sep 17, 2026

Uploaded by Rizky