Julmy Friedgard, Ammann Roland A, Taleghani Behrouz Mansouri, Fontana Stefano, Hirt Andreas, Leibundgut Kurt
Department of Pediatrics, University of Berne, Berne, Switzerland.
Transfusion. 2009 Jan;49(1):21-33. doi: 10.1111/j.1537-2995.2008.01914.x. Epub 2008 Sep 4.
ABO major compatibility is essential in transfusions of red blood cells but is not requisite in PLT transfusions. In adults there is some evidence that transfusion efficacy of ABO blood group-identical platelets (PLTs) is superior to major-mismatched PLTs. However, in children this question has not been investigated for more than 30 years.
In a prospective study, the efficacy (based on the 1-hour percentage of PLT recovery [PPR(1hr)]) of 400 eligible ABO blood group-identical or out-of-group apheresis PLT concentrates (APCs), transfused mainly prophylactically to 50 children with hematologic malignancies, solid tumors, or aplastic anemia was investigated. The primary objective was to compare PPR(1hr) between ABO-identical and major-mismatched transfusions.
After ABO major-mismatched transfusions, PPR(1hr) was significantly lower than after ABO blood group-identical transfusions (median 21% vs. 32%; p = 0.034). Multivariate analysis showed major-mismatched transfusions to be significantly more often unsuccessful than identical transfusions (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.52-10.39; p = 0.005). Using flow cytometry and fluorescent microscopy, it could be demonstrated that PLTs of subgroup A(1), significantly expressing A antigen on their surface, were rapidly cleared from the circulation of group O or B recipients. In contrast, major-mismatched transfusions of A(2) PLTs, expressing no detectable A antigen, were as successful as identical transfusions (OR, 1.13; 95% CI, 0.16-7.88; p = 0.90).
These data clearly indicate that in children ABO major-mismatched PLT transfusions result in inferior transfusion efficacy, with the only exception of group A(2) PLTs. ABO minor-mismatched PLTs showed comparable efficacy to identical transfusions.
ABO血型主要相容性在红细胞输血中至关重要，但在血小板输血中并非必需。在成人中，有一些证据表明ABO血型相同的血小板（PLT）的输血效果优于主要不匹配的血小板。然而，在儿童中，这个问题已经有30多年没有进行过研究了。
在一项前瞻性研究中，对400份符合条件的ABO血型相同或血型不合的单采血小板浓缩物（APC）的疗效（基于1小时血小板回收率[PPR(1hr)]百分比）进行了研究，这些血小板主要预防性地输给了50名患有血液系统恶性肿瘤、实体瘤或再生障碍性贫血的儿童。主要目的是比较ABO血型相同和主要不匹配输血之间的PPR(1hr)。
ABO主要不匹配输血后，PPR(1hr)显著低于ABO血型相同输血后（中位数21%对32%；p = 0.034）。多变量分析显示，主要不匹配输血比相同输血明显更常不成功（优势比[OR]，3.97；95%置信区间[CI]，1.52 - 10.39；p = 0.005）。使用流式细胞术和荧光显微镜可以证明，A(1)亚组的血小板在其表面显著表达A抗原，会从O型或B型受者的循环中迅速清除。相比之下，不表达可检测到的A抗原的A(2)血小板的主要不匹配输血与相同输血一样成功（OR，1.13；95% CI，0.16 - 7.88；p = 0.90）。
这些数据清楚地表明，在儿童中，除了A(2)血小板外，ABO主要不匹配的血小板输血导致输血效果较差。ABO次要不匹配的血小板显示出与相同输血相当的疗效。
