O'Connell B A, Lee E J, Rothko K, Hussein M A, Schiffer C A
Division of Hematologic Malignancies, University of Maryland Cancer Center, Baltimore 21201.
Blood. 1992 Jan 15;79(2):527-31.
It can be impossible to identify compatible platelet donors for alloimmunized patients whose HLA type cannot be determined or who have uncommon HLA types. We have previously shown that histocompatible donors can be rapidly identified by "mass screening" of platelet concentrates (PC), which are readily available in all blood banks, using a solid-phase adherence platelet cross-matching technique. Compatible PC were given to five alloimmunized patients with multispecific HLA antibodies refractory to random donor (RD) PC and selected single-donor platelet transfusions. After transfusions which produced satisfactory responses, we identified the original whole blood donors to serve as apheresis donors. Thus, the donors selected were compatible in vitro by cross-matching, and in vivo by transfusion. Only 3% to 13% of PC cross-matched for these alloimmunized patients were potentially compatible and it was necessary to screen large numbers (65 to 205 U) of PC per patient. Eighteen of 22 PC-selected transfusions produced satisfactory increments, allowing selection of 12 donors, all of whom were willing to undergo apheresis. Ten of 12 of these single-donor transfusions were successful; the two unsuccessful transfusions were infused 2 weeks after the initial PC cross-match and were still compatible with the original serum, but incompatible with more recent serum, demonstrating a change in antibody reactivity. The HLA types of the successful single donors selected by PC cross-matching differed widely from the patients' HLA types and, therefore, these donors would not have been selected by standard approaches using HLA typing. Cross-matching large numbers of RD PC for the identification of apheresis donors is helpful in the management of the alloimmunized patient and may be of particular utility for blood centers that do not have access to HLA-typed donor pools.
对于那些无法确定HLA类型或具有罕见HLA类型的同种免疫患者，可能无法找到相容的血小板供体。我们之前已经表明，通过使用固相黏附血小板交叉配型技术对血小板浓缩物（PC）进行“大规模筛查”，可以快速识别组织相容性供体，而血小板浓缩物在所有血库中都很容易获得。将相容的PC输给了5名同种免疫患者，这些患者对随机供体（RD）PC和选定的单供体血小板输注产生了多特异性HLA抗体且难以耐受。在输注产生满意反应后，我们确定了最初的全血供体作为单采供体。因此，所选的供体在体外通过交叉配型是相容的，在体内通过输血也是相容的。对于这些同种免疫患者，交叉配型的PC中只有3%至13%可能相容，每位患者有必要筛查大量（65至205单位）的PC。22次PC选择的输注中有18次产生了满意的血小板增量，从而能够选择12名供体，所有这些供体都愿意接受单采。这12次单供体输注中有10次成功；两次未成功的输注是在最初的PC交叉配型2周后进行的，它们仍与原始血清相容，但与更新的血清不相容，这表明抗体反应性发生了变化。通过PC交叉配型选择的成功单供体的HLA类型与患者的HLA类型有很大差异，因此，使用HLA分型的标准方法不会选择这些供体。对大量RD PC进行交叉配型以识别单采供体，有助于同种免疫患者的管理，对于无法获取HLA分型供体库的血库可能特别有用。
