Brand Anneke
Leiden University Medical Center, Department of Immunohaematology and Blood Transfusion, Sanquin Foundation, The Netherlands.
Transpl Immunol. 2002 Aug;10(2-3):183-90. doi: 10.1016/s0966-3274(02)00064-3.
Almost all identified acute and/or severe immunological reactions towards blood transfusions, reported by surveillance systems such as SHOT (Severe Hazards of Transfusion) in the UK are mediated by allo-antibodies. In contrast, the clinical effects of transfusion-induced cellular immunity are virtually unknown. Although alterations in lymphocyte responses and natural killer cell functions after blood transfusion has been reported in many publications, the relevance of these in vitro assays for in vivo immunity are lacking. Even for clinically obvious immunomodulatory effect of blood transfusions, such as the mitigation of renal graft rejection, no uniform in vitro explanation has been identified. In the laboratory animal it has been shown that when two antigenic stimuli are given simultaneously, the response to one of these antigens is often decreased. Blood transfusions introduce a multitude of foreign antigens. Indeed, immunostimulation and suppression by blood transfusions have both been found. Systematic studies on immunological side-effects of blood transfusions are hardly available. Since the UK and France introduced a transfusion vigilance system, severe immunological side-effects such as haemolytic reactions, TRALI (acute lung injury), PTP (post-transfusion purpura) and graft vs. host disease are registrated in these countries and their incidence can be estimated based on the national number of transfusions. However, every blood transfusion interferes with the immune system of the recipient. The available evidence of harm from immune responses not leading to severe transfusion reactions will be discussed.
几乎所有已确认的、由诸如英国输血严重危害（SHOT）监测系统报告的针对输血的急性和/或严重免疫反应，都是由同种抗体介导的。相比之下，输血诱导的细胞免疫的临床效应实际上尚不清楚。尽管许多出版物都报道了输血后淋巴细胞反应和自然杀伤细胞功能的改变，但这些体外检测与体内免疫的相关性仍不明确。即使对于输血临床上明显的免疫调节作用，如减轻肾移植排斥反应，也尚未找到统一的体外解释。在实验动物中已经表明，当同时给予两种抗原刺激时，对其中一种抗原的反应通常会降低。输血会引入大量外来抗原。事实上，输血的免疫刺激和免疫抑制作用都已被发现。关于输血免疫副作用的系统性研究几乎没有。自从英国和法国引入输血警戒系统以来，这些国家对严重免疫副作用，如溶血反应、输血相关急性肺损伤（TRALI）、输血后紫癜（PTP）和移植物抗宿主病进行了登记，并且可以根据全国输血次数估计其发生率。然而，每次输血都会干扰受血者的免疫系统。本文将讨论未导致严重输血反应的免疫反应造成危害的现有证据。
