Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Department of Transfusion Medicine, Saga University, Saga, Japan.
Transfusion. 2024 Oct;64(10):1980-1992. doi: 10.1111/trf.18009. Epub 2024 Sep 17.
Despite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion.
Each participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted.
Between October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow-up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti-E was identified in 25 patients, anti-Jk in 5, and anti-c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti-E in 7, anti-Jk in 4, and anti-Le in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p = .012).
The number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.
尽管有几项关于红细胞（RBC）同种免疫的报告，但在接受输血的患者中，同种免疫的实际发生率和相关因素仍未得到充分研究。我们研究了输血后临床因素与 RBC 抗体的产生和消失之间的关系。
每个参与机构都在输血前后进行抗体筛查。进行了一项调查，包括患者特征、抗体筛查和鉴定结果、抗体筛查方法、输血量和不良反应。
2018 年 10 月至 2023 年 3 月期间，5 家机构共登记了 1194 名患者。总体而言，958 名患者在输血后至少进行了一次 RBC 抗体随访筛查，发现有 44 名（4.6%）出现新的抗体产生。在 25 名患者中鉴定出抗-E，5 名患者中鉴定出抗-Jk，4 名患者中鉴定出抗-c。输血后抗体的产生与输血量显著相关（p < .001）。在 55 名输血后鉴定出抗体的患者中，包括既往抗体，有 18 名（33%）抗体消失；7 名患者的抗-E 消失，4 名患者的抗-Jk 消失，2 名患者的抗-Le 消失。盐水和/或酶法鉴定出的消失性抗体比持久性抗体更常见（p = .012）。
输血量可能会影响抗体的产生，且仅通过盐水和/或酶法鉴定出的、被认为临床意义不大的抗体，很可能具有较高的消失率。应仔细进行抗体筛查，特别是在接受大量输血的患者中。应确认之前的抗体筛查结果，以防止遗漏即使无临床意义但已经消失的抗体。
