Wang J, Xia W, Deng J, Xu X, Shao Y, Ding H, Chen Y, Liu J, Chen D, Ye X, Santoso S
Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, Guangdong, China.
Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, Giessen, Germany.
Transfus Med. 2018 Feb;28(1):40-46. doi: 10.1111/tme.12423. Epub 2017 May 18.
Cross-match-compatible platelets can improve corrected count increments (CCIs) in alloimmunised patients with transfusion refractoriness. However, only a few studies mentioned that the specificities of platelet-reactive alloantibodies can predict high reactivity in cross-match assays among these patients.
A total of 204 medical records of patients who were refractory to random single-donor apheresis platelets between January 2014 and December 2014 were enrolled. Platelet-reactive antibodies in patients' serum were screened by an enzyme-linked immunosorbent assay (ELISA).The platelet cross-match assays were performed by a solid-phase adherence assay. The specificities of human leukocyte antigen (HLA) class I and human platelet antigens (HPAs) alloantibodies were determined by Luminex Single Antigen and Monoclonal Antibody-specific Immobilization of Platelet Antigens (MAIPA) assays, respectively.
Anti-HLA and anti-HPA alloantibodies were found in 114 of 204 (55.88%) patients, including 110 (96.49%) with anti-HLA alloantibodies only, 2 (1.75%) with anti-HPA alloantibodies (anti-GPIIb/IIIa) only and 2 (1.75%) with both anti-HLA and anti-HPA alloantibodies (anti-HPA-3a and anti-HPA-5b). The most common HLA class I alloantibody phenotypes in cross-match-incompatible patients were HLA-A23 (59.38%), -A24 (50.00%), -A02 (43.75%), -B27 (65.63%), -B40 (50.00%), -B18 (46.88%) and -B07 (43.75%). A total of 480 cross-matched platelet units were administered in 82 of 114 alloimmunised patients with a mean CCI of 7800 ± 5200, a significant improvement over random platelet units (P < 0.001).
No development of additional platelet alloantibodies was observed during this platelet transfusion regiment. This study showed that transfusion of cross-match-compatible platelet units offers effective and safe management of platelet transfusion refractoriness (PTR). The finding of alloantibodies among cross-match-incompatible cases can be used as predictors for platelet donor selection.
交叉配型相合的血小板可提高同种免疫的输血难治性患者的校正计数增加值（CCI）。然而，仅有少数研究提及血小板反应性同种抗体的特异性可预测这些患者交叉配型试验中的高反应性。
纳入2014年1月至2014年12月间对随机单采血小板难治的204例患者的病历。采用酶联免疫吸附测定（ELISA）筛查患者血清中的血小板反应性抗体。通过固相黏附试验进行血小板交叉配型试验。分别采用Luminex单抗原试验和血小板抗原单克隆抗体特异性固定试验（MAIPA）测定人类白细胞抗原（HLA）I类和人类血小板抗原（HPA）同种抗体的特异性。
204例患者中有114例（55.88%）检测到抗HLA和抗HPA同种抗体，其中仅110例（96.49%）有抗HLA同种抗体，仅2例（1.75%）有抗HPA同种抗体（抗糖蛋白IIb/IIIa），2例（1.75%）同时有抗HLA和抗HPA同种抗体（抗HPA-3a和抗HPA-5b）。交叉配型不相合患者中最常见的HLA I类同种抗体表型为HLA-A23（59.38%）、-A24（50.00%）、-A02（43.75%）、-B27（65.63%）、-B40（50.00%）、-B18（46.88%）和-B07（43.75%）。114例同种免疫患者中的82例共输注了480个交叉配型的血小板单位，平均CCI为7800±5200，与随机血小板单位相比有显著改善（P<0.001）。
在此血小板输注方案期间未观察到额外血小板同种抗体的产生。本研究表明，输注交叉配型相合的血小板单位可为血小板输血难治性（PTR）提供有效且安全的管理。交叉配型不相合病例中同种抗体的发现可作为血小板供体选择的预测指标。
