Reckhaus Johanna, Jutzi Markus, Fontana Stefano, Bacher Vera Ulrike, Vogt Marco, Daslakis Michael, Mansouri Taleghani Behrouz
University Department of Hematology, Inselspital, University of Bern, Bern, Switzerland.
Interregional Blood Transfusion Swiss Red Cross, Bern, Switzerland.
Transfus Med Hemother. 2018 May;45(3):167-172. doi: 10.1159/000490122. Epub 2018 May 24.
Platelet concentrates (PC) contain residual contaminating red blood cells (RBC), being higher in pooled buffy coat PC (BC-PC) than in apheresis units (AP-PC). Data about PC-induced alloimmunization against non-D Rhesus (Rh) antigens are limited.
For all newly detected RhD and non-D alloantibodies between August 2015 and September /2017 we prospectively evaluated if they were triggered through PC by analyzing for incompatible RBC and/or PC transfusions.
We found 5,799 positive results in 89,190 antibody screening tests. We identified 13 newly detectable Rh antibodies through incompatible PCs in 11 patients: 6× anti-D, 4× anti-E, 2× anti-c, 1× anti-f. They received a total of 156 PC (83 BC-PC; 73 AP-PC): 5 patients received incompatible BC-PC only, 1 patient received incompatible AP-PC only, 5 patients received incompatible BC-PC and AP-PC. Quality control showed a mean (range) of 0.304 (0.152-1.662) and 0.014 (0.003-0.080) × 10 RBC/l for BC-PC and AP-PC, respectively. Ten of the 11 patients received RBC transfusions, all of them being antigen-negative for the alloantibodies identified.
PC transfusions may not only induce RhD alloimmunization, but also immunization against further Rh antigens such as c, E, and f. The risk seems higher for BC-PC than for AP-PC. The results may have impact on future recommendations of PC transfusion with respect to Rh compatibility and upper limits of RBC contamination.
血小板浓缩物（PC）含有残留的污染红细胞（RBC），在混合富血小板血浆PC（BC-PC）中的含量高于单采血小板单位（AP-PC）。关于PC诱导的针对非D型恒河猴（Rh）抗原的同种免疫的数据有限。
对于2015年8月至2017年9月期间所有新检测到的RhD和非D型同种抗体，我们通过分析不相容的RBC和/或PC输血情况，前瞻性评估它们是否由PC引发。
在89,190次抗体筛查试验中，我们发现了5,799个阳性结果。我们在11例患者中通过不相容的PC鉴定出13种新可检测到的Rh抗体：6例抗-D、4例抗-E、2例抗-c、1例抗-f。他们共接受了156个PC（83个BC-PC；73个AP-PC）：5例患者仅接受了不相容的BC-PC，1例患者仅接受了不相容的AP-PC，5例患者接受了不相容的BC-PC和AP-PC。质量控制显示，BC-PC和AP-PC的RBC含量平均（范围）分别为0.304（0.152 - 1.662）和0.014（0.003 - 0.080）×10⁹/L。11例患者中有10例接受了RBC输血，所有患者对鉴定出的同种抗体均为抗原阴性。
PC输血不仅可能诱导RhD同种免疫，还可能诱导针对其他Rh抗原（如c、E和f） 的免疫。BC-PC的风险似乎高于AP-PC。这些结果可能会对未来关于PC输血在Rh相容性和RBC污染上限方面的建议产生影响。
