Dzieczkowski J S, Barrett B B, Nester D, Campbell M, Cook J, Sugrue M, Andersen J W, Anderson K C
Wayne State University Medical School, Detroit, Michigan.
Transfusion. 1995 Jan;35(1):20-5. doi: 10.1046/j.1537-2995.1995.35195090654.x.
Potential adverse effects of white cells (WBCs) within transfused cellular blood components include febrile nonhemolytic transfusion reactions (FNHTRs), alloimmunization, transmission of infectious diseases, transfusion-related acute lung injury, and immunomodulation. Although exclusive use of WBC-reduced components to prevent alloimmunization and cytomegalovirus transmission has been studied, the use of these components to avert FNHTR has not been examined.
Transfusion reactions (FNHTRs, allergic reactions, and others) were characterized in recipients of 12,277 WBC-reduced single-donor apheresis platelets (SDAPs) and/or red cells (RBCs). Medical and laboratory evaluations for possible infectious and immunologic (alloimmunization) causes of each reaction were undertaken, and the benefit of further modification of components for the prevention of subsequent reactions was also evaluated.
Transfusion reactions occurred after 481 (3.92%) of 12,277 transfusions. Allergic reactions occurred more commonly after transfusion of SDAPs (3.69%) than of RBCs (0.51%). Conversely, FNHTRs occurred more commonly after transfusion of RBCs (2.15%) than of SDAPs (1.58%). HLA antibodies were present in a posttransfusion sample from 27 (10.6%) of 255 patients; bacterial contamination was a possible cause of only 2 (0.42%) of 481 reactions. In patients with recurrent FNHTRs, further WBC reduction in components did not wholly prevent further FNHTRs.
The incidence of FNHTRs and alloimmunization after exclusive transfusion of WBC-reduced RBCs and SDAPs was low. Further WBC reduction in components transfused to patients with a history of recurrent FNHTRs does not completely prevent subsequent reactions.
输注的细胞血液成分中的白细胞（WBC）可能产生的不良反应包括发热性非溶血性输血反应（FNHTR）、同种免疫、传染病传播、输血相关急性肺损伤和免疫调节。尽管已经研究了单独使用白细胞减少成分来预防同种免疫和巨细胞病毒传播，但尚未研究使用这些成分来避免FNHTR。
对12277例接受白细胞减少的单采单供者血小板（SDAP）和/或红细胞（RBC）输注的受者的输血反应（FNHTR、过敏反应等）进行了特征分析。对每种反应可能的感染性和免疫性（同种免疫）原因进行了医学和实验室评估，并评估了进一步改良成分以预防后续反应的益处。
12277次输血中有481次（3.92%）发生了输血反应。SDAP输注后过敏反应（3.69%）比RBC输注后更常见（0.51%）。相反，RBC输注后FNHTR更常见（2.15%），而SDAP输注后为（1.58%）。255例患者中有27例（10.6%）输血后样本中存在HLA抗体；细菌污染仅可能是481次反应中2次（0.42%）的原因。在复发性FNHTR患者中，进一步减少成分中的白细胞并不能完全预防进一步的FNHTR。
单纯输注白细胞减少的RBC和SDAP后FNHTR和同种免疫的发生率较低。对有复发性FNHTR病史的患者输注的成分进一步减少白细胞并不能完全预防后续反应。
