Federowicz I, Barrett B B, Andersen J W, Urashima M, Popovsky M A, Anderson K C
Blood Component Laboratory, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Transfusion. 1996 Jan;36(1):21-8. doi: 10.1046/j.1537-2995.1996.36196190511.x.
During the storage of cellular components before transfusion, cytokines that may mediate transfusion reactions are released from white cells (WBCs). Adverse effects of transfused cellular blood components therefore depend not only on the number of residual WBCs in blood components, but also on the timing of WBC reduction.
Febrile nonhemolytic transfusion reactions (FNHTRs), allergic reactions, and other reactions were characterized in recipients of 4728 units of red cells (RBCs) and 3405 bags of single-donor apheresis platelets (SDAPs), all of which underwent prestorage WBC reduction. To delineate the impact of prestorage versus poststorage WBC reduction of RBCs on transfusion reactions, these results were compared with reactions occurring after the transfusion to similar recipients of 6447 bags of RBCs that underwent poststorage WBC reduction by bedside filtration and 5197 units of SDAPs that underwent prestorage WBC reduction. The levels of interleukin (IL) 1 beta, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) were measured in a subset of 20 implicated cellular blood components at the time of transfusion reactions and correlated with the duration of storage before transfusion.
The incidence of reactions was greater after transfusions of SDAPs (5.49%) than of RBCs (1.63%). The incidence of FNHTRs after transfusion of RBCs that were WBC reduced before storage (1.1%) was significantly lower (p = 0.0045) than that after transfusion of RBCs that were WBC reduced after storage (2.15%). Although allergic reactions to RBCs that were WBC reduced before storage were also less common (0.41%) than those to RBCs that were WBC reduced after storage (0.51%), the difference was not significant (p = 0.067). At the time of reactions to RBCs and SDAPs that were reduced before storage, the level of IL-6 was negatively correlated (r = -0.54, p = 0.014) with the duration of storage before transfusion, and there was no correlation between the level of either IL-1 beta or IL-8 and the interval before transfusion. TNF-alpha was not detectable in any implicated component.
FNHTRs, but not allergic reactions, were less common after transfusion of RBCs that were WBC reduced before storage than after the transfusion of those WBC reduced after storage at the bedside by filtration. The level of IL-6 in implicated cellular blood components that were WBC reduced before storage was inversely correlated with the length of storage before transfusion. Further studies are needed to determine whether the transfusion of cellular blood components that were WBC reduced before storage can both diminish the incidence of adverse reactions and improve outcome.
在输血前细胞成分储存期间，可能介导输血反应的细胞因子会从白细胞（WBC）中释放出来。因此，输注的细胞血液成分的不良反应不仅取决于血液成分中残留白细胞的数量，还取决于白细胞减少的时机。
对4728单位红细胞（RBC）和3405袋单采单供者血小板（SDAP）的受者的发热非溶血性输血反应（FNHTR）、过敏反应及其他反应进行了特征分析，所有这些血液成分均在储存前进行了白细胞减少处理。为了阐明储存前与储存后对RBC进行白细胞减少处理对输血反应的影响，将这些结果与6447袋通过床边过滤在储存后进行白细胞减少处理的RBC以及5197单位在储存前进行白细胞减少处理的SDAP输注给相似受者后发生的反应进行了比较。在20份涉及输血反应的细胞血液成分的子集中，在输血反应发生时检测了白细胞介素（IL）-1β、IL-6、IL-8和肿瘤坏死因子-α（TNF-α）的水平，并将其与输血前的储存时间进行了相关性分析。
SDAP输注后的反应发生率（5.49%）高于RBC输注后的反应发生率（1.63%）。储存前进行白细胞减少处理的RBC输注后FNHTR的发生率（1.1%）显著低于（p = 0.0045）储存后进行白细胞减少处理的RBC输注后的发生率（2.15%）。尽管储存前进行白细胞减少处理的RBC的过敏反应（0.41%）也比储存后进行白细胞减少处理的RBC的过敏反应（0.51%）少见，但差异不显著（p = 0.067）。在对储存前进行白细胞减少处理的RBC和SDAP发生反应时，IL-6水平与输血前的储存时间呈负相关（r = -0.54，p = 0.014），而IL-1β或IL-8水平与输血前的间隔时间无相关性。在任何涉及的成分中均未检测到TNF-α。
与床边过滤储存后进行白细胞减少处理的RBC输注后相比，储存前进行白细胞减少处理的RBC输注后FNHTR较少见，但过敏反应并非如此。储存前进行白细胞减少处理的涉及输血反应的细胞血液成分中IL-6水平与输血前的储存时长呈负相关。需要进一步研究以确定储存前进行白细胞减少处理的细胞血液成分的输注是否既能降低不良反应的发生率又能改善预后。
