Lee Tzong-Hae, Paglieroni Teresa, Utter Garth H, Chafets Daniel, Gosselin Robert C, Reed William, Owings John T, Holland Paul V, Busch Michael P
Blood Systems Research Institute, Department of Pathology, University of California, Davis, California 94118, USA.
Transfusion. 2005 Aug;45(8):1280-90. doi: 10.1111/j.1537-2995.2005.00201.x.
Long-term white blood cell (WBC) microchimerism (MC), of at least 2 years, has been reported in trauma patients receiving fresh nonleukoreduced (non-LR) blood. It is unknown, however, whether this occurs with LR blood products that are nearly devoid of WBCs. Twenty-seven patients transfused with LR and non-LR blood products were studied after severe traumatic injury. A secondary aim was to explore donor-recipient mixed lymphocyte reactivity in vitro.
To quantify MC, allele-specific real-time polymerase chain reaction assays were developed targeting HLA Class II sequence polymorphisms. Extensive validation showed that these assays reliably detect a single copy of target sequence in a complex allogeneic background without false positivity.
At a median follow-up of 26 months (range, 24-39 months), long-term MC was observed in 3 of 20 patients (15%) who received non-LR blood products and 2 of 7 (29%) who received LR blood products. The maximum MC ranged from 0.40 to 4.90 percent of circulating WBCs and appeared, by Class II genotype analysis, to be attributable to a single donor.
It is concluded that robust levels of long-term MC, apparently traceable to a single donor, occur at similar frequency despite leukoreduction of transfused blood products. Exploratory analysis of donor-recipient mixed lymphocyte reactivity suggests that long-term MC may require a state of bidirectional tolerance before transfusion.
据报道，接受新鲜非白细胞滤除（非LR）血液的创伤患者存在至少2年的长期白细胞（WBC）微嵌合体（MC）现象。然而，尚不清楚这种情况是否会发生在几乎不含白细胞的LR血液制品中。对27例输注LR和非LR血液制品的严重创伤患者进行了研究。次要目的是在体外探索供体-受体混合淋巴细胞反应性。
为了定量MC，开发了针对HLA II类序列多态性的等位基因特异性实时聚合酶链反应检测方法。广泛的验证表明，这些检测方法能够在复杂的异基因背景中可靠地检测到单拷贝的靶序列，且无假阳性。
在中位随访26个月（范围24 - 39个月）时，接受非LR血液制品的20例患者中有3例（15%）观察到长期MC，接受LR血液制品的7例患者中有2例（29%）观察到长期MC。最大MC范围为循环白细胞的0.40%至4.90%，通过II类基因型分析，似乎可归因于单一供体。
得出的结论是，尽管输注的血液制品经过白细胞滤除，但仍会以相似的频率出现明显可追溯至单一供体的高水平长期MC。对供体-受体混合淋巴细胞反应性的探索性分析表明，长期MC可能需要在输血前处于双向耐受状态。
