McLeod B C, Piehl M R, Sassetti R J
Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill.
Vox Sang. 1990;59(3):185-9. doi: 10.1111/j.1423-0410.1990.tb00856.x.
Platelet transfusions from RhD-positive (D-positive) donors are often given to RhD-negative (D-negative) cancer patients. The low observed rate of alloimmunization has been attributed to disease and therapy-related immunosuppression. We have studied the occurrence of alloimmunization in 16 D-negative patients who did not have detectable anti-D prior to autologous bone marrow transplantation for malignant disease. All received D-positive platelets, but no other D-positive blood product. Three patients (19%) developed anti-D at 13, 24 and 83 days, respectively, after first receiving D-positive platelets, and after a total dose of 53, 65 and 119 D-positive platelet unit equivalents, respectively. Two of them also developed anti-C. The 13 patients in whom anti-D was not detected were also heavily transfused with D-positive platelets (mean +/- SD = 136 +/- 82 platelet unit equivalents). In 6 of them, the last recorded antibody screen was less than 3 months after the first D-positive platelets, and may not exclude a primary immune response. Thus, despite profound immunosuppression associated with autologous marrow transplantation, alloimmune responses to D-positive red cells in platelet concentrates can occur in some D-negative recipients.
通常会将RhD阳性（D阳性）供者的血小板输注给RhD阴性（D阴性）癌症患者。观察到的同种免疫发生率较低归因于疾病和治疗相关的免疫抑制。我们研究了16例D阴性患者的同种免疫发生情况，这些患者在因恶性疾病进行自体骨髓移植之前未检测到抗-D。所有患者均接受了D阳性血小板，但未接受其他D阳性血液制品。3例患者（19%）分别在首次接受D阳性血小板后13天、24天和83天，以及分别在接受53、65和119个D阳性血小板单位当量的总剂量后产生了抗-D。其中2例还产生了抗-C。未检测到抗-D的13例患者也大量输注了D阳性血小板（平均±标准差=136±82血小板单位当量）。其中6例患者，首次输注D阳性血小板后最后一次记录的抗体筛查时间少于3个月，可能无法排除初次免疫反应。因此，尽管自体骨髓移植会导致严重的免疫抑制，但一些D阴性受者仍可能对血小板浓缩物中的D阳性红细胞产生同种免疫反应。
