Zhang Bing, Ma Kairong, Huang Xinyu, Hong Xiaozhen, Liu Ying, Wu Zhipan, Xu Xianguo, Zhu Faming
Blood Center of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
Hematology. 2025 Dec;30(1):2549969. doi: 10.1080/16078454.2025.2549969. Epub 2025 Sep 1.
HLA Class I, HPA (Human platelet antigen), CD36 allo/isoantibodies, and platelet glycoprotein autoantibodies are the primary causes of immune-mediated platelet transfusion refractoriness (iPTR). Detecting these antibodies and selecting antigen-negative platelets for transfusion effectively manages iPTR, but large-scale data on platelet antibody distribution in the Chinese population are scarce.
From Jan 2021 to Dec 2023, 2073 patients with suspected iPTR underwent platelet cross-matching via solid-phase red blood cell adherence. Sera from those with positive cross-matching (≥1 donor) were analyzed for platelet antibodies using Luminex. Correlations between antibody prevalence, age, gender, and diseases were statistically analyzed.
621 patients, 30.0% (621/2073) had positive cross-matching with ≥1 donor. Furthermore, 374 (60.2%) patients had platelet antibodies. Moreover, 429 antibodies were detected in these patients, and the constituent ratios of HLA Class I alloantibodies, HPA alloantibodies, autoantibodies (GPIIb/IIIa, etc), and CD36 isoantibodies were 78.09%, 4.65%, 17.01%, and 0.23%, respectively. Abs ranked as follows: HLA Class I > GPIIb/IIIa > GPIa/IIa > HPA-5b, GPIb/IX > HPA-3a > HPA-1b, 2b > HPA-3b, 4b, CD36. Lastly, positive platelet antibodies prevalence correlated with age and sex in leukemia and solid tumor patient groups.
This study clarified platelet antibody distribution in Chinese iPTR patients. Besides HLA Class I antibodies, autoantibodies against platelet glycoproteins play a key role. Among HPA antibodies, HPA-5b may predominate in the Chinese population instead of HPA-1a.
人类白细胞抗原I类（HLA Class I）、人类血小板抗原（HPA）、CD36同种/自身抗体以及血小板糖蛋白自身抗体是免疫介导的血小板输注无效（iPTR）的主要原因。检测这些抗体并选择抗原阴性的血小板进行输血可有效管理iPTR，但关于中国人群血小板抗体分布的大规模数据较为匮乏。
2021年1月至2023年12月，2073例疑似iPTR患者通过固相红细胞黏附法进行血小板交叉配型。对交叉配型阳性（≥1名供者）患者的血清采用Luminex法分析血小板抗体。对抗体发生率与年龄、性别及疾病之间的相关性进行统计学分析。
621例患者（30.0%，621/2073）与≥1名供者交叉配型阳性。此外，374例（60.2%）患者存在血小板抗体。这些患者共检测到429种抗体，其中HLA Class I同种抗体、HPA同种抗体、自身抗体（GPIIb/IIIa等）及CD36自身抗体的构成比分别为78.09%、4.65%、17.01%和0.23%。抗体排序如下：HLA Class I＞GPIIb/IIIa＞GPIa/IIa＞HPA-5b、GPIb/IX＞HPA-3a＞HPA-1b、2b＞HPA-3b、4b、CD36。最后，白血病和实体瘤患者组中血小板抗体阳性发生率与年龄和性别相关。
本研究明确了中国iPTR患者的血小板抗体分布情况。除HLA Class I抗体外，针对血小板糖蛋白的自身抗体起关键作用。在HPA抗体中，中国人群中可能以HPA-5b为主而非HPA-1a。
