TRALI-new challenges for histocompatibility and immunogenetics in transfusion medicine.
TRALI-new challenges for histocompatibility and immunogenetics in transfusion medicine.
复制标题
TRALI-输血医学中组织相容性和免疫遗传学的新挑战。
作者：
B. Flesch;E. Petershofen;J. Bux
抗人类白细胞抗原（HLA）抗体长期以来与输血相关急性肺损伤（TRALI）有关。与免疫患者的发热性输血反应和血小板输注无效相反，TRALI中的致病抗体存在于输注的血液成分中，即它们由献血者而不是受血者形成。因此，具有高血浆容量的血液成分与TRALI特别相关。除了针对HLAs的抗体外，主要是经产女性献血者血浆中存在的针对人中性粒细胞抗原（HNAs）的抗体也会诱导严重的TRALI反应。尤其是HLA-II类和HNA-3a抗原的抗体可在危重患者中诱导严重甚至致命的ALI。在过去的十年中，TRALI作为严重输血相关疾病的主要原因的临床重要性导致了旨在预防这种疾病的新指南的建立，包括对具有同种异体致敏史的血浆供体进行HLA和-HNA抗体的常规检测。这反过来又对输血中心与组织相容性和免疫遗传学实验室之间的密切合作提出了新的挑战，以敏感和特异地检测相关抗体。
Antibodies against human leukocyte antigens (HLAs) have long been associated with transfusion-related acute lung injury (TRALI). In contrast to febrile transfusion reactions and refractoriness to platelet transfusions in immunized patients, the causative antibodies in TRALI are present in the transfused blood component, i.e. they are formed by the blood donor and not by the recipient. Consequently, blood components with high plasma volume are particularly associated with TRALI. In addition to antibodies against HLAs, antibodies directed against human neutrophil antigens (HNAs) present in the plasma of predominantly multiparous female blood donors can induce severe TRALI reactions. Especially, antibodies to HLA class II and HNA-3a antigens can induce severe or even fatal ALI in critically ill patients. Over the last decade, the clinical importance of TRALI as major cause for severe transfusion-related morbidities has led to the establishment of new guidelines aimed at preventing this condition, including routine testing for HLA and -HNA antibodies for plasma donors with a history of allogeneic sensitization. This, in turn, poses new challenges for close collaboration between blood transfusion centers and histocompatibility and immunogenetics laboratories, for sensitive and specific detection of the relevant antibodies.
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影响因子：
20.3
作者：
Khan, Samina Yasmin;Kelher, Marguerite R.;Silliman, Christopher C.
通讯作者：
Silliman, Christopher C.
影响因子：
15.9
作者：
Looney, Mark R.;Nguyen, John X.;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
影响因子：
4.4
作者：
O. Spertini;F. Luscinskas;G. Kansas;J. Munro;James D. Griffin;M. Gimbrone;T. Tedder
通讯作者：
O. Spertini;F. Luscinskas;G. Kansas;J. Munro;James D. Griffin;M. Gimbrone;T. Tedder
影响因子：
15.9
作者：
Looney, Mark R.;Su, Xiao;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
HLA 表型与血浆或血小板中 HLA 浓度之间的关联。
影响因子：
2.7
作者：
Kao,KJ;Scornik,JC;Riley,WJ;McQueen,CF
通讯作者：
McQueen,CF