The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy.
The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy.
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DOI：
10.1111/j.1537-2995.2009.02206.x
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发表时间：
2009-09
期刊：
影响因子：
2.9
通讯作者：
Schreiber GB
中科院分区：
文献类型：
--
作者：
Triulzi DJ;Kleinman S;Kakaiya RM;Busch MP;Norris PJ;Steele WR;Glynn SA;Hillyer CD;Carey P;Gottschall JL;Murphy EL;Rios JA;Ness PM;Wright DJ;Carrick D;Schreiber GB
捐献血液中的人类白细胞抗原 (HLA) 抗体被认为是导致输血相关急性肺损伤 (TRALI) 的原因。降低 TRALI 风险的一项潜在措施包括对血小板单采捐献者进行 HLA 抗体筛查。确定了献血者中 HLA 抗体的患病率及其与之前输血或怀孕的关系。 2006 年 12 月至 2007 年 5 月，美国 6 个血液中心前瞻性招募了 8171 名自愿献血者。献血者提供了详细的怀孕和输血史，以及通过多抗原珠流分析进行 HLA I 类和 II 类抗体检测的样本。共有8171名捐献者入组，7920名（96.9%）有有效的HLA抗体检测结果，其中7841名（99%）有完整的妊娠和输血信息。未输血男性 (n=1138) 和输血男性 (n=895) 中任何 HLA 抗体的患病率相似，分别为 1.0% 和 1.7% (p=0.16)。在 17.3% 的所有女性捐赠者 (n=5834) 和 24.4% 的有既往妊娠史的女性捐赠者 (n=3992) 中检测到 HLA 抗体。妊娠次数较多的女性中 HLA 抗体的患病率增加：1.7%（零次）、11.2%（一次）、22.5%（两次）、27.5%（三次）和 32.2%（四次或多次妊娠），p<0.0001。无论是否输血，在男性捐赠者中以及在没有已知免疫事件的女性捐赠者中，HLA I 类和 II 类抗体的检测率较低。随着怀孕次数的增加，HLA 抗体的患病率显着增加。这些数据将使血液中心能够估计 HLA 抗体检测作为潜在的 TRALI 风险降低措施的影响。
Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening platelet apheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined. 8171 volunteer blood donors were prospectively recruited by 6 U.S. blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion, and a sample for HLA class I and II antibody testing by multi-antigen bead flow analysis. 8171 donors were enrolled, 7920 (96.9%) had valid HLA antibody test results and 7841(99%) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in non-transfused (n=1138) and transfused (n=895) men, 1.0 vs. 1.7% (p=0.16). HLA antibodies were detected in 17.3% of all female donors (n=5834) and in 24.4 % of those with a history of previous pregnancy (n=3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7%(zero), 11.2%(one), 22.5%(two), 27.5%(three) and 32.2%(four or more pregnancies), p<0.0001. HLA class I and class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk-reduction measure.
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