Jia Y, Li W, Liu N, Zhang K, Gong Z, Li D, Wang L, Wang D, Jing Y, Wang J, Shan X
Department of HLA, Beijing Red Cross Blood Center, Beijing, P. R. China.
Transfus Med. 2014 Dec;24(6):406-10. doi: 10.1111/tme.12157. Epub 2014 Oct 19.
The development of specific antibodies against human leukocyte antigen (HLA) and/or human platelet antigen (HPA) could induce platelet transfusion refractoriness especially in patients receiving multiple platelet transfusions. A retrospective analysis was conducted to evaluate the prevalence of platelet-specific antibodies and the efficacy of crossmatch-compatible platelet transfusions in these recipients.
All enrolled patients were refractory to random single-donor apheresis Platelet (PLT) units. Enzyme-linked immunosorbent assay (ELISA) was used to detect anti-HLA and anti-HPA antibodies in serum. For those patients with antibodies, the PLT crossmatch assays were performed to select the compatible PLTs with a commercial solid-phase adherence kit.
A total of 193 patients were included and 29.02% of which was HLA and/or HPA antibody-positive. There were no significant differences in antibody-positive rates among AML/CML, ALL/CLL, MDS, SAA and ITP groups, but they are statistically significantly higher than other groups (P = 0.0035). Of those antibody-positive patients, there were 41 (73.21%) patients with only HLA antibodies, 11 (19.64%) patients with only HPA antibodies and 4 (7.14%) patients with both HLA and HPA antibodies. A total of 43 random PLT units and 88 crossmatch-compatible PLT units were administered. The mean (± SD) corrected count increment (CCI) was 8700 (± 4500) after crossmatch-compatible unit transfusion, significantly higher than 3600 (± 2400) for random PLT units (P < 0.001).
HLA and/or HPA alloimmunisation is an important factor to cause refractoriness to platelet transfusions. Crossmatch-compatible platelet transfusion is an effective method in those patients refractory to random platelet transfusions.
针对人类白细胞抗原（HLA）和/或人类血小板抗原（HPA）的特异性抗体的产生可导致血小板输注无效，尤其是在接受多次血小板输注的患者中。进行了一项回顾性分析，以评估这些受者中血小板特异性抗体的患病率以及交叉配型相合的血小板输注的疗效。
所有纳入的患者对随机单采血小板（PLT）单位均无效。采用酶联免疫吸附测定（ELISA）检测血清中的抗HLA和抗HPA抗体。对于有抗体的患者，使用商业固相黏附试剂盒进行PLT交叉配型试验，以选择相合的PLT。
共纳入193例患者，其中29.02%为HLA和/或HPA抗体阳性。AML/CML、ALL/CLL、MDS、SAA和ITP组之间的抗体阳性率无显著差异，但均显著高于其他组（P = 0.0035）。在这些抗体阳性患者中，仅HLA抗体阳性的患者有41例（73.21%），仅HPA抗体阳性的患者有11例（19.64%），HLA和HPA抗体均阳性的患者有4例（7.14%）。共输注了43个随机PLT单位和88个交叉配型相合的PLT单位。交叉配型相合单位输血后的平均（±标准差）校正计数增加值（CCI）为8700（±4500），显著高于随机PLT单位的3600（±2400）（P < 0.001）。
HLA和/或HPA同种免疫是导致血小板输注无效的重要因素。交叉配型相合的血小板输注是治疗随机血小板输注无效患者的有效方法。
