Acute and transient decrease in neutrophil count in transfusion related acute lung injury: cases at one hospital
Acute and transient decrease in neutrophil count in transfusion related acute lung injury: cases at one hospital
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DOI：
10.1111/j.0041-1132.2004.04194.x
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发表时间：
2004-12-01
期刊：
影响因子：
2.9
通讯作者：
Toy, P
中科院分区：
文献类型：
--
作者：
Nakagawa, M;Toy, P
背景：输血相关急性肺损伤（TRALI）是一种罕见但严重的输血并发症。该综合征的特点是在输血期间或输血后 6 小时内出现新的急性肺损伤。 研究设计和方法：该研究设计本质上是观察性的。结果：所有 3 例 TRALI 病例都与白细胞 (WBC) 计数急性但短暂的减少有关。相关捐献者的 HLA 抗体与受者的 HLA 抗原相匹配。其中一例涉及的单位是血小板去除术，另外两例涉及的单位是新鲜冰冻血浆单位。所有涉及的捐赠者都是多产妇女。所涉及的抗体特异性在一个病例中是抗 HLA I 类和 II 类，在另外两例中是抗 HLA II 类。有趣的是，在所有 3 例病例中，患者中性粒细胞计数均下降了 80% 至 90%，其中包括与 HLA II 类抗体相关的 2 例。 结论：WBC 计数的急性和短暂下降可能是 TRALI 的一个先前未被充分认识的特征。即使相关抗体对 HLA II 类抗原具有特异性，中性粒细胞计数也可能会下降，尽管它们仅在受刺激的中性粒细胞上表达。根据这些病例的观察结果，建议在怀疑 TRALI 时进行全血细胞计数和分类。对与 HLA II 类抗体输注相关的循环中性粒细胞减少机制的进一步研究可能会对 TRALI 的机制产生新的见解。
BACKGROUND: Transfusion-related acute lung injury (TRALI) is a rare but serious complication of blood transfusion. The syndrome is characterized by new acute lung injury developing during or within 6 hours of blood transfusion.STUDY DESIGN AND METHODS: The study design was observational in nature.RESULTS: All three cases of TRALI were associated with acute but transient decrease in the white blood cell (WBC) count. Implicated donors had HLA antibodies that matched the recipients' HLA antigens. The implicated units were a plateletpheresis in one case and fresh frozen plasma units in the other two. All implicated donors were multiparous women. The implicated antibody specificities were anti-HLA Class I and Class II in one case and anti-HLA Class II in the other two cases. Interestingly, patient neutrophil counts decreased by 80 to 90 percent in all three cases, including the two cases associated with HLA Class II antibodies.CONCLUSION: An acute and transient decrease in WBC count may be a previously underrecognized feature of TRALI. A drop in the neutrophil count can occur even when the implicated antibodies have specificities to HLA Class II antigens, although they are expressed only on stimulated neutrophils. Based on the observations in these cases, it is recommended that a complete blood count and differential be obtained when TRALI is suspected. Further investigations into the mechanisms of the decrease in circulating neutrophils that is associated with infusion of HLA Class II antibody may yield new insights into the mechanism of TRALI.