The Development and Consequences of Red Blood Cell Alloimmunization.
The Development and Consequences of Red Blood Cell Alloimmunization.
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DOI：
10.1146/annurev-pathol-042320-110411
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发表时间：
2023-01-24
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--
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虽然红细胞（RBC）输注是住院患者最常见的医疗干预措施，但与任何治疗一样，它并非没有风险。异体红细胞暴露可导致受体异体免疫，这可能会限制未来输血中相容红细胞的可用性，并增加输血并发症的风险。尽管存在这些挑战和一个多世纪前发现的红细胞异体抗原，但历史上对调节红细胞异体抗体形成的免疫因子的了解相对较少。通过最近的流行病学方法、基于体外的转化研究和新开发的临床前模型，控制红细胞同种异体免疫的过程比以前认识到的更加复杂和有趣。虽然存在共同的同种异体免疫机制，但根据所涉及的靶同种异体抗原的不同，可以参与不同的免疫途径。尽管这种复杂性，关键主题开始出现，可能提供有希望的方法，不仅积极预防，而且可能减轻红细胞异体免疫最严重的并发症。
While red blood cell (RBC) transfusion is the most common medical intervention in hospitalized patients, as with any therapeutic, it is not without risk. Allogeneic RBC exposure can result in recipient alloimmunization, which can limit the availability of compatible RBCs for future transfusions and increase the risk of transfusion complications. Despite these challenges and the discovery of RBC alloantigens more than a century ago, relatively little has historically been known regarding the immune factors that regulate RBC alloantibody formation. Through recent epidemiological approaches, in vitro–based translational studies, and newly developed preclinical models, the processes that govern RBC alloimmunization have emerged as more complex and intriguing than previously appreciated. Although common alloimmunization mechanisms exist, distinct immune pathways can be engaged, depending on the target alloantigen involved. Despite this complexity, key themes are beginning to emerge that may provide promising approaches to not only actively prevent but also possibly alleviate the most severe complications of RBC alloimmunization.
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