Schonewille H, Haak H L, van Zijl A M
Department of Hematology, Leyenburg Hospital, The Hague, The Netherlands.
Transfusion. 1999 Jul;39(7):763-71. doi: 10.1046/j.1537-2995.1999.39070763.x.
Because of intensive marrow depression and improved survival, patients with hematologic and oncologic malignancies are dependent on transfusion for a longer period. It has been advocated that these patients should receive blood that is matched for blood group antigens other than ABO and D. A retrospective study was performed on the rate of alloimmunization against red cell antigens in 564 patients with malignant hematologic diseases over a period of 10 years.
Records of transfusion and immunohematologic studies of all patients (n = 1066) with malignant myeloproliferative and lymphoproliferative diseases diagnosed between 1987 and 1996 at one hospital were collected from the hospital computer blood bank files. Transfusions were correlated with antibody formation. Factors affecting this correlation were analyzed.
Seventy-one antibodies were found in 51 patients. The overall immunization rate was 9.0 percent. Fifty percent of antibodies were formed after 13 units had been transfused. Once a patient had formed an antibody, the probability of additional antibodies increased 3.3-fold. Anti-c, anti-E, and anti-K composed the majority of antibodies found. Four patients formed Rh system antibodies after incompatible platelet transfusions. Patients who underwent intensive chemotherapy formed antibodies at a much lower rate than other patients. More than 40 percent of antibodies became undetectable after the first detection. No difficulty was encountered in finding compatible blood for these patients.
Antibody formation in hematologic malignancies is comparable to that in other diseases requiring multiple blood transfusions. Extensive antigen matching before transfusion of patients with hematologic and oncologic malignancies is not necessary and leads to increased costs.
由于严重的骨髓抑制和生存期延长，血液系统和肿瘤性恶性疾病患者对输血的依赖期更长。有人主张这些患者应输注除ABO和D以外血型抗原相匹配的血液。对564例恶性血液病患者在10年期间红细胞抗原同种免疫发生率进行了一项回顾性研究。
从医院计算机血库档案中收集了1987年至1996年间在一家医院诊断的所有恶性骨髓增殖性和淋巴细胞增殖性疾病患者（n = 1066）的输血记录和免疫血液学研究资料。将输血情况与抗体形成相关联。分析影响这种关联的因素。
在51例患者中发现了71种抗体。总体免疫率为9.0%。50%的抗体在输注13单位血液后形成。一旦患者形成一种抗体，产生额外抗体的概率增加3.3倍。发现的抗体中抗-c、抗-E和抗-K占大多数。4例患者在输注不相容血小板后形成了Rh系统抗体。接受强化化疗的患者形成抗体的发生率远低于其他患者。超过40%的抗体在首次检测后无法检测到。为这些患者找到相容血液未遇到困难。
血液系统恶性疾病中的抗体形成与其他需要多次输血的疾病相当。对血液系统和肿瘤性恶性疾病患者输血前进行广泛的抗原匹配没有必要，且会增加成本。
