Benson K, Marks A R, Marshall M J, Goldstein J D
Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa.
Transfusion. 1994 May;34(5):432-7. doi: 10.1046/j.1537-2995.1994.34594249057.x.
Transfusion-associated graft-versus-host disease (TA-GVHD) due to blood from HLA-homozygous related and unrelated blood donors has been described.
Fatal TA-GVHD due to the transfusion of HLA-matched platelets from an unrelated HLA-homozygous donor is reported. A 61-year-old man with a history of diabetes mellitus and myelodysplastic syndrome was diagnosed with acute myelogenous leukemia in November 1991. Induction chemotherapy resulted in aplasia, which was followed by a normocellular marrow with mild dysplasia and continued karyotypic abnormalities. High-dose chemotherapy was given in a second attempt to achieve complete remission. HLA-matched platelets were ordered when platelet refractoriness developed. The patient was HLA-heterozygous for HLA-A and -B antigens (A2, 29; B37, 44). Over the next 7 days, four unirradiated HLA-matched plateletpheresis units were transfused; one was probably homozygous for both HLA-A and -B antigens (A2, -; B44, -) and was transfused first, and three were probably homozygous for an HLA-B antigen (A2, 29; B44, -) and were white cell reduced. No blood relatives served as donors. Seven days after the first HLA-matched platelet transfusion, fever, chills, and diarrhea developed; 2 days later, a rash was present. Liver enzymes increased markedly. Renal and respiratory failure ensured. A skin biopsy was consistent with GVHD. Despite immunosuppressive therapy, the patient died 19 days after the first HLA-matched platelet transfusion.
TA-GVHD has been recognized in immunocompromised, HLA-heterozygous patients receiving blood from blood relatives who are HLA-homozygous. patients receiving blood from either blood relatives or non-blood relatives who are HLA-homozygous. This HLA-heterozygous patient received transfusions of unirradiated, class I HLA-homozygous platelets, which were specifically ordered as HLA-matched, and his death was attributed to TA-GVHD. Consideration should always be given to providing irradiated blood for immunosuppressed patients, especially when HLA-matched platelets are used, to prevent TA-GVHD.
已有文献报道因输注来自 HLA 纯合相关及无关献血者的血液而导致的输血相关移植物抗宿主病（TA-GVHD）。
本文报道了一例因输注来自 HLA 纯合无关供者的 HLA 配型血小板而导致的致命性 TA-GVHD。一名 61 岁男性，有糖尿病和骨髓增生异常综合征病史，于 1991 年 11 月被诊断为急性髓系白血病。诱导化疗导致再生障碍，随后骨髓细胞正常但有轻度发育异常且核型持续异常。第二次尝试给予大剂量化疗以实现完全缓解。当出现血小板输注无效时，订购了 HLA 配型的血小板。该患者 HLA-A 和 -B 抗原为杂合子（A2, 29；B37, 44）。在接下来的 7 天里，输注了 4 个未经辐照的 HLA 配型血小板单采单位；其中一个可能 HLA-A 和 -B 抗原均为纯合子（A2, -；B44, -）且首先输注，另外三个可能 HLA-B 抗原为纯合子（A2, 29；B44, -）且进行了白细胞去除。没有血亲作为供者。首次输注 HLA 配型血小板 7 天后，出现发热、寒战和腹泻；2 天后出现皮疹。肝酶显著升高。继而出现肾衰竭和呼吸衰竭。皮肤活检符合移植物抗宿主病。尽管进行了免疫抑制治疗，患者在首次输注 HLA 配型血小板 19 天后死亡。
TA-GVHD 在接受来自 HLA 纯合血亲的血液的免疫受损、HLA 杂合患者中已有报道，也在接受来自 HLA 纯合血亲或非血亲的血液的患者中出现。该 HLA 杂合患者接受了未经辐照的、I 类 HLA 纯合血小板输注，这些血小板是特意订购为 HLA 配型的，其死亡归因于 TA-GVHD。对于免疫抑制患者，尤其是使用 HLA 配型血小板时，应始终考虑提供辐照血液以预防 TA-GVHD。
Zotero 插件