Fontão-Wendel R, Silva L C N, Saviolo C B R, Primavera B, Wendel S
Banco de Sangue, Hospital Sírio Libanês, São Paulo, SP, Brazil.
Vox Sang. 2007 Oct;93(3):241-9. doi: 10.1111/j.1423-0410.2007.00958.x.
The aim of this work was to study the incidence of transfusion-induced platelet-reactive antibodies in a selective patient population and evaluate different methodologies for platelet antibody screening (PAS).
The patients were retrospectively selected and divided into three separate groups: haematological malignancies (Group 1: n = 33); cardiac and orthopaedic patients (Group 2: n = 31) and a control group (Group 3: n = 23) selected with the same diagnoses of Group 2. PRE- and POST-transfusion samples were tested for PAS by the following tests: PIFT (platelet immunofluorescence test), MAIPA (monoclonal antibody immobilization of platelet antigen), Flow PRA(R) and LCT (lymphocytotoxicity test).
There was not a 100% concordance among the methodologies used. PIFT, MAIPA and Flow PRA presented very similar results whereas that of LCT differed from the other methods. A high rate of positive results (32%) was found in the PRE samples followed by an increase of almost 50% after blood transfusion (POST samples: 42.5% of positivity), but there was a statistical difference (P < 0.05) between the PRE and POST transfusion sample only for the Flow PRA(R) technique tested on Group 2. Human leucocyte antigen (HLA) class I antibodies were present on 97.4% of POST positive samples, 5.4% presented anti-human platelet antigen (HPA)-1b antibodies and 8.1% presented a mix of pan-reactive antibodies against glycoprotein IIbIIIa, IaIIa and IbIX.
Blood transfusion did not increase the rate of alloimmunization in our haematological patients (Group 1); however, the patients were already admitted with a high rate of alloimmunization (12%). Group 2 patients are being immunized and the impact of this procedure remains to be studied as these patients may eventually undergo further hospitalization and receive more blood transfusion.
本研究旨在探讨特定患者群体中输血诱导的血小板反应性抗体的发生率，并评估血小板抗体筛查（PAS）的不同方法。
回顾性选取患者并分为三组：血液系统恶性肿瘤患者（第1组：n = 33）；心脏和骨科患者（第2组：n = 31）以及与第2组诊断相同的对照组（第3组：n = 23）。输血前和输血后的样本通过以下检测进行PAS检测：血小板免疫荧光试验（PIFT）、血小板抗原单克隆抗体固定试验（MAIPA）、流式细胞仪检测群体反应性抗体（Flow PRA）和淋巴细胞毒性试验（LCT）。
所使用的方法之间并非100%一致。PIFT、MAIPA和Flow PRA呈现出非常相似的结果，而LCT的结果与其他方法不同。输血前样本中发现较高的阳性率（32%），输血后阳性率几乎增加了50%（输血后样本：阳性率为42.5%），但仅在对第2组进行检测的Flow PRA技术中，输血前和输血后样本之间存在统计学差异（P < 0.05）。97.4%的输血后阳性样本中存在人类白细胞抗原（HLA）I类抗体，5.4%呈现抗人血小板抗原（HPA）-1b抗体，8.1%呈现针对糖蛋白IIbIIIa、IaIIa和IbIX的泛反应性抗体混合物。
输血并未增加我们血液系统患者（第1组）的同种免疫率；然而，这些患者入院时同种免疫率就很高（12%）。第2组患者正在发生免疫反应，由于这些患者最终可能需要进一步住院并接受更多输血，该过程的影响仍有待研究。
