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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\u2010transfusion hemoglobin increments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010transfusion hemoglobin increments before and after alloimmunization were compared using a mixed effects regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 2.02 (95% confidence interval [CI] 1.08\u20133.78) and 9.72 (95% CI, 5.31\u201317.74), respectively. The transfusion rate following alloimmunization was increased with an incidence rate ratio of 1.33 (95% CI, 0.98\u20131.80) and the post\u2010transfusion hemoglobin increment after alloimmunization was 1.40\u2009g\/L (95% CI, 0.52\u20132.28) lower per red blood cell unit (<jats:italic>p<\/jats:italic>\u2009=\u2009.002) compared to before alloimmunization, in multivariable analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Alloimmunization against blood group antigens was associated with sex, DAT\u2010positivity, increased transfusion needs, and lower post\u2010transfusion hemoglobin increments. These findings warrant further investigation to evaluate the clinical significance of up\u2010front typing and prophylactic antigen matching in patients with MDS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17562","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T05:23:25Z","timestamp":1697088205000},"page":"2040-2051","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Red blood cell alloimmunization in myelodysplastic syndromes: Associations with sex, DAT\u2010positivity, and increased transfusion needs"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0087-8158","authenticated-orcid":false,"given":"Jenny","family":"Ryd\u00e9n","sequence":"first","affiliation":[{"name":"Center for Hematology and Regenerative Medicine, Department of Medicine Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Hematology Karolinska University Hospital 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