Specificities of leucocyte alloantibodies in transfusion-related acute lung injury and results of leucocyte antibody screening of blood donors
Specificities of leucocyte alloantibodies in transfusion-related acute lung injury and results of leucocyte antibody screening of blood donors
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DOI：
10.1111/j.1423-0410.2008.01092.x
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发表时间：
2008-11-01
期刊：
影响因子：
2.7
通讯作者：
Bux, J.
中科院分区：
文献类型：
--
作者：
Reil, A.;Keller-Stanislawski, B.;Bux, J.
背景抗体介导的输血相关急性肺损伤（TRALI）是输血相关发病和死亡的重要原因。预防策略目前是一个问题的debate.Methods的白细胞抗体的特异性牵连在以前的严重TRALI反应，使用标准技术进行了测定。结果36例TRALI患者中，人类白细胞抗原（HLA）Ⅱ类抗体17例，人类中性粒细胞同种异体抗原（HNA）12例，人类白细胞抗原Ⅰ类抗体4例，人类白细胞抗原Ⅰ类和Ⅱ类混合抗体3例。HNA-3a抗体占12例HNA抗体介导的反应中的10例，占10例死亡中的6例，包括输注红细胞后的1例。调查5332例经产女性供者，白细胞抗体阳性473例，异源免疫率8.9%。这些供体中有61%呈现HLA I类，19%呈现HLA II类，12%呈现HLA I类和II类抗体，5%呈现HNA抗体。在39%的HLA II类和17%的HNA抗体中发现了额外的HLA I类抗体。我们的限制性血浆策略未导致血浆或血小板短缺。结论与HLA-I类抗体相比，HLA-II类抗体和HNA-3a抗体具有更高的临床意义。孤立的HLA I类抗体筛查被认为是不足以进行白细胞抗体筛查。
Background Antibody-mediated transfusion-related acute lung injury (TRALI) is an important cause of transfusion-associated morbidity and death. Preventive strategies are currently a matter of debate.Methods Specificities of leucocyte antibodies implicated in previous severe TRALI reactions were determined using standard techniques. Based on these results, a leucocyte antibody screening strategy for the testing of parous female donors was introduced.Results Of 36 TRALI cases, 17, 12, four and three were due to human leucocyte antigen (HLA) class II, human neutrophil alloantigen (HNA), HLA class I, and mixtures of HLA class I and II antibodies, respectively. HNA-3a antibodies accounted for 10 of 12 HNA antibody-mediated reactions and 6 of 10 fatalities including one after transfusion of red blood cells. Investigation 5332 parous female donors showed leucocyte antibodies in 473 samples, resulting in an alloimmunization rate of 8.9%. Sixty-one per cent of these donors presented HLA class I, 19% class II, 12% HLA class I and II antibodies and 5% HNA antibodies. Additional HLA class I antibodies were found in 39% of HLA class II and in 17% of HNA antibodies containing sera. Our restrictive plasma strategy did not result in a shortage of plasma or platelets. No antibody-mediated TRALI case was observed since introduction of the policy of plasma from male, nulliparous or tested multiparous donors.Conclusion Compared to HLA class I antibodies, those directed against HLA class II and HNA-3a were of greater clinical relevance. Isolated HLA class I antibody screening was found to be insufficient for leucocyte antibody screening.