New Zealand Blood Service, Christchurch, New Zealand.
Canterbury District Health Board, Christchurch, New Zealand.
Blood Transfus. 2023 Sep;21(5):390-399. doi: 10.2450/2022.0131-22. Epub 2022 Oct 18.
In the context of critical bleeding and massive transfusion (CB/MT), little is known about the development of new red blood cell (RBC) alloantibodies. We performed a retrospective, observational study to examine the frequency of RBC alloantibodies (pre-existent, anamnestic, or new) in patients with CB/MT, defined as transfusion of five or more RBC units in any 4-hour period, for any cause of CB.
Data on 2,585 New Zealand patients (date/time of MT initiation, demographic data, blood group, clinical context, and transfused RBCs) were obtained from the Australian and New Zealand Massive Transfusion Registry. RBC alloantibody screening/identification data were extracted from the New Zealand Blood Service database. We calculated summary statistics, compared proportions between different independent groups using the Chi-squared test, and performed logistic regression analysis to examine the effects of variables on alloantibody presence or formation. We also determined the immunogenicities of selected RBC antigens in the context of CB/MT.
Of 1,234 assessable patients, 1,166 (94.5%) showed no evidence of any alloantibody. Pre-existent, anamnestic, and new alloantibodies were found, respectively, in 4.3%, 0.4%, and 7.2% of assessable patients. By multivariable regression analysis, transfusion of D-positive RBC to D-negative patients was independently associated with new alloantibody formation. Neither the quantum of RBC transfused nor trauma as clinical context were so associated although the latter trended towards a predisposition. "Antibodies of undetermined specificity" were the commonest pre-existent and new alloantibodies. The immunogenicity of Jk was the highest in this setting.
RBC alloantibodies of any type were rare in this CB/MT population. Patients undergoing CB/MT appear to have low risks of re-stimulating anamnestic alloantibodies, or of developing new RBC alloantibodies.
在严重出血和大量输血（CB/MT）的情况下，人们对新的红细胞（RBC）同种抗体的发展知之甚少。我们进行了一项回顾性观察研究，以检查因任何原因导致 CB 而在 4 小时内输注五单位或更多 RBC 单位的患者中 RBC 同种抗体（预先存在、回忆性或新产生的）的频率。
从澳大利亚和新西兰大量输血登记处获得了 2585 名新西兰患者（MT 开始的日期/时间、人口统计学数据、血型、临床背景和输注的 RBC）的数据。从新西兰血液服务数据库中提取 RBC 同种抗体筛查/鉴定数据。我们计算了汇总统计数据，使用卡方检验比较了不同独立组之间的比例，并进行了逻辑回归分析，以检查变量对同种抗体存在或形成的影响。我们还在 CB/MT 的背景下确定了选定 RBC 抗原的免疫原性。
在 1234 名可评估患者中，有 1166 名（94.5%）没有任何同种抗体的证据。在可评估的患者中，分别有 4.3%、0.4%和 7.2%发现预先存在的、回忆性的和新的同种抗体。通过多变量回归分析，D 阳性 RBC 输注给 D 阴性患者与新的同种抗体形成独立相关。尽管后者有倾向，但输血的 RBC 量和创伤作为临床背景都没有与之相关。“未确定特异性的抗体”是最常见的预先存在和新的同种抗体。在这种情况下，Jk 的免疫原性最高。
在这种 CB/MT 人群中，任何类型的 RBC 同种抗体都很少见。接受 CB/MT 的患者似乎具有重新刺激回忆性同种抗体或产生新的 RBC 同种抗体的低风险。
