Challenges of Blood Centres in Providing Compatible Packed Red Blood Cells in Thalassemia Patients

Thalassemia is a hereditary haemoglobinopathy characterised by ineffective erythropoiesis and chronic anaemia, necessitating lifelong regular packed red blood cell (PRBC) transfusions. While transfusion therapy remains the cornerstone of management and significantly improves survival and quality of life, it presents complex challenges for both patients and blood centres. Repeated transfusions expose patients to risks such as alloimmunisation, autoantibody formation, transfusional iron overload, and transfusion-transmitted infections (TTIs), all of which complicate long-term care and transfusion support. Alloimmunisation, in particular, poses a major obstacle by limiting the availability of compatible PRBC units and increasing the risk of haemolytic transfusion reactions. From the blood centre perspective, ensuring the timely provision of antigen-matched, compatible blood for multi-transfused thalassemia patients is demanding due to limited donor phenotyping, scarcity of rare blood groups, and the need for advanced immunohaematology testing. The implementation of extended antigen matching, molecular genotyping, maintenance of rare donor registries, and regular antibody screening are critical strategies to mitigate transfusion-related complications. However, these measures require significant infrastructure, expertise, and financial investment, which may be challenging in resource-constrained settings. This article highlights the multifaceted challenges faced by blood centres in providing compatible PRBCs to thalassemia patients and emphasises the importance of a proactive, multidisciplinary transfusion strategy. Strengthening donor programmes, adopting advanced testing technologies, and fostering collaboration among transfusion services are essential to improving transfusion safety and outcomes in transfusion-dependent thalassemia.