Acute and delayed hemolytic transfusion reactions secondary to HLA alloimmunization
Acute and delayed hemolytic transfusion reactions secondary to HLA alloimmunization
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DOI：
10.1046/j.1537-2995.2003.00381.x
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发表时间：
2003-06-01
期刊：
影响因子：
2.9
通讯作者：
Leparc, GF
中科院分区：
文献类型：
--
作者：
Benson, K;Agosti, SJ;Leparc, GF
背景：HLA 抗体可能针对红细胞上的 HLA 抗原，但通常认为这些抗体在输血实践中没有临床意义。报道一例因 HLA 相关 Bg 抗体导致经产妇女发生溶血性输血反应的病例。病例报告：一名 37 岁妇女因贫血入院。没有发现意外的红细胞抗体。输注了两个O、D+组红细胞单位。十天后，她因溶血和贫血而返回。又订购了两个红细胞单位，没有鉴定出意外的红细胞抗体，并发出了两个交叉配型兼容单位。输血过程中，患者出现急性反应症状，输血后样本显示血管内溶血的证据。结果：重复红细胞抗体筛查显示抗Bg。 HLA抗体筛选鉴定出抗HLA-A2、A28、137、137交叉反应群（CREG）。第一次输血的两个红细胞单位和第二次输血的一个红细胞单位与患者的 HLA 不相容。没有发现溶血反应的其他原因。随后，患者成功输注了来自 HLA 相容供体的 1 个红细胞单位。结论：当未发现红细胞特异性抗体是溶血性输血反应的病因时，应考虑对发生溶血性输血反应的患者使用 HLA 抗体。
BACKGROUND: HLA antibodies may be directed against HLA antigens on RBCs, but these antibodies are generally not considered to be clinically significant in transfusion practice. A case of a multiparous woman who had hemolytic transfusion reactions due to HLA-related Bg antibodies is reported.CASE REPORT: A 37-year-old woman was admitted with anemia. No unexpected RBC antibodies were identified. Two group O, D+ RBC units were transfused. Ten days later she returned with hemolysis and anemia. Two more RBC units were ordered, no unexpected RBC antibodies were identified, and two crossmatch-compatible units were issued. During the transfusion, the patient developed symptoms of an acute reaction, and the posttransfusion sample showed evidence of intravascular hemolysis.RESULTS: Repeat RBC antibody screen showed anti-Bg. HLA antibody screen identified anti-HLA-A2, A28, 137, 137 cross-reactive group (CREG). The two RBC units from the first transfusion episode and one RBC unit from the second transfusion episode were HLA incompatible with the patient. No other cause for the hemolytic reactions was identified. The patient was later successfully transfused with one RBC unit from an HLA-compatible donor.CONCLUSION: HLA antibodies should be considered in patients with hemolytic transfusion reactions when RBC-specific antibodies are not found to be the etiology.