Laine E P, Leger R M, Arndt P A, Calhoun L, Garratty G, Petz L D
Research Department, American Red Cross Blood Services, Southern California Region, Los Angeles, California 90006, USA.
Transfusion. 2000 Nov;40(11):1384-7. doi: 10.1046/j.1537-2995.2000.40111384.x.
In a patient with warm autoantibodies who has recently received a transfusion, it is not recommended to perform adsorptions using autologous RBCs to detect alloantibodies. Although not scientifically documented, this position is based on the theory that transfused RBCs in the patient's circulation would be capable of adsorbing alloantibodies that may be present. This in vitro study was designed to determine what percentage of transfused RBCs might completely remove alloantibodies in vivo.
Selected D, E, K, Fy(a), and Jk(a) antibodies were adsorbed with mixtures of antigen-positive and antigen-negative RBCs to determine the lowest concentration of antigen-positive RBCs capable of removing all alloantibody reactivity. The percentage of antigen-positive RBCs in each mixture was determined by flow cytometry.
Small amounts of antigen-positive RBCs (2-6%, as determined by flow cytometry) completely removed anti-D, -E, and -Fy(a) reactivity. Reactivity of two examples of anti-K was removed by 11 percent and 17 percent of K+ RBCs, respectively. Anti-Jk(a) reactivity was completely removed by 4 to 5 percent Jk(a+) RBCs using a PEG adsorption; the endpoint (>11%) was estimated, but complete adsorption with ZZAP-treated RBCs was not performed.
Small amounts of antigen-positive RBCs are generally capable of removing all alloantibody reactivity. Thus, waiting for 3 months after transfusion before performing autologous adsorptions is a prudent policy.
对于近期接受过输血的伴有温自身抗体的患者，不建议使用自身红细胞进行吸附以检测同种抗体。尽管尚无科学文献记载，但这一观点基于这样的理论，即患者循环中的输血红细胞能够吸附可能存在的同种抗体。这项体外研究旨在确定输血红细胞在体内能完全清除同种抗体的比例。
选用D、E、K、Fy(a)和Jk(a)抗体，用抗原阳性和抗原阴性红细胞的混合物进行吸附，以确定能够消除所有同种抗体反应性的抗原阳性红细胞的最低浓度。通过流式细胞术测定每种混合物中抗原阳性红细胞的比例。
少量抗原阳性红细胞（通过流式细胞术测定为2% - 6%）能完全消除抗-D、-E和-Fy(a)的反应性。两例抗-K的反应性分别被11%和17%的K +红细胞消除。使用聚乙二醇吸附时，4% - 5%的Jk(a+)红细胞可完全消除抗-Jk(a)的反应性；终点（>11%）是估算得出的，且未用ZZAP处理的红细胞进行完全吸附。
少量抗原阳性红细胞通常能够消除所有同种抗体反应性。因此，输血后等待3个月再进行自身吸附是一项审慎的策略。
