Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands.
Department of Experimental Immunohematology, Sanquin Research, Amsterdam, the Netherlands.
PLoS One. 2018 Apr 26;13(4):e0196382. doi: 10.1371/journal.pone.0196382. eCollection 2018.
Anti-RhD immunised donors provide anti-RhD immunoglobulins used for the prevention of rhesus disease. These donors are periodically hyper-immunised (boostered) to retain a high titer level of anti-RhD.
We analysed anti-RhD donor records from 1998 to 2016, consisting of 30,116 anti-RhD titers from 755 donors, encompassing 3,372 booster events. Various models were fit to these data to allow describing the anti-RhD titers over time.
A random effects model with a log-linear anti-RhD titer decline over time and a saturating titer response to boostering is shown to fit the data well. This model contains two general model parameters, relating timing and maximum of the booster effect, as well as two parameters characterizing the individual donor, namely how fast the booster effect saturates with current titer and the anti-RhD decline rate. The average individual log2 decline is 0.55 per year, i.e. a 32% decline in absolute titer, with half of the donors declining between 13% and 41% per year. Their anti-RhD titer peaks around 26 days following a booster event. Boostering response reduces with higher titers at boostering; at median titer (log2 11) the mean increase per booster is log2 0.38, that is from an absolute titer of 2048 to 2665 (+30%), with half of all donors increasing between 16% and 65% in their titer.
The model describes anti-RhD titer change per individual with only four parameters, two of which are donor specific. This information can be used to enhance the blood bank's immunisation programme, by deriving individualized immunization policies in which boostering is adjusted to the anticipated anti-RhD decline, effectiveness of boostering and titer levels required.
抗 RhD 免疫供者提供用于预防 Rh 同种免疫病的抗 RhD 免疫球蛋白。这些供者定期进行超免疫（加强免疫）以保持高滴度的抗 RhD。
我们分析了 1998 年至 2016 年的抗 RhD 供者记录，这些记录包括 755 名供者的 30116 个抗 RhD 滴度，涵盖了 3372 次加强免疫事件。为了描述随时间变化的抗 RhD 滴度，我们对这些数据进行了各种模型拟合。
显示出随时间对数线性下降的随机效应模型和对加强免疫有饱和反应的抗 RhD 滴度，适合拟合数据。该模型包含两个通用模型参数，与加强免疫效果的时间和最大值有关，以及两个描述个体供者的参数，即当前滴度下加强免疫效果的饱和速度和抗 RhD 下降速度。个体的平均对数 2 下降为每年 0.55，即绝对滴度下降 32%，其中一半供者每年下降 13%至 41%。他们的抗 RhD 滴度在加强免疫后约 26 天达到峰值。加强免疫反应随加强免疫时的滴度增加而降低；在中位数滴度（对数 2 11）下，每次加强免疫的平均增加量为对数 2 0.38，即从绝对滴度 2048 增加到 2665（增加 30%），其中一半供者的滴度增加 16%至 65%。
该模型用仅四个参数描述每个个体的抗 RhD 滴度变化，其中两个参数是供者特异性的。该信息可用于增强血库的免疫计划，通过制定个体化免疫策略，根据预期的抗 RhD 下降、加强免疫的有效性和所需的滴度水平来调整加强免疫。
