Bensinger W I, Buckner C D, Clift R A, Thomas E D
J Clin Apher. 1987;3(3):174-7. doi: 10.1002/jca.2920030310.
Plasma exchange (PE) is performed only rarely to remove a specific, well defined antibody. ABO incompatibility in marrow transplantation has allowed us a unique opportunity to compare the effectiveness of three apheresis procedures for removing anti-red cell antibodies. We performed 140 marrow transplants in which a major ABO incompatibility between donor and recipient existed. To avoid a hemolytic transfusion reaction at the time of marrow infusion PE, plasma immunoadsorption (PIA) or whole-blood immunoadsorption (WBIA) was performed a total of 243 times. PE removed a mean of 87% of intravascular IgM and 86% of intravascular IgG directed against red cell antigens. PIA removed 75% and 73% of IgM and IgG, respectively (P less than .001 when compared to PE). Results for WBIA were 66% and 65%, respectively. Thus, PIA and WBIA were less efficient at removing antibody than PE. Furthermore, there were a few specific instances in which PIA or WBIA removed little or no antibody owing to differences in antibody specificity. PIA and WBIA resulted in less platelet consumption than PE. Although somewhat less effective that PE, PIA and WBIA have other advantages that can make them more desirable.
仅在极少数情况下进行血浆置换（PE）以去除特定的、明确界定的抗体。骨髓移植中的ABO血型不合为我们提供了一个独特的机会，来比较三种血液分离程序去除抗红细胞抗体的效果。我们进行了140例骨髓移植，供体和受体之间存在主要的ABO血型不合。为避免在输注骨髓时发生溶血性输血反应，共进行了243次PE、血浆免疫吸附（PIA）或全血免疫吸附（WBIA）。PE平均去除了87%的血管内针对红细胞抗原的IgM和86%的血管内IgG。PIA分别去除了75%和73%的IgM和IgG（与PE相比，P<0.001）。WBIA的结果分别为66%和65%。因此，PIA和WBIA在去除抗体方面不如PE有效。此外，由于抗体特异性的差异，在一些特定情况下，PIA或WBIA去除的抗体很少或没有。PIA和WBIA导致的血小板消耗比PE少。尽管PIA和WBIA的效果略逊于PE，但它们具有其他优势，可能使其更具可取性。
