Cox J V, Steane E, Cunningham G, Frenkel E P
Department of Internal Medicine, University of Texas Health Science Center, Dallas 75235-9030.
Arch Intern Med. 1988 Nov;148(11):2485-9.
Blood transfusion is an integral part of the supportive care of patients with sickle cell diseases. The hazards of red blood cell alloimmunization and delayed hemolytic transfusion reactions (DHTRs) complicate the treatment of patients with sickle cell diseases, particularly since such reactions may be misinterpreted as a pain crisis, and, as a result, specific transfusion serologic studies may not be performed. The frequency of alloimmunization in this population has been the subject of several reports; however, the frequency of DHTRs is unknown. To determine the frequency of this event, we retrospectively reviewed the medical and transfusion service records of all adult patients with sickle cell diseases transfused during the six-year period from January 1980 to December 1985. Seventy-three adult patients with sickle cell diseases received transfusions. The prevalence of recognized DHTR was three (4%) of 73. Red blood cell alloimmunization was seen in 22 (30%) of 73 of the patients. The calculated risk of alloimmunization was 3.1% per unit of blood. These observations suggest that alloimmunization and clinically apparent DHTRs occur more frequently in patients with sickle cell diseases and support pretransfusion testing for at least Rh and Kell red blood cell antigens in patients who are at high risk of such events (patients who have formed an alloantibody or who are being enrolled in a transfusion program).
输血是镰状细胞病患者支持性治疗中不可或缺的一部分。红细胞同种免疫和迟发性溶血性输血反应（DHTRs）的风险使镰状细胞病患者的治疗变得复杂，特别是因为此类反应可能被误诊为疼痛危象，结果可能未进行特定的输血血清学研究。该人群中同种免疫的发生率已有多篇报道；然而，DHTRs的发生率尚不清楚。为了确定这一事件的发生率，我们回顾性分析了1980年1月至1985年12月这六年期间所有接受输血的成年镰状细胞病患者的医疗和输血服务记录。73名成年镰状细胞病患者接受了输血。已确认的DHTRs发生率为73例中的3例（4%）。73例患者中有22例（30%）出现红细胞同种免疫。计算得出每单位血液的同种免疫风险为3.1%。这些观察结果表明，同种免疫和临床上明显的DHTRs在镰状细胞病患者中更频繁发生，并支持对发生此类事件风险较高的患者（已形成同种抗体或正在接受输血治疗的患者）至少进行Rh和Kell红细胞抗原的输血前检测。
