Lin Y, Saskin A, Wells R A, Lenis M, Mamedov A, Callum J, Buckstein R
Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Vox Sang. 2017 Jan;112(1):79-86. doi: 10.1111/vox.12455. Epub 2016 Oct 19.
Thirty to 80 per cent of patients with myelodysplastic syndromes (MDS) become transfusion-dependent and are at risk for red blood cell (RBC) alloimmunization. This study compared alloimmunization rates in transfusion-dependent patients with MDS at an institution with a policy of prophylactic antigen matching for RhCE and K (PAM) with those transfused at institutions without such a policy (non-PAM).
Transfusion records were retrospectively reviewed to determine total number of RBC transfusions received, whether RBC phenotyping was performed, the type and date of first alloantibody development and receipt of prophylactic antigen matching for RhCE and K.
In 176 transfusion-dependent patients with MDS, the overall rate of new alloimmunization was 17%; the majority of patients (87%) developed at least one alloantibody to Rh or Kell antigens. The alloimmunization rate at the institution with a PAM policy was 11% compared with 23% at non-PAM institutions (P = 0·06). The rate of Rh/K alloimmunization was 7 vs. 22%, respectively (P = 0·008). No patient who received PAM developed a Rh/K alloantibody.
The rate of alloimmunization was 11% at an institution with a PAM policy which was non-significantly lower than 23% at institutions without a PAM policy. However, rates of Rh/K alloimmunization were significantly lower. Such a policy should be considered in transfusion-dependent patients with MDS, although further studies on cost-effectiveness and careful consideration of resource availability in the local context are required.
30%至80%的骨髓增生异常综合征（MDS）患者会变得依赖输血，并有红细胞（RBC）同种免疫的风险。本研究比较了在一家实行RhCE和K预防性抗原匹配政策（PAM）的机构中依赖输血的MDS患者的同种免疫率与在没有此类政策的机构（非PAM）中接受输血的患者的同种免疫率。
回顾性审查输血记录，以确定接受的RBC输血总数、是否进行了RBC表型分析、首次同种抗体产生的类型和日期以及RhCE和K预防性抗原匹配的接受情况。
在176例依赖输血的MDS患者中，新同种免疫的总体发生率为17%；大多数患者（87%）产生了至少一种针对Rh或Kell抗原的同种抗体。实行PAM政策的机构的同种免疫率为11%，而非PAM机构为23%（P = 0·06）。Rh/K同种免疫率分别为7%和22%（P = 0·008）。接受PAM的患者均未产生Rh/K同种抗体。
实行PAM政策的机构的同种免疫率为11%，略低于未实行PAM政策的机构的23%，但差异无统计学意义。然而，Rh/K同种免疫率显著较低。对于依赖输血的MDS患者应考虑采用此类政策，不过还需要进一步研究成本效益，并根据当地情况仔细考虑资源可用性。
