Redman M, Regan F, Contreras M
National Blood Service, North London Blood Transfusion Centre, UK.
Vox Sang. 1996;71(4):216-20. doi: 10.1046/j.1423-0410.1996.7140216.x.
To establish the incidence and timing of red cell allo-immunisation following transfusion, pretransfusion and serial post-transfusion samples were screened for allo-antibodies in a total of 452 patients who had undergone elective surgery. Antibody screening was performed by 2-stage papain, manual polybrene and indirect antiglobulin techniques (IAT). Red cell allo-antibodies were found in 42 patients and 38 of these (8.4% overall) demonstrated antibodies only after transfusion; 76% of them had Rh specificity. This rate of red cell allo-immunisation is higher than what would be expected if transfused patients were tested only once post-transfusion, as has been the case in several previous studies. For the type of patients studied, this finding may not be of clinical relevance at present because most patients undergoing elective surgery do not require further transfusion in their lifetime. However, this is changing with the longer life expectancy of the population and the increased probability of repeat surgery. Twenty-two (58%) of the antibodies were initially detected by the 2-stage papain and/or polybrene techniques, when the IAT was negative, although later 19 became positive by IAT; this added sensitivity of techniques other than the IAT, to detect early allo-immunisation may be relevant in pretransfusion testing to prevent haemolytic transfusion reactions in patients requiring repeated transfusions.
为确定输血后红细胞同种免疫的发生率及发生时间，对452例接受择期手术的患者的输血前及系列输血后样本进行了同种抗体筛查。抗体筛查采用两阶段木瓜蛋白酶法、手工聚凝胺法及间接抗球蛋白试验（IAT）。42例患者检测到红细胞同种抗体，其中38例（总体发生率8.4%）仅在输血后出现抗体；76%具有Rh特异性。红细胞同种免疫的发生率高于既往多项研究中仅在输血后检测一次受血者时的预期发生率。对于所研究的这类患者，目前这一发现可能无临床意义，因为大多数接受择期手术的患者一生中不需要再次输血。然而，随着人群预期寿命延长及再次手术可能性增加，情况正在发生变化。22例（58%）抗体最初在IAT阴性时通过两阶段木瓜蛋白酶法和/或聚凝胺法检测到，不过后来19例通过IAT转为阳性；IAT以外的技术检测早期同种免疫的这种额外敏感性，在输血前检测中对于预防需要反复输血患者的溶血性输血反应可能具有重要意义。
