Aygun Banu, Padmanabhan Savitri, Paley Carole, Chandrasekaran Visalam
Division of Pediatric Hematology/Oncology, Schneider Children's Hospital, New Hyde Park, NY, USA.
Transfusion. 2002 Jan;42(1):37-43. doi: 10.1046/j.1537-2995.2002.00007.x.
The clinical significance of alloimmunization to RBC antigens in sickle cell patients was analyzed by a retrospective review of the records of pediatric and adult sickle cell patients who received transfusions and who were followed over a 10-year period.
Charts of pediatric and adult sickle cell patients followed at Schneider Children's Hospital (SCH) and Long Island Jewish Medical Center between 1989 and 1999 were retrieved. Patients followed at SCH were classified as pediatric, regardless of age. Data on transfusion history, alloimmunization, and transfusion reactions from 1990 were retrieved from computerized blood bank records. Transfusion history, development of alloantibodies and autoantibodies, and transfusion reactions were correlated with clinical evidence of hemolysis or other adverse reactions from the charts. All patients received ABO- and Rh-compatible blood transfusions for which a partial or extended antigen match was not performed.
Among pediatric patients, 29 percent developed clinically significant alloantibodies, and 8 percent developed autoantibodies. Seven patients developed delayed hemolytic and/or serologic transfusion reactions, two with hyperhemolysis, two with clinical evidence of hemolysis, and three with serologic evidence only. The two patients with hyperhemolysis had received extended antigen-matched RBC transfusions to provide blood compatible with their existing antibodies. Among adult patients, 47.0 percent developed significant alloantibodies, and 9.7 percent developed autoantibodies. Five incidences of delayed hemolytic and/or serologic transfusion reactions occurred, one with hyperhemolysis and four with serologic evidence only.
The alloimmunization rate is 29 percent in pediatric and 47 percent in adult sickle cell patients when partial or extended RBC antigen match is not performed. However, the delayed serologic and/or hemolytic transfusion reactions did not result in severe clinical outcome in most instances. The most important adverse event was hyperhemolysis, which may be triggered by a transfusion, but was not prevented by matching for RBC antigens. In most instances, the cause of hyperhemolysis was multifactorial.
通过回顾性分析接受输血并随访10年的儿童和成人镰状细胞病患者的记录，分析了红细胞抗原同种免疫在镰状细胞病患者中的临床意义。
检索1989年至1999年期间在施耐德儿童医院（SCH）和长岛犹太医疗中心随访的儿童和成人镰状细胞病患者的病历。在SCH随访的患者，无论年龄大小，均归类为儿童患者。从计算机化血库记录中检索1990年以来的输血史、同种免疫和输血反应数据。输血史、同种抗体和自身抗体的产生以及输血反应与病历中溶血或其他不良反应的临床证据相关。所有患者均接受ABO和Rh血型相合的输血，未进行部分或扩展抗原匹配。
在儿童患者中，29%产生了具有临床意义的同种抗体，8%产生了自身抗体。7名患者发生了迟发性溶血性和/或血清学输血反应，2例为高溶血，2例有溶血的临床证据，3例仅有血清学证据。两名高溶血患者接受了扩展抗原匹配的红细胞输血，以提供与其现有抗体相容的血液。在成人患者中，47.0%产生了显著的同种抗体，9.7%产生了自身抗体。发生了5例迟发性溶血性和/或血清学输血反应，1例为高溶血，4例仅有血清学证据。
当不进行部分或扩展红细胞抗原匹配时，儿童镰状细胞病患者的同种免疫率为29%，成人患者为47%。然而，在大多数情况下，迟发性血清学和/或溶血性输血反应并未导致严重的临床后果。最重要的不良事件是高溶血，它可能由输血引发，但红细胞抗原匹配并不能预防。在大多数情况下，高溶血的原因是多因素的。
