Kickler T S, Ness P M, Braine H G
Department of Laboratory Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Clin Pathol. 1988 Jul;90(1):69-72. doi: 10.1093/ajcp/90.1.69.
Selection of platelets for alloimmunized, thrombocytopenic patients has traditionally been based on HLA matching. This approach is indirect and may not adequately recognize incompatibility between the recipient and the platelet donor. The authors evaluated the usefulness of directly showing donor-recipient compatibility by crossmatching the patient's serum with prospective platelet donors who were not preselected on the basis of their HLA type. Eleven alloimmunized patients were chosen for study, and crossmatching was done by a radiolabeled antiglobulin test. These patients had high levels of HLA alloantibody, and their unusual HLA types made the provision of HLA-matched platelets difficult. When the crossmatch was compatible, the mean one-hour corrected count increment was 18,379 +/- 4,670 (1 standard deviation), n = 22, and at 18-24 hours, 7,318 +/- 3,317. If the crossmatch was positive, the mean one-hour corrected increment was 2,536 +/- 3,057, and at 18-24 hours, 227 +/- 657, n = 16. There were two false negative crossmatches and one false positive crossmatch. One hundred forty-eight crossmatches were done to find 48 potential donors, who, by conventional selection using HLA matching, would not have been considered appropriate donors. These results show that successful platelet transfusions for alloimmunized thrombocytopenic patients can be prospectively selected by platelet crossmatching without the need of doing expensive HLA typing of a large population of platelet donors. Although it may be difficult to find compatible platelets for some patients with broadly reactive HLA antibodies, platelet crossmatching may detect compatible donors who are ordinarily excluded on the basis of their HLA phenotype.
传统上，为同种免疫性血小板减少症患者选择血小板是基于人类白细胞抗原（HLA）配型。这种方法是间接的，可能无法充分识别受者与血小板供者之间的不相容性。作者评估了通过将患者血清与未基于HLA类型预先选择的潜在血小板供者进行交叉配型，直接显示供者 - 受者相容性的实用性。选择了11名同种免疫患者进行研究，并通过放射性标记抗球蛋白试验进行交叉配型。这些患者具有高水平的HLA同种抗体，且其不寻常的HLA类型使得提供HLA匹配的血小板变得困难。当交叉配型相容时，平均1小时校正计数增加值为18,379±4,670（1个标准差），n = 22，在18 - 24小时时为7,318±3,317。如果交叉配型为阳性，平均1小时校正增加值为2,536±3,057，在18 - 24小时时为227±657，n = 16。有2次交叉配型出现假阴性和1次出现假阳性。共进行了148次交叉配型以找到48名潜在供者，按照使用HLA配型的传统选择方法，这些供者不会被认为是合适的供者。这些结果表明，对于同种免疫性血小板减少症患者，通过血小板交叉配型可以前瞻性地选择成功的血小板输注，而无需对大量血小板供者进行昂贵的HLA分型。尽管对于一些具有广泛反应性HLA抗体的患者可能难以找到相容的血小板，但血小板交叉配型可能会检测到通常因HLA表型而被排除的相容供者。
