Legler T J, Fischer I, Dittmann J, Simson G, Lynen R, Humpe A, Riggert J, Schleyer E, Kern W, Hiddemann W, Köhler M
Department of Transfusion Medicine, University of Göttingen, Germany.
Ann Hematol. 1997 Apr;74(4):185-9. doi: 10.1007/s002770050280.
The use of leukocyte-depleted blood components has become the standard therapy for multiply transfused patients during the past few years, as a measure to reduce the frequency of alloimmunization and refractoriness. We assessed frequency and causes of refractoriness, defined as a repeated 24-h post-transfusion platelet count below 20,000/microliters, in 145 consecutive patients who received three or more single-donor platelet concentrates during a 1-year period. Flow-cytometric detection of anti-platelet antibodies and a glycoprotein-specific ELISA were applied for the diagnosis of alloimmunization. Forty patients (27.6%) had at least one episode of refractoriness. In 25 of these 40 patients (62.5%), nonimmune factors (fever, sepsis, coagulopathy, splenomegaly) alone were the cause. In 15 refractory patients alloantibodies were detected. In seven patients (17.5%), alloimmunization alone caused an inadequate transfusion response, while in eight refractory patients (20.0%) alloimmunization and fever or sepsis were present. HLA antibodies were detected in 17 patients (11.7%); three patients (2%) had platelet-specific antibodies in addition to HLA antibodies; in two patients panreactive platelet antibodies were detectable. All 17 patients had a history of previous transfusions or pregnancy. We did not observe primary immunization in patients transfused exclusively with filtered (leukodepleted) blood products. Our data suggest that alloimmunization in patients with a negative risk history can be prevented by the exclusive use of leukodepleted blood components.
在过去几年中，使用去除白细胞的血液成分已成为多次输血患者的标准治疗方法，作为减少同种免疫和输注无效发生率的一项措施。我们评估了145例在1年期间接受三次或更多次单供者血小板浓缩物输注的连续患者中输注无效的发生率及原因，输注无效定义为输血后24小时血小板计数反复低于20,000/微升。采用流式细胞术检测抗血小板抗体和糖蛋白特异性酶联免疫吸附测定法诊断同种免疫。40例患者（27.6%）至少有一次输注无效发作。在这40例患者中的25例（62.5%），仅非免疫因素（发热、败血症、凝血病、脾肿大）是原因。在15例输注无效患者中检测到同种抗体。在7例患者（17.5%）中，仅同种免疫导致输血反应不足，而在8例输注无效患者（20.0%）中存在同种免疫和发热或败血症。在17例患者（11.7%）中检测到HLA抗体；3例患者（2%）除HLA抗体外还有血小板特异性抗体；在2例患者中可检测到全反应性血小板抗体。所有17例患者都有既往输血或妊娠史。我们在仅输注过滤（去除白细胞）血液制品的患者中未观察到初次免疫。我们的数据表明，对于无风险史的患者，通过仅使用去除白细胞的血液成分可预防同种免疫。
