Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series
Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series
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DOI：
10.1111/trf.13379
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Stowell, Sean R.
中科院分区：
文献类型：
--
作者：
Nickel, Robert Sheppard;Hendrickson, Jeanne E.;Stowell, Sean R.
背景：虽然红细胞（RBC）输血是镰状细胞病（SCD）治疗的重要组成部分，但一些患者的输血支持可能导致对红细胞抗原的异体免疫。与未接受同种异体免疫的患者相比，接受同种异体免疫的SCD患者的生存率似乎更差。虽然这种死亡率的差异可能部分是由于与疾病严重程度相关的潜在免疫差异，但它也可能反映了红细胞同种异体免疫的直接临床后果。同种异体免疫的患者发生严重溶血性输血反应（HTRs）的风险增加，由于缺乏相容的红细胞单位，可能无法获得足够的红细胞输血支持。病例报告：本研究报告了5例红细胞异体免疫的SCD死亡患者，以说明红细胞异体免疫本身有助于过早死亡的概念。结果：每个报告患者的临床病程提供了对RBC同种异体免疫的直接和间接后果的见解，其中患者经历延迟的htr或没有接受所需的RBC输血。结论未来研究红细胞同种异体免疫的临床影响的工作不仅要考虑hrs，而且要解决与难以获得相容血液相关的潜在后果。
BACKGROUNDAlthough red blood cell (RBC) transfusion represents an integral component of sickle cell disease (SCD) care, transfusion support for some patients can result in alloimmunization to RBC antigens. Alloimmunized patients with SCD appear to experience worse survival compared to nonalloimmunized patients. While this difference in mortality may in part be due to underlying immunologic differences related to disease severity, it may also reflect direct clinical consequences of RBC alloimmunization. Alloimmunized patients have an increased risk of serious hemolytic transfusion reactions (HTRs) and may not receive adequate RBC transfusion support due to lack of compatible RBC units.CASE REPORTThis study reports on five RBC alloimmunized patients with SCD who died, to illustrate the concept that RBC alloimmunization itself contributes to premature death.RESULTSThe clinical course for each of the reported patients provides insight into the direct and indirect consequences of RBC alloimmunization, where patients experienced delayed HTRs or did not receive needed RBC transfusions.CONCLUSIONFuture work examining the clinical impact of RBC alloimmunization should not only consider HTRs but should also address the potential consequences associated with difficulties in obtaining compatible blood.