Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
Vox Sang. 2011 May;100(4):395-400. doi: 10.1111/j.1423-0410.2010.01435.x. Epub 2010 Oct 28.
Apheresis platelets (APs) have gained favour over whole blood-derived platelets on the presumption that they are less likely to provoke alloimmunization to red-blood-cell antigens.
Non-D Rh antibodies appeared in three patients after apheresis platelet transfusion. Anti-C and anti-E arose in two female patients with previous antigen exposure. Both anti-c and anti-E arose in a male recipient with no prior transfusion history.
Fifty APs were analysed for residual RBCs and RBC-derived microparticles, using samples obtained from a local blood centre. Cells and microparticles were quantified with a flow cytometry gating scheme, using PE-labelled anti-CD235a (glycophorin A) and FITC-labelled anti-CD41a (platelet gp IIb/IIIa) to distinguish lineage.
Apheresis platelets were found to contain a mean of 7·5×10(6) (95% C.I. [6·3-8·5×10(6) ]) RBCs on one manufacturer's device and 5·2×10(6) (95% C.I. [4·0-6·3×10(6) ]) RBCs on another's. RBC-derived microparticles averaged 210·7×10(6) (95% C.I. [166·2-254·2×10(6) ]) on one manufacturer's device and 232·3×10(6) (95% C.I. [194·3-272·9×10(6) ]) on another's. These counts all correspond to volumes of <1 μl.
Despite RBC contamination of APs below commonly accepted thresholds for Rh immunogenicity, AP transfusion can provoke non-D Rh antibody formation. RBC-derived microparticles, smaller but more numerous than RBCs, are volumetrically comparable and may be a hitherto underappreciated antibody stimulus. Further microparticle research will guide considerations of extended phenotypic matching of platelet components.
由于人们认为与全血来源的血小板相比，其更不易引起红细胞抗原的同种免疫反应，因此， 血小板分离术（AP） 血小板已受到青睐。
在接受血小板分离术血小板输注后，三名患者出现非 D 型 Rh 抗体。两名有抗原暴露史的女性患者出现抗-C 和抗-E。一名无既往输血史的男性患者出现抗-c 和抗-E。
使用当地血库提供的样本，对 50 个 AP 进行残留 RBC 和 RBC 衍生微颗粒分析。使用 PE 标记的抗 CD235a（糖蛋白 A）和 FITC 标记的抗 CD41a（血小板 gp IIb/IIIa）通过流式细胞术门控方案对细胞和微颗粒进行定量，以区分谱系。
一台制造商的设备上分离的血小板平均含有 7.5×10（6）（95%CI [6.3-8.5×10（6）]）个 RBC，另一台制造商的设备上平均含有 5.2×10（6）（95%CI [4.0-6.3×10（6）]）个 RBC。一个制造商设备上 RBC 衍生的微颗粒平均为 210.7×10（6）（95%CI [166.2-254.2×10（6）]），另一个制造商设备上的微颗粒平均为 232.3×10（6）（95%CI [194.3-272.9×10（6）]）。这些计数均对应于<1 μl 的体积。
尽管 AP 中的 RBC 污染低于 Rh 免疫性的普遍接受阈值，但 AP 输血可引起非 D 型 Rh 抗体形成。RBC 衍生的微颗粒虽然较小，但数量更多，体积相当，可能是迄今为止被低估的抗体刺激物。进一步的微粒研究将指导血小板成分的扩展表型匹配的考虑。
