Westat, Inc., Rockville, Maryland, USA.
Transfusion. 2011 Oct;51(10):2092-101. doi: 10.1111/j.1537-2995.2010.03048.x. Epub 2011 Feb 18.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related deaths. Donor HLA antibodies have been implicated in TRALI cases. Blood centers are implementing TRALI risk reduction strategies based on HLA antibody screening of some subpopulations of ever-pregnant apheresis platelet (PLT) donors. However, if screening assay cutoffs are too sensitive, donation loss may adversely impact blood availability.
Pregnancy history and HLA antibody screening and single-antigen bead data from blood donors in the Retrovirus Epidemiology Donor Study-II Leukocyte Antibody Prevalence Study were evaluated for correlations between assay screening values, HLA antibody titer, and number of HLA antigen specificities. The probabilities of matching a cognate antigen in a recipient were calculated and examined in association with total number of specificities observed and screening values. The relative impact of imposing various screening assay cutoffs or pregnancy stratification was examined in relation to detection of HLA antibody-reactive donations and loss of donors and donations.
We provide evidence that higher HLA antibody screening assay values are associated with maintaining higher screening signals upon dilution and an increased breadth of specificities compared with lower screening values; the latter correlated with an increased risk of a cognate antigen match in potential recipients. Depending on the TRALI risk reduction strategy used, the potential loss of donations ranged between 0.9 and 6.0%.
This analysis should enable blood centers to decide upon a TRALI risk reduction strategy for apheresis PLTs that is consistent with how much donation loss the blood center can tolerate.
输血相关性急性肺损伤（TRALI）是输血相关死亡的主要原因。供体 HLA 抗体已被牵连到 TRALI 病例中。血液中心正在根据一些妊娠史过的机采血小板（PLT）供者亚群的 HLA 抗体筛查来实施 TRALI 降低风险策略。然而，如果筛查检测的截止值过于敏感，可能会对血液供应产生不利影响，导致捐血损失。
评估了来自 Retrovirus Epidemiology Donor Study-II Leukocyte Antibody Prevalence Study 的献血者的妊娠史、HLA 抗体筛查和单抗原珠数据，以评估检测值、HLA 抗体效价和 HLA 抗原特异性数量之间的相关性。计算了与受者相匹配的同源抗原的概率，并与观察到的特异性总数和筛查值进行了关联。还检查了在检测 HLA 抗体反应性献血以及捐血者和捐血损失方面，实施各种筛查检测截止值或妊娠分层的相对影响。
我们提供了证据表明，较高的 HLA 抗体筛查检测值与保持较高的稀释后筛查信号以及与较低的筛查值相比增加特异性广度相关；后者与潜在受者中同源抗原匹配的风险增加相关。根据使用的 TRALI 降低风险策略，捐血损失的潜在范围在 0.9%到 6.0%之间。
这项分析应该使血液中心能够决定用于机采 PLT 的 TRALI 降低风险策略，该策略与血液中心可以承受的捐血损失量一致。
