Donor selection for alloimmunized patients by platelet crossmatching of random-donor platelet concentrates.
Donor selection for alloimmunized patients by platelet crossmatching of random-donor platelet concentrates.
复制标题
通过随机供体血小板浓缩物的血小板交叉配血来选择同种免疫患者的供体。
DOI：
10.1046/j.1537-2995.1990.30490273438.x
复制
发表时间：
1990
期刊：
影响因子：
2.9
通讯作者：
Schiffer,CA
中科院分区：
文献类型：
--
作者：
O'Connell,BA;Schiffer,CA
从储存的浓缩血小板(PC)的袋段中获得的样本与同种免疫患者的血清进行交叉匹配，以确定潜在的相容捐赠者。对随机供者血小板输注无效的41例患者的血清进行检测。所有的血清都有淋巴细胞毒性抗体(LCTAb)，37名患者的LCTAb对小组中75%的细胞有强烈的反应。每个患者至少测试了18台个人电脑。用微量酶联免疫吸附试验(MicroEL ISA)检测33例患者血清。与944个PC中703个(74%)的交叉匹配为阳性，23%为阴性，3%为不确定。另外8名患者也接受了固相系统的测试；417个交叉匹配中有352个(85%)呈阳性，15%呈阴性。反应性较强的LCTAb患者的体外相容单位很少(通常为0-2个)。对临床可评估的患者进行了34次共用兼容PC的输血，全部保存3天。在由微量酶联免疫吸附试验选择的20种输液中，有6种在14名患者中有4名在输血10分钟后出现令人满意的增加(校正计数增量[CCIS]>；7500)。通过固相选择的14种输液中的8种在8名患者中的5名患者中产生了CCIS>；7500。虽然通过这些技术很难为高度同种异体免疫的患者选择大量相容的单位，但一些输血成功地适用于很少有相合的供者的患者。这种方法在紧急情况下可能特别有价值。
Samples obtained from bag segments of stored platelet concentrates (PCs) were crossmatched with sera from alloimmunized patients to identify potentially compatible donors. Sera from 41 patients who were refractory to random‐donor platelet transfusions were tested. All sera had lymphocytotoxic antibody (LCTAb), and 37 patients had LCTAb that reacted strongly against >75 percent of the cells in the panel. At least 18 units of PCs were tested per patient. Sera from 33 patients were tested by microenzyme‐linked immunosorbent assay (microELISA). Crossmatches with 703 (74 percent) of 944 PCs were positive, 23 percent were negative, 3 percent were indeterminate. Eight additional patients were also tested with a solid‐phase system; 352 (85 percent) of 417 crossmatches were positive and 15 percent were negative. Patients with more reactive LCTAb had very few (often 0–2) in vitro compatible units. Thirty‐four transfusions of pooled compatible PCs, all stored <3 days, were administered to clinically evaluable patients. Six of 20 transfusions selected by microELISA produced satisfactory increases (corrected count increments [CCIs] >7500) 10 minutes after transfusion in 4 of 14 patients. Eight of 14 transfusions selected by solid‐phase produced CCIs >7500 in 5 of 8 patients. Although it is difficult to select large numbers of compatible units for heavily alloimmunized patients by these techniques, some transfusions were successful in patients who had very few HLA‐compatible donors. This approach may be of particular value in emergency situations.