Matsuyama Nobuki, Yasui Kazuta, Amakishi Etsuko, Hayashi Tomoya, Kuroishi Ayumu, Ishii Hiroyuki, Matsukura Harumichi, Tani Yoshihiko, Furuta Rika A, Hirayama Fumiya
Japanese Red Cross Kinki Block Blood Center, 7-5-17, Saitoasagi, Ibaraki, Osaka, 567-0085, Japan.
Int J Hematol. 2015 Jul;102(1):93-100. doi: 10.1007/s12185-015-1794-0. Epub 2015 Apr 4.
On transfusion, several plasma proteins can cause anaphylaxis in patients deficient in the corresponding plasma proteins. However, little is known about other allergens, which are encountered much more infrequently. Although it has been speculated that an allergen-independent pathway underlying allergic transfusion reactions (ATRs) is elicited by biological response modifiers accumulated in blood components during storage, the exact mechanisms remain unresolved. Furthermore, it is difficult even to determine whether ATRs are induced via allergen-dependent or allergen-independent pathways. To distinguish these two pathways in ATR cases, we established a basophil activation test, in which the basophil-activating ability of supernatants of residual transfused blood of ATR cases to whole blood basophils was assessed in the presence or absence of dasatinib, an inhibitor of IgE-mediated basophil activation. Three of 37 supernatants from the platelet concentrates with ATRs activated panel blood basophils in the absence, but not in the presence, of dasatinib. The basophil activation was inhibited by treatment of anti-fish collagen I MoAb in one case, suggesting that the involvement of fish allergens may have been present in donor plasma. We concluded that unknown non-plasma proteins, some of which had epitopes similar to fish antigens, in blood component may be involved in ATRs via an allergen/IgE-dependent pathway.
在输血过程中，几种血浆蛋白可使相应血浆蛋白缺乏的患者发生过敏反应。然而，对于其他较少见的过敏原，人们了解甚少。虽然有人推测，储存期间血液成分中积累的生物反应调节剂引发了过敏输血反应（ATR）的非过敏原依赖性途径，但其确切机制仍未明确。此外，甚至难以确定ATR是通过过敏原依赖性途径还是非过敏原依赖性途径诱导的。为了在ATR病例中区分这两种途径，我们建立了一种嗜碱性粒细胞活化试验，即在有或没有达沙替尼（一种IgE介导的嗜碱性粒细胞活化抑制剂）的情况下，评估ATR病例剩余输血血液上清液对全血嗜碱性粒细胞的嗜碱性粒细胞活化能力。37份发生ATR的血小板浓缩物上清液中有3份在没有达沙替尼的情况下可激活混合血液嗜碱性粒细胞，但在有达沙替尼的情况下则不能。在1例中，抗鱼胶原蛋白I单克隆抗体处理可抑制嗜碱性粒细胞活化，这表明供体血浆中可能存在鱼过敏原。我们得出结论，血液成分中未知的非血浆蛋白（其中一些具有与鱼抗原相似的表位）可能通过过敏原/IgE依赖性途径参与ATR。
