Hendrickson Jeanne E, Tormey Christopher A, Shaz Beth H
Yale University School of Medicine, New Haven, CT.
Yale University School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
Transfus Med Rev. 2014 Jul;28(3):137-44. doi: 10.1016/j.tmrv.2014.04.008. Epub 2014 May 15.
Hemolytic transfusion reactions due to red blood cell (RBC) alloantibodies are a leading cause of transfusion-associated death. In addition to reported deaths, RBC alloantibodies also cause significant morbidity in the form of delayed hemolytic transfusion reactions. These alloantibodies may also cause morbidity in the form of anemia, with compatible RBC units at times being unable to be located for highly alloimmunized patients, or in the form of hemolytic disease of the newborn. Thus, preventing RBC alloantibodies from developing in the first place, or mitigating the dangers of existing RBC alloantibodies, would decrease transfusion-associated morbidity and mortality. A number of human studies have evaluated the impact on RBC alloimmunization rates of providing partially phenotypically or genotypically matched RBCs for transfusion, and a number of animal studies have evaluated the impact of single variables on RBC alloimmunization. The goal of this review is to take a comprehensive look at existing human and animal data on RBC alloimmunization, focusing on strategies that may mitigate this serious hazard of transfusion. Potential factors that impact initial RBC alloimmunization, on both the donor and recipient sides, will be discussed. These factors include, but are not limited to, exposure to the antigen and an ability of the recipient's immune system to present that antigen. Beyond these basic factors, coexisting "danger signals," which may come from the donor unit itself or which may be present in the recipient, also likely play a role in determining which transfusion recipients may become alloimmunized after RBC antigen exposure. In addition, to better understanding factors that influence the development of RBC alloantibodies, this review will also briefly discuss strategies to decrease the dangers of existing RBC alloantibodies.
由红细胞（RBC）同种抗体引起的溶血性输血反应是输血相关死亡的主要原因。除了已报告的死亡病例外，RBC同种抗体还会以迟发性溶血性输血反应的形式导致严重的发病情况。这些同种抗体还可能以贫血的形式导致发病，对于高度同种免疫的患者，有时无法找到相容的RBC单位，或者会导致新生儿溶血病。因此，首先预防RBC同种抗体的产生，或减轻现有RBC同种抗体的危害，将降低输血相关的发病率和死亡率。一些人体研究评估了输注部分表型或基因型匹配的RBC对RBC同种免疫率的影响，一些动物研究评估了单一变量对RBC同种免疫的影响。本综述的目的是全面审视现有的关于RBC同种免疫的人体和动物数据，重点关注可能减轻这种严重输血危害的策略。将讨论影响初次RBC同种免疫的潜在因素，包括供体和受体方面的因素。这些因素包括但不限于抗原暴露以及受体免疫系统呈递该抗原的能力。除了这些基本因素外，共存的“危险信号”，可能来自供体单位本身或存在于受体中，也可能在决定哪些输血受者在RBC抗原暴露后可能发生同种免疫方面发挥作用。此外，为了更好地理解影响RBC同种抗体产生的因素，本综述还将简要讨论降低现有RBC同种抗体危害的策略。
