Sanquin-LUMC, Jon J van Rood Center for Clinical Transfusion Research, Leiden, The Netherlands.
Transfus Med Rev. 2012 Oct;26(4):342-53, 353.e1-5. doi: 10.1016/j.tmrv.2011.12.001. Epub 2012 Jan 13.
Large scale red blood cell (RBC) antigen genotyping of donors is currently well developed. There is scarce information, however, to select patients who might benefit from preemptive extended RBC antigen-matched transfusions. Female sex has been proposed as a risk factor for RBC alloimmunization after transfusion. To asses whether females respond differently to RBC alloantigens compared with males, we conducted a literature review on RBC alloimmunization. Clinical studies on RBC alloimmunization incidence were searched for in databases from 1950 through 2011. Studies were included when data were available to calculate the female-to-male risk ratio for alloimmunization. Based on the reported age, adult patients (>18 years) were distinguished from pediatric patients (≤18 years), and articles were analyzed according to disease categories. Thirty articles fulfilled the inclusion criteria. The Mantel-Haenszel risk ratio estimate of combined adult studies showed that women with sickle cell disease had an increased relative risk (27%) on RBC alloantibodies compared with men. Other groups showed equal alloimmunization risk in women and men. Women slightly more often than men possess RBC antibodies. This is likely explained by more exposure to immunizing events through pregnancy and/or transfusions in females with sickle cell disease. The results support the current policy implemented in many countries for Rhesus/Kell matching in patients with a hemoglobinopathy irrespective of sex. Thus, based solely on sex difference, the results do not justify recommending additional matching for women, besides preemptive K and c antigen matching for women during the (pre-) fertile age, as already applied in many European countries for the prevention of fetal morbidity.
目前，对供者进行大规模红细胞（RBC）抗原基因分型已经得到了很好的发展。然而，关于选择可能受益于预防性扩展 RBC 抗原匹配输血的患者的信息却很少。女性被认为是输血后 RBC 同种免疫的一个危险因素。为了评估女性对 RBC 同种抗原的反应是否与男性不同，我们对 RBC 同种免疫进行了文献复习。在 1950 年至 2011 年期间，在数据库中搜索了关于 RBC 同种免疫发生率的临床研究。当有数据可计算同种免疫的女性与男性风险比时，研究就被纳入。根据报告的年龄，将成年患者（>18 岁）与儿科患者（≤18 岁）区分开来，并根据疾病类别对文章进行分析。有 30 篇文章符合纳入标准。综合成人研究的 Mantel-Haenszel 风险比估计表明，与男性相比，镰状细胞病女性对 RBC 同种抗体的相对风险增加（27%）。其他组显示女性和男性的同种免疫风险相等。女性比男性更容易拥有 RBC 抗体。这很可能是由于镰状细胞病女性通过妊娠和/或输血更多地接触到免疫事件。结果支持许多国家目前在无论性别如何，对患有血红蛋白病的患者实施 Rh（D）/Kell 匹配的政策。因此，仅基于性别差异，结果并不 justifies 推荐对女性进行额外的匹配，除了对（前）生育期的女性进行 K 和 c 抗原的预防性匹配外，这已经在许多欧洲国家实施，以预防胎儿发病率。
