Pamphilon D H
South-western Regional Transfusion Centre, Bristol, UK.
Blood Coagul Fibrinolysis. 1992 Oct;3(5):651-4.
Refractoriness occurs in a proportion of patients who receive multiple platelet transfusions. Alloantibodies, in particular those directed against the class I human leucocyte antigens (HLA) present on the platelet surface, are frequently associated with accelerated platelet destruction and transfusion failure. Compatible platelets for transfusion may be found by selecting donations from HLA-typed individuals, crossmatching patients' sera against donor lymphocytes and platelets or both. Maintaining a large panel of HLA-typed apheresis donors is expensive and some mismatching is inevitable due to the polymorphic nature of the HLA system. Cross-matching may improve the outcome when HLA-matched donations are transfused and may also be a cost-effective strategy for the selection of compatible untyped platelets. Administration of intravenous immunoglobulin, plasma exchange and ex vivo removal of platelet HLA have been employed successfully in a few refractory alloimmunized patients but do not yet have an established role. Experimental studies in animal models suggest that it may be possible to induce tolerance to HLA and prevent alloimmunization.
一部分接受多次血小板输注的患者会出现输注无效的情况。同种抗体，尤其是那些针对血小板表面存在的I类人类白细胞抗原（HLA）的抗体，常常与血小板加速破坏和输血失败有关。通过从HLA分型个体中选择献血、将患者血清与供体淋巴细胞和血小板或两者进行交叉配型，可以找到相容的血小板用于输血。维持大量HLA分型的单采献血者成本高昂，并且由于HLA系统的多态性，一些不匹配情况不可避免。当输注HLA匹配的献血时，交叉配型可能会改善结果，并且对于选择相容的未分型血小板来说，交叉配型也可能是一种具有成本效益的策略。静脉注射免疫球蛋白、血浆置换以及体外去除血小板HLA已在少数难治性同种免疫患者中成功应用，但尚未确立其作用。动物模型的实验研究表明，诱导对HLA的耐受性并预防同种免疫可能是可行的。
