Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia.
School of Natural Sciences, Macquarie University, Sydney, New South Wales, Australia.
Transfusion. 2024 Oct;64(10):1830-1840. doi: 10.1111/trf.18010. Epub 2024 Oct 3.
Donor leucocyte survival following red blood cell (RBC) transfusion, known as transfusion-associated microchimerism (TAM), can occur in some patients. In Australia, despite the introduction of leucocyte filtration (leucodepletion) during RBC manufacture, TAM has been detected in adult trauma patients. However, the incidence of TAM in Australian pediatric patients has not been analyzed.
Patients aged 0-16 years were recruited across two cohorts. Retrospective participants had RBC transfusion between January 1, 2002 and November 15, 2017 and prospective participants received RBC transfusion between December 1, 2016 and November 25, 2020. Twelve bi-allelic insertion/deletion (InDel) polymorphisms were used to detect microchimerism amplification patterns using real-time PCR (RT-PCR) and droplet digital PCR (ddPCR).
Of the retrospective cohort (n = 40), six patients showed amplification of InDel sequences indicating potential microchimerism. For three patients, minor InDel sequences were detected using RT-PCR only, two patients had minor InDel amplification using ddPCR only, and one patient had minor InDel amplification that was confirmed using both techniques. Amplification of minor sequences occurred in three patients who had received a bone marrow transplant in addition to RBC transfusion. In the prospective cohort (n = 25), no InDel amplification indicating potential microchimerism was detected using RT-PCR.
Cell-based therapies had been administered in three patients where microchimerism amplification patterns were detected. Three patients have microchimerism that may be attributed to RBC transfusion. In prospective patients, who received leucodepleted and gamma-irradiated RBC units, no potential microchimerism amplification were detected. ddPCR may be a suitable technique for TAM analysis but requires further evaluation.
在一些患者中，红细胞（RBC）输注后供体细胞的存活被称为输血相关微嵌合体（TAM）。在澳大利亚，尽管在 RBC 生产过程中采用了白细胞滤除（白细胞去除）技术，但在成年创伤患者中已经检测到 TAM。然而，尚未对澳大利亚儿科患者中的 TAM 发生率进行分析。
在两个队列中招募了 0-16 岁的患者。回顾性参与者在 2002 年 1 月 1 日至 2017 年 11 月 15 日期间接受 RBC 输血，前瞻性参与者在 2016 年 12 月 1 日至 2020 年 11 月 25 日期间接受 RBC 输血。使用实时 PCR（RT-PCR）和液滴数字 PCR（ddPCR），使用 12 个双等位基因插入/缺失（InDel）多态性来检测微嵌合体扩增模式。
在回顾性队列（n=40）中，6 名患者的 InDel 序列扩增表明存在潜在的微嵌合体。在 3 名患者中，仅通过 RT-PCR 检测到较小的 InDel 序列，2 名患者仅通过 ddPCR 检测到较小的 InDel 扩增，1 名患者通过两种技术均确认存在较小的 InDel 扩增。在除 RBC 输血外还接受骨髓移植的 3 名患者中，发生了较小序列的扩增。在前瞻性队列（n=25）中，通过 RT-PCR 未检测到潜在微嵌合体的 InDel 扩增。
在检测到微嵌合体扩增模式的 3 名患者中，已经进行了细胞为基础的治疗。3 名患者存在微嵌合体，可能归因于 RBC 输血。在接受白细胞去除和γ射线辐照的 RBC 单位的前瞻性患者中，未检测到潜在的微嵌合体扩增。ddPCR 可能是一种适合 TAM 分析的技术，但需要进一步评估。
