Castellino S M, Combs M R, Zimmerman S A, Issitt P D, Ware R E
Duke University Sickle Cell Program, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
Br J Haematol. 1999 Jan;104(1):189-94. doi: 10.1046/j.1365-2141.1999.01127.x.
The formation of erythrocyte autoantibodies following transfusion therapy has been described in case reports and small series. To determine the frequency, serological characteristics, and clinical significance of this phenomenon in paediatric patients with sickle cell disease, we analysed the patient database at the Duke University Pediatric Hematology Clinic. We identified children who received multiple erythrocyte transfusions, then reviewed clinical records to identify children who developed erythrocyte autoantibodies in association with transfusions. Among 184 paediatric patients who received multiple erythrocyte transfusions, 14 children (7.6%) developed warm (IgG) erythrocyte autoantibodies. Median transfusion exposure at the time of autoantibody formation was 24 erythrocyte units, range 3-341 units. The autoantibody reacted as a panagglutinin in 11 cases but had anti-e specificity in three patients. Surface complement also was detected in five patients. Clinically significant haemolysis was documented in four patients, each of whom had both surface IgG and C3 detected. The development of erythrocyte autoantibodies was associated with the presence of erythrocyte alloantibodies. Formation of warm erythrocyte autoantibodies in association with transfusions is not rare in paediatric patients with sickle cell disease. Clinicians should be aware of this complication and recognize that the presence of surface C3 is often associated with significant haemolysis.
病例报告和小规模系列研究中已描述了输血治疗后红细胞自身抗体的形成情况。为确定这种现象在镰状细胞病儿科患者中的发生率、血清学特征及临床意义，我们分析了杜克大学儿科血液学诊所的患者数据库。我们确定了接受多次红细胞输血的儿童，然后查阅临床记录以确定因输血而产生红细胞自身抗体的儿童。在184例接受多次红细胞输血的儿科患者中，14名儿童（7.6%）产生了温抗体型（IgG）红细胞自身抗体。自身抗体形成时的输血暴露中位数为24个红细胞单位，范围为3 - 341个单位。11例患者的自身抗体表现为全凝集素，但3例患者的自身抗体具有抗 - e特异性。5例患者还检测到表面补体。4例患者记录到具有临床意义的溶血，这4例患者均检测到表面IgG和C3。红细胞自身抗体的产生与红细胞同种抗体的存在有关。在镰状细胞病儿科患者中，与输血相关的温抗体型红细胞自身抗体的形成并不罕见。临床医生应意识到这种并发症，并认识到表面C3的存在通常与显著溶血相关。
