Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna General Hospital, Medical University of Vienna, Austria.
Am J Med. 2012 Jul;125(7):717.e1-8. doi: 10.1016/j.amjmed.2011.11.028. Epub 2012 May 4.
Anemia is highly prevalent in inflammatory bowel disease patients, and red blood cell transfusion is often indicated already at reproductive age. Both transfusion and pregnancy may induce red cell alloantibodies, potentially complicating further transfusions and pregnancies. As recent evidence suggests that inflammation may promote red cell antibody induction, the alloimmunization risk of these patients after allogenic erythrocyte exposure was investigated.
Red cell alloantibody status and clinical data were analyzed in 193 inflammatory bowel disease patients with a history of transfusion or pregnancy, and compared with transfused controls with noninflammatory diseases (n=357).
In transfused patients with inflammatory bowel disease, a 2.5-fold-increased red cell antibody prevalence was found (10/119, 8.4%), compared with transfused sex-matched controls with noninflammatory diseases (12/357, 3.4%; P=.023). Patients with inflammatory bowel disease had fewer transfusions (mean 3.0 vs 4.2, P=.003) but higher C-reactive protein levels during transfusion than controls (mean 8.4 vs 5.4 mg/dL, P <.001). The red cell antibodies of inflammatory bowel disease patients were clinically significant, directed against different Rh, Kell, Duffy, or Lutheran blood group antigens, and associated with higher number of transfusions (odds ratio 1.57; 95% confidence interval, 1.03-2.39). Conversely, immunomodulatory therapy during transfusion showed negative association (odds ratio 0.12; 95% confidence interval, 0.02-0.61). Only 1.4% of inflammatory bowel disease patients with pregnancy alone had antibodies.
Patients with inflammatory bowel disease exhibited a very high risk of transfusion-induced red cell alloimmunization, possibly potentiated by inflammation. Aside from a restrictive transfusion strategy, the implementation of prophylactic blood group phenotype matching of red cell concentrates (not only for ABO and RhD but also RhCcEe, Kell, Kidd, Duffy) could prevent antibody induction and associated complications in these patients.
贫血在炎症性肠病患者中很常见，在生育年龄往往需要输血。输血和妊娠都会引起红细胞同种抗体，可能会使进一步的输血和妊娠复杂化。由于最近的证据表明炎症可能会促进红细胞抗体的产生，因此研究了这些患者在异体红细胞暴露后的同种免疫风险。
分析了 193 例有输血或妊娠史的炎症性肠病患者的红细胞同种抗体状态和临床数据，并与非炎症性疾病的输血对照（n=357）进行比较。
在患有炎症性肠病的输血患者中，发现红细胞抗体的患病率增加了 2.5 倍（10/119，8.4%），与非炎症性疾病的输血性别匹配对照（12/357，3.4%；P=.023）相比。炎症性肠病患者的输血次数较少（平均 3.0 次比 4.2 次，P=.003），但在输血期间的 C 反应蛋白水平高于对照组（平均 8.4 毫克/分升比 5.4 毫克/分升，P <.001）。炎症性肠病患者的红细胞抗体具有临床意义，针对不同的 Rh、Kell、Duffy 或 Lutheran 血型抗原，与输血次数较多相关（比值比 1.57；95%置信区间，1.03-2.39）。相反，输血期间的免疫调节治疗呈负相关（比值比 0.12；95%置信区间，0.02-0.61）。仅有 1.4%单独妊娠的炎症性肠病患者有抗体。
炎症性肠病患者输血后发生红细胞同种免疫的风险非常高，炎症可能会加剧这种风险。除了限制输血策略外，还可以实施红细胞浓缩物的预防性血型表型匹配（不仅针对 ABO 和 RhD，还针对 RhCcEe、Kell、Kidd、Duffy），以防止这些患者发生抗体诱导和相关并发症。
