Molina-Aguilar Rubiraida, Gómez-Ruiz Soledad, Vela-Ojeda Jorge, Montiel-Cervantes Laura Arcelia, Reyes-Maldonado Elba
Morphology Department, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico.
Hematology Department, UMAE, Hospital de Especialidades Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Transfus Med Hemother. 2020 Apr;47(2):152-159. doi: 10.1159/000501861. Epub 2019 Aug 6.
Alloimmunization is caused by exposure to erythrocytes from a donor that expresses blood group antigens other than those of the recipient and is related to processes that alter the balance of the immune system. Knowing the pathophysiology of alloimmunization process is essential to understand clinical complications associated with this process.
From October 2016 to April 2017, irregular antibody screening was performed in 1,434 polytransfused (compatible with the ABO and D system) patients by means of agglutination techniques using erythrocytes of a known phenotype of 44 patients with a positive alloantibody screening. Non-alloimmunized (control) subjects were matched for age, gender, pathology, and treatment group with alloimmunized patients. The subsets of B, T, and Treg lymphocytes were determined by flow cytometry.
The results of screening for alloantibodies in patients by specificity of antibodies were as follows: nonspecific (30%), followed by anti-Di (13%), anti-e (9%), anti-S (9%), anti-I (7%), anti-K (7%), and anti-P (7%). A lower percentage of CD4+ T lymphocytes and an increase of CD8+ T lymphocytes were observed in alloimmunized patients, as well as a low CD4/CD8 ratio (0.7 vs. 1.6, = 0.003), a higher percentage of B lymphocytes versus the control group (30 vs. 20%, = 0.003), and a decrease of Treg CD4+ lymphocytes versus the control group (3 vs. 12 cells/μL, = 0.043). These observations suggest that alloimmunized patients have important alterations in the number of some lymphocyte subsets that can be translated into clinical immune dysregulation.
A decreased CD4/CD8 ratio, increased B lymphocytes, and Treg lymphocyte deficiency are the most significant changes observed in alloimmunized patients.
同种免疫是由于接触到供者表达的血型抗原不同于受者的红细胞所致，并且与改变免疫系统平衡的过程相关。了解同种免疫过程的病理生理学对于理解与此过程相关的临床并发症至关重要。
2016年10月至2017年4月，对1434例多次输血（ABO和D系统相容）患者采用凝集技术进行不规则抗体筛查，使用44例同种抗体筛查阳性患者的已知表型红细胞。非同种免疫（对照）受试者在年龄、性别、病理和治疗组方面与同种免疫患者相匹配。通过流式细胞术测定B、T和调节性T（Treg）淋巴细胞亚群。
按抗体特异性对患者进行同种抗体筛查的结果如下：非特异性（30%），其次是抗-Di（13%）、抗-e（9%）、抗-S（9%）、抗-I（7%）、抗-K（7%）和抗-P（7%）。在同种免疫患者中观察到CD4+T淋巴细胞百分比降低和CD8+T淋巴细胞增加，以及CD4/CD8比值较低（0.7对1.6，P=0.003），与对照组相比B淋巴细胞百分比更高（30%对20%，P=0.003），与对照组相比Treg CD4+淋巴细胞减少（3对12个细胞/μL，P=0.043）。这些观察结果表明，同种免疫患者某些淋巴细胞亚群数量存在重要改变，这可能转化为临床免疫失调。
CD4/CD8比值降低、B淋巴细胞增加和Treg淋巴细胞缺乏是同种免疫患者中观察到的最显著变化。
