Kruskall M S, AuBuchon J P, Anthony K Y, Herschel L, Pickard C, Biehl R, Horowitz M, Brambilla D J, Popovsky M A
Departments of Pathology and Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Transfusion. 2000 Nov;40(11):1290-8. doi: 10.1046/j.1537-2995.2000.40111290.x.
The transfusion of ABO-incompatible RBCs is the leading cause of fatal transfusion reactions. Group O RBCs, lacking terminal immunodominant A and B sugars to which humans are immunized, are safe for transfusion to persons of any ABO blood group. With the use of a recombinant alpha-galactosidase to remove terminal galactose from group B RBCs, the safety and efficacy of enzyme-converted group-B-to-group-O (ECO) RBC components were studied in transfusion-dependent patients.
Twenty-four patients (blood groups A and O) were randomly assigned to receive transfusion(s) of either ECO or control group O RBCs. If a second transfusion was given, the other blood component was administered.
Twenty-one patients were given ECO RBCs; 18 also underwent control transfusions. One patient received only a small aliquot for RBC survival studies, instead of a full-unit transfusion, because his serum was incompatible with ECO RBCs. No adverse events occurred. Both ECO and control transfusions resulted in appropriate Hb increments and comparable (51)Cr-labeled RBC survival studies. One patient developed a transient, weak-positive DAT, without hemolysis. Two weeks after transfusion, 5 of 19 evaluable ECO RBC recipients had increases in anti-B titers.
ECO RBCs were comparable to group O cells for safety and efficacy in this study. The clinical significance of the increase in anti-B and of occasional serologic incompatibilities with ECO RBCs is unclear. If strategies can be developed to remove A epitopes, enzymatic conversion could be used to create a universal (group O) donor blood supply.
输注ABO血型不相容的红细胞是致命输血反应的主要原因。O型红细胞缺乏人类会产生免疫反应的末端免疫显性A和B糖类，对任何ABO血型的人进行输血都是安全的。通过使用重组α-半乳糖苷酶去除B型红细胞上的末端半乳糖，对依赖输血的患者研究了酶转化的B型转O型（ECO）红细胞成分的安全性和有效性。
24例患者（A血型和O血型）被随机分配接受ECO或对照O型红细胞输血。如果进行第二次输血，则给予另一种血液成分。
21例患者接受了ECO红细胞输血；其中18例还接受了对照输血。1例患者仅接受了一小份用于红细胞存活研究的样本，而不是全单位输血，因为他的血清与ECO红细胞不相容。未发生不良事件。ECO输血和对照输血均导致血红蛋白适当增加，且（51）Cr标记的红细胞存活研究结果相当。1例患者出现短暂的弱阳性直接抗球蛋白试验（DAT），无溶血现象。输血两周后，19例可评估的ECO红细胞接受者中有5例抗B效价升高。
在本研究中，ECO红细胞在安全性和有效性方面与O型细胞相当。抗B效价升高以及偶尔与ECO红细胞出现血清学不相容的临床意义尚不清楚。如果能够开发出去除A抗原决定簇的策略，酶转化可用于创建通用的（O型）供血。
