Division of Transfusion and Laboratory Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA.
Harvard Medical School, Boston, MA.
Am J Clin Pathol. 2019 Jul 5;152(2):146-154. doi: 10.1093/ajcp/aqz024.
No validated screening methods identify patients at risk for human leukocyte antigen (HLA) alloimmune-mediated platelet refractoriness (alloPR). We determined if bead-based HLA antibody tests could predict risk of developing HLA alloPR.
Hematopoietic progenitor cell transplant patients screened for HLA antibodies without prior refractoriness were identified. Phenotype bead screening results were compared between patients who later did and did not develop alloPR.
Seven of 27 patients identified subsequently developed alloPR. The panel reactive antibody (PRA) and mean fluorescence intensity (MFI) of the 10 most reactive beads in the initial screen were significantly higher among patients who later developed alloPR (P < .001). Specifically, PRA of more than 30% and mean MFI of 1,500 or more in the most reactive beads identified at-risk patients. Administration of HLA-compatible platelets yielded significant posttransfusion count increments compared with routine platelets.
HLA antibody screening by phenotype bead assay may prospectively identify at-risk patients for the development of alloPR. However, clinical trials are needed to validate these findings.
目前尚无经过验证的筛选方法能够识别出发生人类白细胞抗原（HLA）同种免疫介导的血小板输注无效（alloPR）风险的患者。我们旨在确定基于珠粒的 HLA 抗体检测是否可以预测 HLA alloPR 发生的风险。
筛选出无既往血小板输注无效史的造血祖细胞移植患者。比较随后发生 alloPR 与未发生 alloPR 的患者之间的表型珠粒筛选结果。
27 例患者中有 7 例随后发生 alloPR。在初始筛选中，10 个反应性最强的珠粒的群体反应性抗体（PRA）和平均荧光强度（MFI）在随后发生 alloPR 的患者中明显更高（P<0.001）。具体而言，反应性最强的珠粒的 PRA 超过 30%且平均 MFI 为 1500 或更高时可识别出高危患者。与常规血小板相比，输注 HLA 相容的血小板可显著增加输血后的血小板计数。
通过表型珠粒检测进行 HLA 抗体筛查可能可以前瞻性地识别发生 alloPR 的高危患者。但是，需要进行临床试验来验证这些发现。
