American Red Cross, Penn-Jersey Region, Philadelphia, Pennsylvania 19123, USA.
Transfusion. 2010 Aug;50(8):1766-77. doi: 10.1111/j.1537-2995.2010.02626.x. Epub 2010 Mar 12.
Efforts to minimize white blood cell alloantibodies, responsible for transfusion-related acute lung injury (TRALI) in components with high-volume single-donor plasma include consideration of plateletpheresis donor screening for human leukocyte antigen (HLA) antibodies. High-throughput screening platforms make this feasible for large blood centers. Which platform to use, donor subgroups to screen, characteristics of detected antibodies, and operational impact of deferring reactive donors are important questions.
We screened 2462 plateletpheresis donor sera for HLA antibodies on automated instruments using HLA Class I and II enzyme-linked immunosorbent assays (ELISA) or a mixed Class I/II Luminex flow analyzer. Screen-reactive samples were further tested by manual Luminex single-antigen assay to determine antibody specificity, estimated corresponding antigen frequency, and signal strength.
Alloexposed females had the highest reactivity rate on both platforms (21.0%), with much lower rates for nonexposed individuals or transfused males (1.4%-5.4%). Increasing parity and more recent pregnancy increased their likelihood of screen reactivity. Deferring screen-reactive parous females would result in at least a 4.8% plateletpheresis donor base decrement. Supplemental testing showed higher rates of nonspecific or natural antibodies in ELISA screen-reactive alloexposed females (2.5%) than Luminex (0%). Both assays were more likely to identify antibodies directed against a larger number of HLA antigens and/or of presumed higher titer in alloexposed donors.
A strategy screening only parous female donors is reasonable. Both automated HLA antibody detection platforms are easy to use and preferentially identify alloexposed individuals with antibodies of presumed higher titer directed against more recipient HLA antigens.
为了减少导致输血相关急性肺损伤（TRALI）的白细胞同种抗体，在含有大量单供体血浆的成分中，可以考虑对血小板单采供体进行人类白细胞抗原（HLA）抗体筛查。高通量筛选平台使大型血库能够实现这一目标。选择使用哪种平台、筛选哪些供体亚组、检测到的抗体特征以及推迟反应性供体的操作影响，都是重要的问题。
我们使用 HLA Ⅰ类和Ⅱ类酶联免疫吸附试验（ELISA）或混合 HLA Ⅰ/Ⅱ Luminex 流式细胞分析仪，在自动化仪器上对 2462 份血小板单采供体血清进行 HLA 抗体筛查。对筛查反应性样本进一步进行手动 Luminex 单抗原检测，以确定抗体特异性、估计相应抗原频率和信号强度。
在两个平台上，暴露于同种异体的女性的反应率最高（21.0%），未暴露个体或接受过输血的男性的反应率要低得多（1.4%-5.4%）。生育次数增加和最近妊娠增加了她们的筛查反应性。推迟筛查反应性多产妇女性将导致至少 4.8%的血小板单采供体减少。补充测试显示，ELISA 筛查反应性暴露于同种异体的女性中出现非特异性或天然抗体的比例较高（2.5%），而 Luminex 较低（0%）。两种检测方法都更有可能识别针对更多 HLA 抗原的抗体，或在暴露于同种异体的供体中具有更高滴度的抗体。
仅筛查多产妇女性的策略是合理的。两种自动化 HLA 抗体检测平台都易于使用，并且优先识别出具有更高滴度的、针对更多受者 HLA 抗原的同种异体暴露个体的抗体。
