TRANSFUSION TRIAL TO PREVENT PLATELET ALLOIMMUNIZATION

同种异体免疫是难治性相关性的主要原因之一， 血小板输注疗法 这可能导致重大的 病态和道德 血小板不应性的管理通常是 没有效果;因此，预防血小板不应性是 更好。 已经尝试了几种方法来减少 血小板输注的同种异体免疫，包括使用：HLA匹配 血小板、单一供体血小板、白细胞缺乏血小板，以及 免疫抑制疗法，例如用免疫抑制剂治疗接受者， 环孢素或血小板输注紫外线治疗 辐照 尽管HLA I类抗体经常与 作为血小板不应性的原因，它们不能解释血小板不应性。 所有同种免疫患者的血小板应答。 只有相对 血小板特异性和/或药物依赖性 抗体在血小板难治性中的作用， 调查了他们在这个问题上的潜在作用。 年发现 1988年发现了新的血小板同种异体抗原，如Br a和巴克B， 万古霉素与血小板聚集的关系 耐火性强烈表明需要进行全面的测试， 分析来自难治性患者的血清中所有可能的抗血小板 抗体的 因此，建议进行调查，以减少 同种异体免疫和随后的血小板不应性的发生率， 通过使用单一供体减少供体暴露次数 血小板和红细胞中的白细胞已经耗尽。 二十- 每年将有4名新诊断的ANLL患者进入 随机试验 还建议制定一项敏感和 检测血小板不应性的特定实验室检查， 同种免疫 使用的测定包括单克隆抗体- 特异性抗原捕获ELISA，免疫荧光，蛋白A花环 形成、51 Cr释放和淋巴细胞毒性。

Alloimmunization is one of the major causes of refractoriness associated with platelet transfusion therapy. This can lead to significant morbidity and morality. Management of platelet refractoriness often is not effective; thus, prevention of platelet refractoriness is preferable. Several approaches have been attempted to reduce alloimmunization to platelet transfusion including use of: HLA matched platelets, single donor platelets, leukocyte-poor platelets, and immunosuppressive therapies, such as treatment of recipients with cyclosporine or transfusion of platelets treated with ultraviolet irradiation. Although HLA class I antibodies are frequently implicated as a cause of platelet refractoriness, they do not account for poor platelet responses in all alloimmunized patients. Only a relatively minor role has been ascribed to platelet-specific and/or drug-dependent antibodies in platelet refractoriness and no systematic study has investigated their potential role in this problem. The discovery in 1988 of new platelet alloantigens, such as Br a and Bak b, and the recent association of amphotericin B and vancomycin, with platelet refractoriness strongly suggest the need for a comprehensive test to analyze serum from refractory patients for all possible anti-platelet antibodies. Therefore, an investigation is proposed to reduce the incidence of alloimmunization and subsequent platelet refractoriness by reducing the number of donor exposures through use of single donor platelets and red cells that have been depleted of leukocytes. Twenty- four patients with newly diagnosed ANLL will be entered yearly in the randomized trial. It is further proposed to develop a sensitive and specific laboratory test to detect platelet refractoriness due to alloimmunization. The assays to be used include monoclonal antibody- specific antigen capture ELISA, immunofluorescence, protein A rosette formation, 51 Cr release and lymphocytotoxicity.