THE DIFFERENTIATION OF DELAYED SEROLOGIC AND DELAYED HEMOLYTIC TRANSFUSION REACTIONS - INCIDENCE, LONG-TERM SEROLOGIC FINDINGS, AND CLINICAL-SIGNIFICANCE
THE DIFFERENTIATION OF DELAYED SEROLOGIC AND DELAYED HEMOLYTIC TRANSFUSION REACTIONS - INCIDENCE, LONG-TERM SEROLOGIC FINDINGS, AND CLINICAL-SIGNIFICANCE
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DOI：
10.1046/j.1537-2995.1990.30891020325.x
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发表时间：
1990-10-01
期刊：
影响因子：
2.9
通讯作者：
BUCK, SA
中科院分区：
文献类型：
--
作者：
NESS, PM;SHIREY, RS;BUCK, SA
对大型三级医院延迟血清学输血反应（DSTRs）和延迟溶血性输血反应（DHTRs）进行了研究。DSTR的定义是输血后发现直接抗球蛋白试验（DAT）阳性和新开发的同种抗体特异性。DHTR被定义为表现出溶血的临床和/或实验室证据的DSTR病例。34例DSTR病例，其中70%是由抗- e和/或jka引起的，在20个月的时间内进行了前瞻性记录。对病历的回顾性分析发现34例患者中仅有6例（18%）有溶血的临床证据。因此，151例输血后样本可供检测的接受者中DSTR的发生率为1(0.66%)，而接受检测的854例患者中DHTR的发生率仅为1（0.12%）。34例患者中有15例在反应后随访174天。15例中仍有12例仅抗igg阳性。初步研究表明，DSTR或DHTR后DAT持续阳性可能涉及多种免疫机制，包括输血后自身抗体的产生。本研究表明1)DSTR是多次输血患者的常见发现，尽管大多数病例是良性的，不符合DHTR的严格标准；2)DHTR DSTR后持续阳性DAT是常见的。
Delayed serologic transfusion reactions (DSTRs) and delayed hemolytic transfusion reactions (DHTRs) were studied in large tertiary-care hospital. A DSTR was defined by the posttransfusion finding of a positive direct antiglobulin test (DAT) and a newly developed alloantibody specificity. A DHTR was defined as a DSTR case that showed clinical and/or laboratory evidence of hemolysis. Thirty-four cases of DSTR, 70 percent of which were due to ant-E and/or-JKa, were documented prospectively over a 20-month period. Retrospective review of the medical records found clinical evidence of hemolysis in only 6 (18%) of the 34. Thus, the incidence of DSTR was 1 (0.66%) of 151 recipients with posttransfusion samples available for testing, whereas the incidence of DHTR was only 1 (0.12%) of 854 patients tested. Fifteen of the 34 patients were followed for up to 174 days after reaction. Twelve of the 15 still demonstrated a positive DAT with anti-IgG only. Eluate studies indicated that the persistence of a positive DAT after DSTR or DHTR may involve several immunologic mechanisms, including the development of posttransfusion autoantibodies. This study indicates 1) that DSTRs are a frequent finding in multiply transfused patients, although most cases are benign and fail to meet rigid criteria for DHTR, and 2) that the persistence of a positive DAT after DSTR of DHTR is common.