UMR_S1255, INSERM, Strasbourg, France.
Etablissement Français du Sang-Grand Est, Strasbourg, France.
Front Immunol. 2023 Feb 9;14:1125367. doi: 10.3389/fimmu.2023.1125367. eCollection 2023.
Patients with hematological disorders and severe thrombocytopenia require extensive and iterative platelet transfusion support. In these patients, platelet transfusion refractoriness represents a serious adverse transfusion event with major outcomes for patient care. Recipient alloantibodies against the donor HLA Class I antigens expressed at the cell surface of platelets result in a rapid removal of transfused platelets from the circulation and thus, therapeutic and prophylactic transfusion failure leading to a major bleeding risk. In this case, the only way to support the patient relies on the selection of HLA Class I compatible platelets, an approach restricted by the limited number of HLA-typed donors available and the difficulty of meeting the demand in an emergency. However, not all patients with anti-HLA Class I antibodies develop refractoriness to platelet transfusions, raising the question of the intrinsic characteristics of the antibodies and the immune-mediated mechanisms of platelet clearance associated with a refractory state. In this review, we examine the current challenges in platelet transfusion refractoriness and detail the key features of the antibodies involved that should be considered. Finally, we also provide an overview of future therapeutic strategies.
患有血液系统疾病和严重血小板减少症的患者需要广泛且反复的血小板输注支持。在这些患者中，血小板输注无效是一种严重的不良输血事件，对患者的治疗结果有重大影响。受者针对供者 HLA I 类抗原的同种异体抗体与血小板表面表达的细胞表面结合，导致输注的血小板迅速从循环中清除，从而导致治疗性和预防性输血失败，导致大出血风险。在这种情况下，唯一能够支持患者的方法是选择 HLA I 类相容的血小板，但这种方法受到可供选择的 HLA 配型供者数量有限以及在紧急情况下难以满足需求的限制。然而，并非所有携带抗 HLA I 类抗体的患者都会对血小板输注产生耐药性，这就提出了一个问题，即与耐药状态相关的抗体的固有特征和免疫介导的血小板清除机制是什么。在这篇综述中，我们检查了血小板输注无效的当前挑战，并详细介绍了相关抗体的关键特征，这些特征应该得到考虑。最后，我们还概述了未来的治疗策略。
