Guelsin Gláucia A S, Rodrigues Camila, Visentainer Jeane E L, De Melo Campos Paula, Traina Fabíola, Gilli Simone C O, Saad Sara T O, Castilho Lilian
Hemocentro-UNICAMP, Campinas State University, Campinas, Sao Paulo, Brazil.
Basic Health Sciences Department, Maringa State University, Maringa, Parana, Brazil.
Blood Transfus. 2015 Jan;13(1):53-8. doi: 10.2450/2014.0332-13. Epub 2014 Jun 12.
Matching for Rh and K antigens has been used in an attempt to reduce antibody formation in patients receiving chronic transfusions but an extended phenotype matching including Fy(a) and Jk(a) antigens has also been recommended. The aim of this study was to identify an efficient transfusion protocol of genotype matching for patients with myelodysplastic syndrome (MDS) or chronic myelomonocytic leukaemia. We also examined a possible association of HLA class II alleles with red blood cell (RBC) alloimmunisation.
We evaluated 43 patients with MDS undergoing transfusion therapy with and without antibody formation. We investigated antigen-matched RBC units for ABO, D, C, c, E, e, K, Fy(a), Fy(b), Jk(a), Jk(b), S, s, Do(a), Do(b) and Di(a) on the patients' samples and on the donor units serologically matched for them based on their ABO, Rh and K phenotypes and presence of antibodies. We also determined the frequencies of HLA-DRB1 alleles in the alloimmunised and non-alloimmunised patients.
Seventeen of the 43 patients had discrepancies or mismatches for multiple antigens between their genotype-predicted profile and the antigen profile of the units of blood serologically matched for them. We verified that 36.8% of patients had more than one RBC alloantibody and 10.5% of patients had autoantibodies. Although we were able to find a better match for the patients in our extended genotyped/phenotyped units, we verified that matching for Rh and K would be sufficient for most of the patients. We also observed an over-representation of the HLA-DRB1*13 allele in the non-alloimmunised group of patients with MDS.
In our population molecular matching for C, c, E, e, K was able to reduce RBC alloimmunisation in MDS patients. An association of HLA-DRB1*13 and protection from RBC alloimmunisation should be confirmed.
对Rh和K抗原进行配型，旨在减少接受长期输血患者体内抗体的形成，但也有人建议进行更广泛的表型配型，包括Fy(a)和Jk(a)抗原。本研究的目的是确定一种针对骨髓增生异常综合征（MDS）或慢性粒单核细胞白血病患者的高效基因型配型输血方案。我们还研究了人类白细胞抗原（HLA）II类等位基因与红细胞（RBC）同种免疫之间可能存在的关联。
我们评估了43例接受输血治疗且有或无抗体形成的MDS患者。我们检测了患者样本以及基于ABO、Rh和K表型及抗体存在情况与其血清学匹配的供体单位上针对ABO、D、C、c、E、e、K、Fy(a)、Fy(b)、Jk(a)、Jk(b)、S、s、Do(a)、Do(b)和Di(a)的抗原匹配红细胞单位。我们还测定了同种免疫患者和未同种免疫患者中HLA - DRB1等位基因的频率。
43例患者中有17例在其基因型预测谱与为其血清学匹配的血液单位的抗原谱之间存在多种抗原差异或不匹配。我们证实36.8%的患者有不止一种红细胞同种抗体，10.5%的患者有自身抗体。尽管我们能够在扩展的基因型/表型单位中为患者找到更好的匹配，但我们证实对大多数患者而言，对Rh和K进行配型就足够了。我们还观察到在未发生同种免疫的MDS患者组中，HLA - DRB1*13等位基因的比例过高。
在我们的研究群体中，对C、c、E、e、K进行分子配型能够减少MDS患者的红细胞同种免疫。HLA - DRB1*13与预防红细胞同种免疫之间的关联应得到确认。
