Determinants of red blood cell alloantibody detection duration: analysis of multiply alloimmunized patients supports peritransfusion factors.
Determinants of red blood cell alloantibody detection duration: analysis of multiply alloimmunized patients supports peritransfusion factors.
复制标题
红细胞同种抗体检测持续时间的决定因素：对多重同种免疫患者的分析支持围输血因素。
DOI：
10.1111/trf.14157
复制
发表时间：
2017
期刊：
影响因子：
2.9
通讯作者：
Higgins,JohnM
中科院分区：
文献类型：
--
作者：
Noiret,Lorette;Slater,Amy;Higgins,JohnM
背景红细胞（RBC）的同种免疫可能引起严重的输血反应，并使寻找相容的血液制品变得复杂。同种抗体可以在几天到几年的时间内被检测到，但控制可检测持续时间的机制仍然未知。我们研究了形成多种抗体的患者的检测持续时间，以调查持续时间是否更强烈地由每次输血时存在的条件（围输血因素）决定，还是由可能在输血期间持续存在的更稳定的患者特异性因素决定。研究设计和方法我们研究了马萨诸塞州总医院和布莱根妇女医院同种免疫患者的回顾性医疗记录（1461 名患者；2187 种抗体）。结果在患者体内同时发现抗体有着相似的命运：76% 的人坚持通过了最后一个屏幕，或者在同一屏幕中第一次变得无法检测到。同时鉴定的抗体也比顺序鉴定的抗体更持久（平均 9.2 个月 vs. 4.9 个月；p < 10−3）。在患者体内，同时发现的抗体往往会在相似的时间段内被检测到（平均差为 25 天），而顺序发现的抗体的检测周期（107 天，p < 10−3）则相反。结论同时发现的抗体检测持续时间的相似性表明，围输血因素是同种抗体可检测性和持续时间的重要决定因素。我们还发现一些证据表明，在所有患者中，顺序识别的抗体的检测持续时间也比随机选择的抗体的检测持续时间具有更高的相关性，这表明患者特异性因素在决定同种抗体持久性方面也发挥着作用。
BACKGROUNDAlloimmunization to red blood cells (RBCs) can cause serious transfusion reactions and complicate the search for compatible blood products. Alloantibodies can be detected for periods ranging from a few days to several years, yet the mechanisms controlling the duration of detectability remain unknown. We studied the detection durations in patients forming multiple antibodies to investigate whether the duration is more strongly determined by conditions present at the time of each transfusion (peritransfusion factors) or by more stable patient‐specific factors likely to persist across transfusions.STUDY DESIGN AND METHODSWe studied retrospective medical records for alloimmunized patients at Massachusetts General Hospital and Brigham and Women's Hospital (1461 patients; 2187 antibodies).RESULTSAntibodies discovered simultaneously in a patient shared similar fates: 76% persisted through the last screen or first became undetectable during the same screen. Simultaneously identified antibodies were also more persistent than sequentially identified antibodies (mean, 9.2 months vs. 4.9 months; p < 10−3). Within a patient, antibodies discovered simultaneously tended to be detected for similar periods of time (mean difference, 25 days), compared to the detection period for sequentially discovered antibodies (107 days, p < 10−3).CONCLUSIONSThe similarity in detection duration of simultaneously identified antibodies suggests that peritransfusion factors are important determinants of alloantibody detectability and duration. We also find some evidence that detection durations for sequentially identified antibodies are also more highly correlated than those for randomly selected antibodies across all patients, suggesting that patient‐specific factors also play a role in determining alloantibody persistence.