Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Pediatr Blood Cancer. 2010 Dec 1;55(6):1134-7. doi: 10.1002/pbc.22647.
Erythrocytapheresis, or red blood cell exchange transfusion (RBCX), with donor red blood cell (RBC) units is now increasingly used in the treatment of acute and chronic complications of sickle cell disease (SCD). As in all transfusions, RCBX carries a risk of immunization against foreign antigen on transfused cells. However, by selecting donor units with RBC phenotypes similar to the patient, the risk of allo- and autoimmunization can be reduced.
The formation of RBC alloantibodies and/or autoantibodies in 32 multitransfused pediatric SCD patients undergoing monthly RBCX over a 11-year period (12/1998 to 12/2009) was evaluated utilizing a retrospective patient chart review at Kosair Children's Hospital, Louisville, Kentucky.
After starting C, E, K antigen-matched RBCX, the rate of clinically significant allo-immunization decreased from 0.189/100 to 0.053/100 U, with a relative risk of 27.9%. Likewise, the rate of autoimmunization decreased from 0.063/100 to 0.035/100 U, with a relative risk of 55.9%.
After controlling for clinically insignificant antibodies, our auto- and alloimmunization rate was much less than previously reported values. In addition, the incidence of clinically significant allo- and autoimmunization decreased in our patient population after starting minor antigen-matched RBCX. These results suggest that by matching selected RBC phenotypes, there may be an association in the risk of allo- and autoimmunization of multi-transfused SCD patients.
红细胞单采术（erythrocytapheresis），或红细胞交换输血（red blood cell exchange transfusion，RBCX），使用供者的红细胞（red blood cell，RBC）单位，现在越来越多地用于治疗镰状细胞病（sickle cell disease，SCD）的急性和慢性并发症。与所有输血一样，RBCX 存在针对输注细胞上外来抗原免疫的风险。然而，通过选择与患者 RBC 表型相似的供者单位，可以降低同种异体和自身免疫的风险。
在肯塔基州路易斯维尔 Kosair 儿童医院，通过回顾性患者病历评估，在 11 年期间（1998 年 12 月至 2009 年 12 月），对 32 名接受每月 RBCX 的多输血儿科 SCD 患者形成 RBC 同种异体抗体和/或自身抗体的情况进行了评估。
在开始 C、E、K 抗原匹配 RBCX 后，临床显著同种免疫的发生率从 0.189/100 降至 0.053/100 U，相对风险为 27.9%。同样，自身免疫的发生率从 0.063/100 降至 0.035/100 U，相对风险为 55.9%。
在控制临床无意义抗体后，我们的自身免疫和同种免疫率远低于之前的报告值。此外，在开始进行次要抗原匹配 RBCX 后，我们的患者人群中临床显著同种异体和自身免疫的发生率降低。这些结果表明，通过匹配选定的 RBC 表型，可能与多输血 SCD 患者的同种异体和自身免疫风险有关。
