Michot Jean-Marie, Driss Françoise, Guitton Corinne, Moh Klaren Julia, Lefebvre François, Chamillard Xavier, Gallon Philippe, Fourn Erwan, Pela Alain M, Tertian Gérard, Le Bras Philippe, Chantalat-Auger Christelle, Delfraissy Jean-François, Goujard Cécile, Lambotte Olivier
Service de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Bicêtre, Le Kremlin-Bicêtre, France; Université Paris Sud 11, Le Kremlin-Bicêtre, France.
Transfusion. 2015 Feb;55(2):357-63. doi: 10.1111/trf.12875. Epub 2014 Sep 23.
Sickle cell disease (SCD) has become a major public health issue. Hydroxyurea and red blood cell (RBC) transfusion are the cornerstone treatments. Erythrocytapheresis (ECP) is an automated method for transfusion exchange. Given that ECP requires more blood than conventional transfusion, there is concern about alloimmunization and hemolytic transfusion reactions. We evaluate the incidence of hemolytic transfusion reactions and alloimmunization rates in patients receiving conventional blood transfusions and in patients participating in long-term blood exchange programs with ECP.
All hemolytic transfusion reactions and alloimmunizations in SCD patients were recorded over the period 2006 to 2011. Conventional transfusions and ECP were compared.
The cohort consisted of 188 SCD patients. The median (±SD) age was 23 (±14) years. The ECP and conventional transfusion groups comprised 49 and 139 patients, respectively. The prevalence of alloimmunization was 33% in the ECP group and 22% in the conventional transfusion group (p = 0.1797). The alloimmunization/RBC unit (RBCU) ratio was lower in the ECP group than in the conventional transfusion group (1.6 and 11.6 per 1000, respectively; p < 0.0001). Although patients in the ECP group received more than 10 times more RBCUs than patients in the conventional transfusion group (206 vs. 19 RBCUs per patient, respectively; p < 0.0001), none of the four recorded hemolytic transfusion reactions (n = 4) occurred.
Regarding alloimmunization, ECP exhibits a good immunohematologic safety profile relative to conventional transfusion in a large SCD mainly adult cohort.
镰状细胞病（SCD）已成为一个主要的公共卫生问题。羟基脲和红细胞（RBC）输血是主要的治疗方法。红细胞单采术（ECP）是一种用于输血置换的自动化方法。鉴于ECP比传统输血需要更多的血液，人们担心同种免疫和溶血性输血反应。我们评估接受传统输血的患者以及参与ECP长期血液置换项目的患者中溶血性输血反应的发生率和同种免疫率。
记录2006年至2011年期间SCD患者的所有溶血性输血反应和同种免疫情况。对传统输血和ECP进行比较。
该队列由188例SCD患者组成。中位（±标准差）年龄为23（±14）岁。ECP组和传统输血组分别有49例和139例患者。ECP组同种免疫的患病率为33%，传统输血组为22%（p = 0.1797）。ECP组的同种免疫/红细胞单位（RBCU）比率低于传统输血组（分别为每1000个中有1.6个和11.6个；p < 0.0001）。尽管ECP组患者接受的RBCU比传统输血组患者多10倍以上（分别为每位患者206个和19个RBCU；p < 0.0001），但记录的4例溶血性输血反应（n = 4）均未发生。
关于同种免疫，在一个主要为成人的大型SCD队列中，相对于传统输血，ECP表现出良好的免疫血液学安全性。
