Flesch B K, Petershofen E K, Bux J
HLA-Laboratory, German Red Cross Blood Service West, Bad Kreuznach and Hagen, Germany.
Tissue Antigens. 2011 Jul;78(1):1-7. doi: 10.1111/j.1399-0039.2011.01713.x.
Antibodies against human leukocyte antigens (HLAs) have long been associated with transfusion-related acute lung injury (TRALI). In contrast to febrile transfusion reactions and refractoriness to platelet transfusions in immunized patients, the causative antibodies in TRALI are present in the transfused blood component, i.e. they are formed by the blood donor and not by the recipient. Consequently, blood components with high plasma volume are particularly associated with TRALI. In addition to antibodies against HLAs, antibodies directed against human neutrophil antigens (HNAs) present in the plasma of predominantly multiparous female blood donors can induce severe TRALI reactions. Especially, antibodies to HLA class II and HNA-3a antigens can induce severe or even fatal ALI in critically ill patients. Over the last decade, the clinical importance of TRALI as major cause for severe transfusion-related morbidities has led to the establishment of new guidelines aimed at preventing this condition, including routine testing for HLA and -HNA antibodies for plasma donors with a history of allogeneic sensitization. This, in turn, poses new challenges for close collaboration between blood transfusion centers and histocompatibility and immunogenetics laboratories, for sensitive and specific detection of the relevant antibodies.
针对人类白细胞抗原（HLA）的抗体长期以来一直与输血相关急性肺损伤（TRALI）有关。与免疫患者的发热性输血反应和血小板输注无效不同，TRALI中的致病抗体存在于输注的血液成分中，即它们是由献血者而非受血者形成的。因此，血浆量高的血液成分与TRALI尤其相关。除了针对HLA的抗体外，主要为经产妇的女性献血者血浆中存在的针对人类中性粒细胞抗原（HNA）的抗体也可引发严重的TRALI反应。特别是，针对HLA II类和HNA - 3a抗原的抗体可在重症患者中诱发严重甚至致命的急性肺损伤（ALI）。在过去十年中，TRALI作为严重输血相关并发症的主要原因的临床重要性促使制定了旨在预防这种情况的新指南，包括对有同种异体致敏史的血浆捐献者进行HLA和 - HNA抗体的常规检测。这反过来又给输血中心与组织相容性和免疫遗传学实验室之间的密切合作带来了新挑战，以便对相关抗体进行灵敏和特异的检测。
