Hogge D E, McConnell M, Jacobson C, Sutherland H J, Benny W B, Massing B G
Cell Separator Unit, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
Transfusion. 1995 Aug;35(8):645-52. doi: 10.1046/j.1537-2995.1995.35895357895.x.
The purposes of this study were to determine the overall incidence of platelet refractoriness and alloimmunization among multiply transfused children on a medical oncology and bone marrow transplant service and to evaluate the effect of routine white cell reduction in blood components on that incidence.
The platelet transfusion records of 128 consecutive children admitted to the hospital and requiring blood component support for the treatment of disease were evaluated retrospectively. Mean corrected count increments (CCIs) for each patient were calculated for all random-donor platelet transfusions given within 7 days of the routine weekly testings of the patient's serum for lymphocytotoxic antibodies (LCTAbs). Mean CCIs for HLA-matched platelet transfusions were calculated separately for the patients receiving them.
Thirty-one patients (24%) had or developed persistently positive LCTAbs (patient's serum reacted with > or = 3/10 panel lymphocytes); 22 (71%) of these patients had a mean CCI < 7.5 to random-donor platelet transfusions. In contrast, of the 97 patients with negative or transiently positive LCTAbs, only 25 (26%) had a mean CCI < 7.5. The overall incidence of platelet refractoriness (CCI < 7.5) was 37 percent. Patients with acute myelogenous leukemia had a significantly (p < 0.01) reduced incidence (17%) of low CCIs, with or without positive LCTAbs, as compared to patients with other malignant or nonmalignant disorders (41%). No difference in the incidence of LCTAbs or low CCIs was seen in patients undergoing allogeneic or autologous bone marrow transplant or receiving drug therapy only. Among the 24 patients who received HLA-matched platelets, only those with positive LCTAbs showed a significant improvement in CCIs over that achieved with random-donor platelet transfusions. Routine white cell reduction in red cell and platelet components with third-generation white cell filters was performed prior to transfusion in 73 of the patients. There was no significant difference between the incidence of LCTAbs and/or low CCIs in this group and that in the 55 children receiving unfiltered transfusions.
Alloimmunization and platelet refractoriness occur in pediatric oncology and bone marrow transplant patients, but the incidence--particularly in children with acute myelogenous leukemia--appears to be low. The detection of LCTAbs predicts a poor response to random-donor platelet transfusion, but most such patients show improved CCIs with HLA-matched platelets. Routine use of white cell-reduction filters has thus far failed to eliminate alloimmunization in children requiring prolonged blood component support.
本研究的目的是确定在肿瘤内科和骨髓移植科多次输血的儿童中血小板输注无效和同种免疫的总体发生率，并评估血液成分中常规白细胞去除对该发生率的影响。
回顾性评估了连续收治入院且因疾病治疗需要血液成分支持的128名儿童的血小板输血记录。计算了在对患者血清进行淋巴细胞毒抗体（LCTAbs）常规每周检测的7天内给予的所有随机供者血小板输血的每位患者的平均校正计数增加值（CCI）。分别计算接受HLA配型血小板输血的患者的平均CCI。
31名患者（24%）有或出现持续阳性的LCTAbs（患者血清与≥3/10的一组淋巴细胞发生反应）；其中22名（71%）患者对随机供者血小板输血的平均CCI<7.5。相比之下，在97名LCTAbs阴性或短暂阳性的患者中，只有25名（26%）的平均CCI<7.5。血小板输注无效（CCI<7.5）的总体发生率为37%。与患有其他恶性或非恶性疾病的患者（41%）相比，急性髓性白血病患者低CCI的发生率（无论LCTAbs是否阳性）显著降低（p<0.01）。接受异基因或自体骨髓移植或仅接受药物治疗的患者中，LCTAbs或低CCI的发生率没有差异。在24名接受HLA配型血小板的患者中，只有那些LCTAbs阳性的患者与随机供者血小板输血相比，CCI有显著改善。73名患者在输血前使用第三代白细胞滤器对红细胞和血小板成分进行常规白细胞去除。该组中LCTAbs和/或低CCI的发生率与55名接受未过滤输血的儿童相比没有显著差异。
同种免疫和血小板输注无效在儿科肿瘤学和骨髓移植患者中发生，但发生率——尤其是急性髓性白血病儿童——似乎较低。LCTAbs的检测预示着对随机供者血小板输血反应不佳，但大多数此类患者使用HLA配型血小板时CCI有所改善。到目前为止，常规使用白细胞去除滤器未能消除需要长期血液成分支持的儿童中的同种免疫。
