Dinardo Carla Luana, Fernandes Frederico Leon Arrabal, Sampaio Luciana Ribeiro, Sabino Ester Cerdeira, Mendrone Alfredo
Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, SP, Brazil; Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Rev Bras Hematol Hemoter. 2015 Sep-Oct;37(5):320-3. doi: 10.1016/j.bjhh.2015.07.003. Epub 2015 Jul 29.
Experimental data have shown that the transfusion of older red blood cell units causes alloimmunization, but the clinical applicability of this statement has never been properly assessed in non-sickle cell patients. It has been hypothesized that older units have higher numbers of cytokines, increasing the risk of alloimmunization related to antigen-presenting events. The goal of this study was to evaluate the association between the transfusion of older red blood cell units subjected to bedside leukodepletion and alloimmunization.
All patients submitted to transfusions of bedside leukodepletion red blood cell units proven to have become alloimmunized in one oncologic service between 2009 and 2013 were enrolled in this study. A control group was formed by matching patients without alloimmunization in terms of number of transfusions and medical specialty. The median age of transfused units, the percentage of transfused red blood cell units >14 days of storage in relation to fresher red cell units (≤14 days of storage) and the mean age of transfused units older than 14 days were compared between the groups.
Alloimmunized and control groups were homogeneous regarding the most relevant clinical variables (age, gender, type of oncological disease) and inflammatory background (C-reactive protein and Karnofsky scale). The median age of transfused red blood cell units, the ratio of older units transfused compared to fresher units and the mean age of transfused units older than 14 days did not differ between alloimmunized and control patients (17 vs. 17; 68/32 vs. 63.2/36.8 and 21.8±7.0 vs. 21.04±7.9; respectively).
The transfusion of older red blood cell units subjected to bedside leukodepletion is not a key risk factor for alloimmunization. Strategies of providing fresh red cell units aiming to avoid alloimmunization are thus not justified.
实验数据表明，输注保存时间较长的红细胞单位会导致同种免疫，但这一说法在非镰状细胞病患者中的临床适用性从未得到恰当评估。据推测，保存时间较长的红细胞单位含有更多细胞因子，增加了与抗原呈递事件相关的同种免疫风险。本研究的目的是评估床边白细胞滤除的保存时间较长的红细胞单位输注与同种免疫之间的关联。
本研究纳入了2009年至2013年期间在某肿瘤科室接受床边白细胞滤除红细胞单位输注且被证实发生同种免疫的所有患者。通过匹配输血次数和医学专科方面未发生同种免疫的患者组成对照组。比较两组之间输注单位的中位年龄、保存时间>14天的红细胞单位输注量相对于较新鲜红细胞单位（保存时间≤14天）的百分比以及保存时间超过14天的输注单位的平均年龄。
在最相关的临床变量（年龄、性别、肿瘤疾病类型）和炎症背景（C反应蛋白和卡诺夫斯基量表）方面，同种免疫组和对照组具有同质性。同种免疫组和对照组患者之间，输注红细胞单位的中位年龄、输注的较老单位与较新鲜单位的比例以及保存时间超过14天的输注单位的平均年龄没有差异（分别为17岁对17岁；68/32对63.2/36.8；21.8±7.0对21.04±7.9）。
床边白细胞滤除的保存时间较长的红细胞单位输注不是同种免疫的关键危险因素。因此，旨在避免同种免疫而提供新鲜红细胞单位的策略是不合理的。
