Garraud Olivier, Cognasse Fabrice, Moncharmont Pierre
EA_3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne, France.
Institut National de la Transfusion Sanguine, 75015 Paris, France.
Diseases. 2019 Jan 14;7(1):7. doi: 10.3390/diseases7010007.
Alloimmunisation to platelet antigens is not uncommon; a large number of females, having had pregnancies, developed antibodies to Human Leukocyte Antigen (HLA) moieties harboured on their foetuses' cells (inherited from the father(s)) that may conflict with further pregnancies and transfused Platelet Components occasionally. This is possible since platelets constitutionally express HLA class I molecules (though in copy numbers that consistently differ among individuals). Platelets also express HPA moieties that are variants of naturally expressed adhesion and aggregation molecules; HPA differences between mothers and foetuses and between donors and recipients explain alloimmune conflicts and consequences. Lastly, platelets express ABO blood group antigens, which are rarely immunising, however transfusion mismatches in ABO groups seem to be related to immunisation in other blood and tissue groups. Transfusion also brings residual leukocytes that may also immunise through their copious copy numbers of HLA class I (rarely class II on activated T lymphocytes, B cells, and dendritic cells). In addition, residual red blood cells in platelet concentrates may induce anti-red blood cell allo-antibodies. This short review aims to present the main mechanisms that are commonly reported in alloimmunisation. It also critically endeavours to examine paths to either dampen alloimmunisation occurrences or to prevent them.
血小板抗原同种免疫并不罕见；许多有过妊娠经历的女性会产生针对胎儿细胞（从父亲遗传而来）所携带的人类白细胞抗原（HLA）部分的抗体，这些抗体偶尔可能会影响后续妊娠及输注的血小板成分。这是有可能的，因为血小板固有地表达HLA I类分子（尽管个体之间其拷贝数始终存在差异）。血小板还表达人类血小板抗原（HPA）部分，这些是天然表达的黏附及聚集分子的变体；母亲与胎儿之间以及供者与受者之间的HPA差异解释了同种免疫冲突及后果。最后，血小板表达ABO血型抗原，其很少引起免疫反应，然而ABO血型的输血不匹配似乎与其他血液及组织类型的免疫反应有关。输血还会带来残留白细胞，这些白细胞也可能因其大量的HLA I类拷贝数（在活化的T淋巴细胞、B细胞和树突状细胞上很少有II类）而引起免疫反应。此外，血小板浓缩物中的残留红细胞可能诱导抗红细胞同种抗体。这篇简短综述旨在介绍同种免疫中常见报道的主要机制。它还批判性地努力探讨减轻或预防同种免疫发生的途径。
