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献血者、成分修饰与输血受者同种免疫之间的关联。

Associations between blood donors, component modifications, and the alloimmunization of transfusion recipients.

作者信息

Yu Han, Karafin Matthew S, Tormey Christopher Anthony, Goel Ruchika, Spencer Bryan Ross, Hendrickson Jeanne E, Hauser Ronald George

机构信息

Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

出版信息

Transfusion. 2025 Mar;65(3):588-603. doi: 10.1111/trf.18135. Epub 2025 Jan 17.

Abstract

BACKGROUND

Prior studies have evaluated transfusion recipient variables impacting red blood cell (RBC) alloimmunization, but few focused on potentially modifiable blood donor or blood component variables.

STUDY DESIGN AND METHODS

Data from the Recipient Epidemiology and Donor Evaluation Study (REDS)-III, which links donor, component, and patient data in an integrated database, were accessed. For any given RBC unit with sufficient blood donor and component data, we determined if the transfusion recipient experienced a new RBC alloimmunization event ("case") within 16 weeks of the transfusion or not ("control"). Recipient diagnoses were included in the case-control matching algorithm.

RESULTS

A total of 2676 cases were matched with 10,160 controls. In a multivariate conditional logistic regression analysis, recipients who received an RBC unit from donors with a different ABO group had a higher risk of alloimmunization (OR 1.60, 95% CI: 1.35-1.89, p < .001). Likewise, recipients who received RBCs from older donors had a higher risk of RBC alloimmunization (OR 1.01 per year of age, 95% CI: 1.00-1.01, p < .001). Irradiated RBCs were associated with a decreased risk of RBC alloimmunization in transfusion recipients (OR 0.52, 95% CI: 0.46-0.59, p < .001), though a sub-analysis of RBCs transfused to people with sickle cell disease showed no such association (p = .75). Recipients who received RBCs stored for a longer duration also had a lower risk (OR 0.99 per day of storage, 95% CI: 0.99-0.99, p < .001) of alloimmunization.

DISCUSSION

This case-control study identified donor and component variables associated with recipient RBC alloantibody formation. Future mechanistic studies exploring these associations are warranted.

摘要

背景

既往研究评估了影响红细胞(RBC)同种免疫的输血受者变量,但很少关注潜在可改变的献血者或血液成分变量。

研究设计与方法

获取了来自受者流行病学与献血者评估研究(REDS)-III的数据,该研究将献血者、成分和患者数据链接到一个综合数据库中。对于任何给定的具有足够献血者和成分数据的RBC单位,我们确定输血受者在输血后16周内是否经历了新的RBC同种免疫事件(“病例”)或未经历(“对照”)。病例对照匹配算法中纳入了受者诊断信息。

结果

共2676例病例与10160例对照进行了匹配。在多变量条件逻辑回归分析中,接受来自不同ABO血型组献血者的RBC单位的受者发生同种免疫的风险更高(比值比[OR]1.60,95%置信区间[CI]:1.35 - 1.89,p <.001)。同样,接受来自年龄较大献血者的RBC的受者发生RBC同种免疫的风险更高(每年年龄的OR为1.01,95%CI:1.00 - 1.01,p <.001)。辐照RBC与输血受者中RBC同种免疫风险降低相关(OR 0.52,95%CI:0.46 - 0.59,p <.001),尽管对输给镰状细胞病患者的RBC的亚分析未显示这种关联(p = 0.75)。接受储存时间较长的RBC的受者发生同种免疫的风险也较低(每储存一天的OR为0.99,95%CI:0.99 - 0.99,p <.001)。

讨论

这项病例对照研究确定了与受者RBC同种抗体形成相关的献血者和成分变量。有必要开展进一步的机制研究来探索这些关联。

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