Nishizawa Masatoshi, Hirayama Fumiya, Matsuyama Nobuki, Tada Kohei, Kaneko Hitomi, Watanabe Mitsumasa, Miura Yasuo, Tsudo Mitsuru
Department of Hematology, Osaka Red Cross Hospital.
Rinsho Ketsueki. 2009 Jan;50(1):16-22.
We report a fatal case of transfusion-related acute lung injury (TRALI) with anti-leukocyte antibodies detected both in the patient's serum and in the causative red cell concentrate (RC-M.A.P). A 41-year-old Japanese woman diagnosed as having acute myeloid leukemia (AML, M2) developed TRALI caused by RC-M.A.P 15 days after the start of induction therapy for AML. Although we conducted intratracheal intubation, positive end-expiratory pressure ventilation, and steroid pulse therapy, she died 3 days after the onset of TRALI. We detected anti-human leukocyte antigen (HLA) class I antibody and anti-HLA class II antibody in the patient's serum and anti-neutrophil antibody in the RC-M.A.P, using the newly developed immunofluorescence tests with high specificity and low background interference. We assume that these anti-leukocyte antibodies were responsible for TRALI via an immune-mediated mechanism.
我们报告了一例与输血相关的急性肺损伤（TRALI）致死病例，在患者血清和致病红细胞浓缩物（RC-M.A.P）中均检测到抗白细胞抗体。一名41岁被诊断为急性髓细胞白血病（AML，M2型）的日本女性，在AML诱导治疗开始15天后，因RC-M.A.P引发了TRALI。尽管我们进行了气管插管、呼气末正压通气和类固醇冲击治疗，但她在TRALI发病3天后死亡。我们使用新开发的具有高特异性和低背景干扰的免疫荧光试验，在患者血清中检测到抗人类白细胞抗原（HLA）I类抗体和抗HLA II类抗体，在RC-M.A.P中检测到抗中性粒细胞抗体。我们推测这些抗白细胞抗体通过免疫介导机制导致了TRALI。
