Rottenberg Yakir, Yahalom Vered, Shinar Eilat, Barchana Micha, Adler Bella, Paltiel Ora
Department of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Transfusion. 2009 May;49(5):838-42. doi: 10.1111/j.1537-2995.2008.02054.x. Epub 2009 Jan 2.
Positive direct antiglobulin tests (DATs) have been associated with both autoimmunity and lymphoproliferative disorders. However, it is unknown whether DAT+ in healthy blood donors is associated with an increased risk of malignancies.
In the current study, all blood donors with DAT+ samples were identified during the years 1999 through 2003 through the Magen David Adom National Blood Services in Israel. This study compared the risk of cancer among 586 DAT+ and 2344 DAT- donors who were matched according to sex, age, and year of donation. The risk of cancer in DAT+ donors was also compared to expected rates in the general Israeli population. Cancer was ascertained through the Israel Cancer Registry.
Malignancies occurred among 17 (2.9%) of the DAT+ and 27 (1.2%) of the DAT- blood donors; of these, 3 donors in the DAT+ group were diagnosed with hematopoietic malignancies within 12 months of their donation. Even after excluding these early cases, the relative risk of developing cancer was 2.14 (95% confidence interval [CI], 1.13-4.10) comparing DAT+ with DAT- donors, while the relative risk for hematopoietic cancer was 8.3 (95% CI, 1.5-43.2). Comparing DAT+ blood donors with the general population, the standardized incidence ratios (observed/expected cases) were elevated at 2.11 (95% CI, 1.15-3.54; p = 0.16) for all malignancies and 8.03 (95% CI, 2.2-20.6; p = 0.003) for hematologic malignancies.
There is evidence of a significantly increased risk of cancer, especially hematologic malignancies, among blood donors with a positive DAT even within a short follow-up period.
直接抗球蛋白试验（DAT）阳性与自身免疫和淋巴增殖性疾病均有关联。然而，健康献血者中DAT阳性是否与恶性肿瘤风险增加相关尚不清楚。
在本研究中，通过以色列马根大卫·阿多姆国家血液服务中心，确定了1999年至2003年间所有DAT阳性样本的献血者。本研究比较了586名DAT阳性和2344名DAT阴性献血者的癌症风险，这些献血者根据性别、年龄和献血年份进行了匹配。DAT阳性献血者的癌症风险也与以色列普通人群的预期发病率进行了比较。癌症通过以色列癌症登记处确定。
DAT阳性献血者中有17人（2.9%）发生恶性肿瘤，DAT阴性献血者中有27人（1.2%）发生恶性肿瘤；其中，DAT阳性组有3名献血者在献血后12个月内被诊断为造血系统恶性肿瘤。即使排除这些早期病例，DAT阳性与DAT阴性献血者相比，患癌的相对风险为2.14（95%置信区间[CI]，1.13 - 4.10），而造血系统癌症的相对风险为8.3（95%CI，1.5 - 43.2）。将DAT阳性献血者与普通人群进行比较，所有恶性肿瘤的标准化发病比（观察到的/预期的病例数）为2.11（95%CI，1.15 - 3.54；p = 0.16），血液系统恶性肿瘤为8.03（95%CI，2.2 - 20.6；p = 0.003）。
有证据表明，即使在短时间随访期内，DAT阳性的献血者患癌风险，尤其是血液系统恶性肿瘤的风险显著增加。
