Castro Oswaldo, Sandler S Gerald, Houston-Yu Patricia, Rana Sohail
Department of Internal Meidicine, Howard University College of Medicine, Washington, DC, USA.
Transfusion. 2002 Jun;42(6):684-90. doi: 10.1046/j.1537-2995.2002.00126.x.
Transfusing only phenotype-matched RBCs has been recommended to reduce the incidence of alloimmunization to blood group antigens in patients with sickle cell disease (SCD).
The expected benefit of phenotype matching was determined by identifying which of the existing blood group alloantibodies in patients with SCD who received conventional transfusions would not have been formed if they had received only phenotype-matched RBCs. By use of each patient's alloantibodies as a baseline, it was possible to identify specific alloantibodies that would not have been formed if each of five different phenotype-matching protocols had been used.
During a 12-year period, 351 patients received transfusions with 8939 units of ABO- and D-matched RBCs. Of these, 102 patients (29.1%) formed at least one blood group alloantibody. An additional 35 patients with SCD with alloantibodies were identified by reviewing clinical records, yielding a total of 137 alloimmunized patients for inclusion in this study. If all transfusions had been selected by limited phenotype matching (C, c, E, e, and K, as well as for ABO and D), all alloantibodies would have been prevented for more than half (53.3%) of the 137 alloimmunized patients. If all transfusions had been matched for C, c, E, e, K, S, Fya, and Jkb, all antibodies would have been prevented for 70.8 percent of the 137 alloimmunized patients. Approximately 13.6 percent of random white blood donors would be expected to match a limited phenotype-matching protocol, whereas only 0.6 percent would match an extended phenotype-matching protocol.
Limited phenotype matching would have prevented all alloantibodies in 53.3 percent of the patients who formed alloantibodies. This protocol requires RBCs that are readily available. Extended phenotype matching would have prevented alloimmunization in 70.8 percent of patients who formed alloantibodies. However, this would require phenotypes that are 22.7 times less prevalent among random blood donors and is therefore impractical for a long-term strategy.
建议仅输注血型匹配的红细胞以降低镰状细胞病（SCD）患者对血型抗原产生同种免疫的发生率。
通过确定接受常规输血的SCD患者中，如果仅接受血型匹配的红细胞，哪些现有的血型同种抗体不会形成，来确定血型匹配的预期益处。以每位患者的同种抗体为基线，若采用五种不同的血型匹配方案中的每一种，就有可能确定不会形成的特定同种抗体。
在12年期间，351例患者接受了8939单位ABO和D匹配的红细胞输注。其中，102例患者（29.1%）形成了至少一种血型同种抗体。通过查阅临床记录又发现了另外35例有同种抗体的SCD患者，共计137例同种免疫患者纳入本研究。如果所有输血都通过有限血型匹配（C、c、E、e、K以及ABO和D）来选择，那么137例同种免疫患者中超过一半（53.3%）的所有同种抗体都可避免产生。如果所有输血都进行C、c、E、e、K、S、Fya和Jkb匹配，那么137例同种免疫患者中70.8%的所有抗体都可避免产生。预计约13.6%的随机白人献血者能匹配有限血型匹配方案，而只有0.6%能匹配扩展血型匹配方案。
有限血型匹配可避免53.3%形成同种抗体的患者产生所有同种抗体。该方案所需的红细胞易于获取。扩展血型匹配可避免70.8%形成同种抗体的患者发生同种免疫。然而，这需要在随机献血者中发生率低22.7倍的血型，因此作为长期策略不切实际。
