Department of Transfusion Medicine, Children's National Medical Centre, Washington, DC, USA; Department of Haematology, Children's National Medical Centre, Washington, DC, USA.
Br J Haematol. 2015 Jan;168(2):291-300. doi: 10.1111/bjh.13123. Epub 2014 Sep 26.
Sickle cell disease (SCD) patients are at increased risk of red blood cell (RBC) alloimmunization. Recipient inflammatory state at time of transfusion has been shown to regulate alloimmunization in murine models, but evidence is lacking in SCD patients. We retrospectively studied a cohort of alloimmunized SCD patients to determine the influence of pro-inflammatory SCD-related complications at time of transfusion on alloimmunization. For each transfusion, the presence of pro-inflammatory state, degree of RBC antigen matching, unit age, storage solution and alloantibody detection date were ascertained. Transfusion-associated pro-inflammatory events were compared between transfusions resulting and not resulting in new alloantibodies. Univariate analysis and multivariate logistic regression were performed. Fifty-two patients received 3166 pre-storage leuco-reduced transfusions of which 128 resulted in alloantibodies. Transfusions during inflammatory events were associated with increased alloantibody risk on univariate and multivariate analysis; acute chest syndrome and vaso-occlusive crisis showed strongest associations with alloimmunization. Increased antigen matching demonstrated a protective effect on alloimmunization (univariate and multivariate analysis). Although an association was seen between citrate-phosphate-dextrose (adenine) stored units and alloimmunization on univariate analysis, no effect was found on multivariate analysis. Identifying recipient pro-inflammatory states at time of transfusion that promote alloimmunization can impact RBC unit selection decisions for SCD patients at risk for alloimmunization.
镰状细胞病 (SCD) 患者发生红细胞 (RBC) 同种免疫的风险增加。在鼠模型中已表明，输血时受者的炎症状态可调节同种免疫，但在 SCD 患者中缺乏相关证据。我们对一组同种免疫性 SCD 患者进行了回顾性研究，以确定输血时促炎的 SCD 相关并发症对同种免疫的影响。对于每一次输血，均确定了炎症状态、RBC 抗原匹配程度、单位年龄、储存液和同种抗体检测日期等因素。比较了导致和未导致新同种抗体产生的输血之间与输血相关的促炎事件。进行了单变量分析和多变量逻辑回归分析。52 例患者接受了 3166 次输血前白细胞减少的输血，其中 128 次导致了同种抗体。在单变量和多变量分析中，输血期间发生炎症事件与同种抗体风险增加相关；急性胸部综合征和血管阻塞性危象与同种免疫的相关性最强。增加抗原匹配对同种免疫具有保护作用（单变量和多变量分析）。虽然枸橼酸盐-磷酸盐-葡萄糖（腺嘌呤）储存单位与单变量分析中的同种免疫之间存在关联，但在多变量分析中未发现其影响。确定输血时促炎的受者状态可促进同种免疫，这可能会影响有同种免疫风险的 SCD 患者的 RBC 单位选择决策。
