Blood Systems Research Institute, San Francisco, California 85282, USA.
Transfusion. 2010 Aug;50(8):1749-60. doi: 10.1111/j.1537-2995.2010.02589.x. Epub 2010 Feb 11.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. Blood centers are implementing TRALI risk reduction strategies based on screening apheresis donors for antibodies to human leukocyte antigens (HLA).
HLA antibody screening was performed on 7920 blood donors from the Leukocyte Antibody Prevalence Study (LAPS) using Luminex-based normalized background (NBG) cutoff ratios of 10.8 (Class I) and 6.9 (Class II). Single antigen bead (SAB) assay cutoffs of 2500 median fluorescence intensity units (Class I) and 1500 (Class II) were established based on results of two subpopulations of LAPS donors. Antibody frequencies against HLA A, B, C, DR, DQ, and DP antigens were determined for screen-reactive donors with prior pregnancies.
SAB reactivity for samples above our multiantigen bead NBG cutoffs was 78% for Class I and 79% for Class II. The SAB-positive rate increased among women with zero to four or more pregnancies (0.3%-15.6% Class I and 0.4%-18% Class II; p < 0.00001). The highest frequency antibodies were DR11 and B15 (4.4% of women with prior pregnancies). The majority of Class I positives contained more than five specificities. For Class II, antibody-positive women segregated into two groups: a single specificity or more than five specificities.
Identification of HLA antigen specificities supports pregnancy associations previously found with screening assays. The significance of particular HLA specificities for inducing TRALI is currently being evaluated in a large lookback study of recipients of high-plasma-volume components from this donor cohort.
输血相关性急性肺损伤（TRALI）是输血相关死亡的主要原因。血液中心正在基于对单采献血者的人白细胞抗原（HLA）抗体筛查，实施 TRALI 降低风险策略。
使用基于 Luminex 的归一化背景（NBG）截断比值 10.8（I 类）和 6.9（II 类），对来自白细胞抗体流行率研究（LAPS）的 7920 名献血者进行 HLA 抗体筛查。基于 LAPS 献血者两个亚群的结果，建立了单抗原珠（SAB）检测的截断值，即 2500 中位荧光强度单位（I 类）和 1500（II 类）。对于有既往妊娠的筛查反应性献血者，确定了针对 HLA A、B、C、DR、DQ 和 DP 抗原的抗体频率。
多抗原珠 NBG 截断值以上的 SAB 反应性样本的阳性率为 I 类 78%，II 类 79%。SAB 阳性率随着女性妊娠次数从 0 次到 4 次或更多次增加（I 类 0.3%-15.6%，II 类 0.4%-18%；p<0.00001）。最常见的抗体是 DR11 和 B15（4.4%有既往妊娠的女性）。大多数 I 类阳性者包含超过五种特异性。对于 II 类，抗体阳性的女性可分为两组：一种特异性或五种以上特异性。
HLA 抗原特异性的鉴定支持以前在筛查检测中发现的与妊娠相关的结果。目前，正在对来自该献血者队列的高血浆容量成分受者进行的大型回溯研究中，评估特定 HLA 特异性引发 TRALI 的意义。
