Alloimmunization among Multiply Transfused Pediatric Patients with Sickle Cell Disease Attending Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

Abstract

Background: Sickle cell disease (SCD) is a major inherited haemoglobin disorder and a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Repeated blood transfusions, although life-saving, increase the risk of red blood cell (RBC) alloimmunization, complicating future transfusions and predisposing patients to haemolytic transfusion reactions. Aims: This study determined the prevalence and determinants of RBC alloimmunization among multiply transfused children with SCD attending Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. Methods: A hospital-based cross-sectional study enrolled 190 children younger than 10 years with confirmed SCD and at least two previous transfusions from October 2025 to January 2026. Clinical and demographic data were collected using structured case report forms. Alloantibodies were detected using the indirect antiglobulin test. Data were analysed using descriptive statistics, chi-square tests, and logistic regression. Results: The participants ranged in age from 6 months to 10 years, with a nearly equal sex distribution (54% male and 46% female). Blood group O was the most common (44%), and most participants were Rh-positive (99.5%). Most children (72.1%) had received between three and five transfusions. Overall, four of the 190 participants tested positive for RBC alloantibodies, giving a prevalence of 2.1%. All alloimmunized cases occurred among children who had received three or more transfusions. Although the number of transfusions showed a positive association with alloimmunization (OR = 1.45; 95% CI: 0.94–2.23), the association was not statistically significant (p = 0.091). Age and sex were also not significantly associated with alloantibody development. Conclusion: The prevalence of RBC alloimmunization among transfused paediatric patients with SCD in this setting was relatively low (2.1%). Nevertheless, the positive trend between increasing transfusion exposure and alloantibody formation highlights the need for improved transfusion safety strategies, including routine antibody screening and consideration of extended antigen matching for multiply transfused children.