Yasui Kazuta, Matsuyama Nobuki, Okamura-Shiki Ikue, Ikeda Takashi, Ishii Kazuyoshi, Furuta Rika A, Hirayama Fumiya
Japanese Red Cross Kinki Block Blood Center, Osaka, Japan.
Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan.
Transfusion. 2017 Sep;57(9):2084-2095. doi: 10.1111/trf.14208. Epub 2017 Jun 27.
In previous studies, we demonstrated that the basophil activation test, which is performed using patient blood and the supernatants from transfused blood components, was able to elucidate not only the causative relationship between allergic transfusion reactions and the transfusion but also the mechanisms behind allergic transfusion reactions. However, for a large number of allergic transfusion reactions, patients are in a state of myelosuppression, and the basophil activation test cannot be performed for these patients because there are insufficient numbers of peripheral blood basophils.
To overcome this obstacle, we developed a passive immune basophil activation test, in which patient plasma and residually transfused blood are used as the patient's sources of immunoglobulin E and allergen, respectively, whereas healthy volunteer basophils serve as the responder cell source. The passive immune basophil activation test was performed for two patients who had severe allergic transfusion reactions, using supernatants of the residual platelet concentrates and the patients' own immunoglobulin E.
There were no differences in either surface immunoglobulin E or activation in response to allergens between untreated basophils and so-called quasi-basophils, in which immunoglobulin E was replaced by a third party's immunoglobulin E. In these patients, the supernatants of the residual platelet concentrates exclusively activated basophils in response to quasi-basophils onto which the patients' immunoglobulin E, but not a third party's immunoglobulin E, was bound.
The passive immune basophil activation test may help clarify the causal relationship between allergic transfusion reactions and transfused blood, even when patients experience myelosuppression.
在先前的研究中，我们证明了使用患者血液和输血成分的上清液进行的嗜碱性粒细胞活化试验，不仅能够阐明过敏输血反应与输血之间的因果关系，还能揭示过敏输血反应背后的机制。然而，对于大量的过敏输血反应患者，他们处于骨髓抑制状态，由于外周血嗜碱性粒细胞数量不足，无法对这些患者进行嗜碱性粒细胞活化试验。
为克服这一障碍，我们开发了一种被动免疫嗜碱性粒细胞活化试验，其中分别使用患者血浆和剩余的输血作为患者免疫球蛋白E和变应原的来源，而健康志愿者的嗜碱性粒细胞作为反应细胞来源。使用剩余血小板浓缩物的上清液和患者自身的免疫球蛋白E，对两名发生严重过敏输血反应的患者进行了被动免疫嗜碱性粒细胞活化试验。
未处理的嗜碱性粒细胞与所谓的准嗜碱性粒细胞（其中免疫球蛋白E被第三方免疫球蛋白E替代）之间，在表面免疫球蛋白E或对变应原的反应性活化方面均无差异。在这些患者中，剩余血小板浓缩物的上清液仅能激活与患者免疫球蛋白E而非第三方免疫球蛋白E结合的准嗜碱性粒细胞。
即使患者处于骨髓抑制状态，被动免疫嗜碱性粒细胞活化试验也可能有助于阐明过敏输血反应与输血之间的因果关系。
