Kekomäki S, Volin L, Koistinen P, Koivunen E, Koskimies S, Ruutu T, Timonen T, Kekomäki R
Finnish Red Cross Blood Transfusion Service, Helsinki.
Eur J Haematol. 1998 Feb;60(2):112-8. doi: 10.1111/j.1600-0609.1998.tb01007.x.
Six patients, 4 with acute myeloid leukaemia and 2 with a myelodysplastic syndrome who were refractory to random donor platelet transfusions and alloimmunized to human leucocyte antigens (HLA) and human platelet alloantigens (HPA), were treated with HLA- and HPA-matched platelet transfusions. In all the patients refractoriness and alloantibodies to HLA as well as HPA-1b or HPA-5b were detected simultaneously. Sixty-seven transfusions (445 units) of HLA- and HPA-matched platelets were given and responses to them were, in general, satisfactory in all the patients. No major spontaneous bleeding occurred. Four patients underwent bone marrow transplantation despite alloimmunization. The percentages of platelet transfusion days with a platelet nadir below 20x10(9)/l were 88% for the last 3 random donor platelet transfusions and 39% for the first 3 HLA- and HPA-matched platelet transfusions, respectively (p=0.009, Fisher's exact test). Four patients received also HLA-matched platelets, but responses to them were poor. The small number of transfusions with HLA-matched platelets precluded comparisons to either the random donor or HLA- and HPA-matched platelet transfusions. It seems that HLA- and HPA-alloimmunized patients can be successfully supported with HLA- and HPA-matched platelet concentrates.
6例患者，4例急性髓系白血病，2例骨髓增生异常综合征，对随机供者血小板输注无效且对人类白细胞抗原（HLA）和人类血小板同种抗原（HPA）产生同种免疫，接受了HLA和HPA配型相合的血小板输注。在所有患者中，同时检测到对HLA以及HPA-1b或HPA-5b的输注无效和同种抗体。共输注了67次（445单位）HLA和HPA配型相合的血小板，总体而言，所有患者对这些输注的反应均令人满意。未发生严重自发性出血。4例患者尽管存在同种免疫仍接受了骨髓移植。最后3次随机供者血小板输注时血小板最低点低于20×10⁹/L的血小板输注天数百分比分别为88%，而前3次HLA和HPA配型相合的血小板输注时该百分比为39%（p=0.009，Fisher精确检验）。4例患者还接受了HLA配型相合的血小板，但对其反应较差。HLA配型相合的血小板输注次数较少，无法与随机供者或HLA和HPA配型相合的血小板输注进行比较。看来，HLA和HPA同种免疫的患者可以通过HLA和HPA配型相合的血小板浓缩物得到成功支持。
