Blood Bank, Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, and the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Transfusion. 2013 May;53(5):1019-23. doi: 10.1111/j.1537-2995.2012.03855.x. Epub 2012 Aug 15.
Administration of intensive chemotherapy used in the management of malignancies is accompanied with marrow suppression. Patients undergoing such treatments and especially those with acute leukemia need prolonged blood component support and are at risk for platelet (PLT) refractoriness. Irradiated and filtered blood, although effective, does not eliminate the risk for refractoriness and consequent fatal hemorrhage.
The current report presents a case of an acute myeloid leukemia patient who became alloimmunized to multiple HLA antigens after complicated autologous stem cell transplantation and to whom granulocytes were transfused as part of treatment for overwhelming sepsis. Poor engraftment necessitated prolonged transfusion dependency with rare HLA-compatible donors detected according to the indirect PLT immunofluorescence test. During the proceeding weeks the patient suffered from recurrent severe attacks of gastrointestinal bleeding. When several conservative treatments failed, a fully HLA-matched, bidirectionally ABO-incompatible allogeneic transplantation from a sibling donor was performed.
Allogeneic transplantation was uneventful, with stable full donor-derived lymphohematopoietic engraftment.
Immune PLT refractoriness can appear at later stages of treatment even in severely immunocompromised patients. Granulocyte transfusions could lead to alloimmunization and should therefore be cautiously considered in this patient population.
恶性肿瘤治疗中使用的强化化疗伴随着骨髓抑制。接受此类治疗的患者，尤其是急性白血病患者，需要长期的血液成分支持，并且存在血小板（PLT）抵抗的风险。辐照和过滤血液虽然有效，但不能消除抵抗的风险，继而导致致命性出血。
本报告介绍了一例急性髓系白血病患者，在复杂的自体干细胞移植后对多种 HLA 抗原产生同种异体免疫，并且为治疗严重败血症输注了粒细胞。由于根据间接血小板免疫荧光试验检测到罕见的 HLA 相容供体，植入不良需要长期依赖输血。在接下来的几周里，患者反复出现严重的胃肠道出血。当几种保守治疗失败后，对患者进行了来自同胞供体的完全 HLA 匹配、双向 ABO 不相容的同种异体移植。
同种异体移植过程顺利，完全供体来源的淋巴造血细胞成功植入且稳定。
即使在严重免疫功能低下的患者中，免疫性 PLT 抵抗也可能在治疗后期出现。粒细胞输注可能导致同种异体免疫，因此在这类患者中应谨慎考虑。
