Wu K K, Thompson J S, Koepke J A, Hoak J C, Flink R
J Clin Invest. 1976 Aug;58(2):432-8. doi: 10.1172/JCI108487.
To study the antibody response to human platelet transfusions, nine thrombocytopenia patients with bone marrow failure were given 6 U (3X10(11)) of random platelet concentrates twice a week. Before transfusion, none of the patients had preexisting antibodies detectable with lymphocytotoxicity, platelet aggregation, or capillary leukoagglutination techniques. After receiving 18-78 U of platelets, they became refractory to further transfusions of random platelets and alloantibodies were detectable. Two patterns of antibody response could be identified. In three patients, the sera were not lymphocytotoxic with a panel of standard cells in which all the known HLA antigens in the first and second series were represented at least once. Yet, they caused platelet aggregation with 30, 24, and 60%, respectively, of a donor population studied. The aggregating activities were inhibited by antihuman IgG but not by antihuman IgA or antihuman IgM antiserum. The aggregating antibodies could be absorbed out with donor platelets but not lymphocytes or granulocytes. Antibodies from two of these patients aggregated platelets of their respective siblings matched for both HLA haplotypes. Transfusion of platelets from these two siblings did not increase the platelet count while platelets obtained from aggregation-negative donors did. The sera from the remaining six patients were lymphocytotoxic with 15-100% of the panel of standard cells. They also had aggregating antibodies, which could be absorbed out by both platelets and lymphocytes, suggesting that they were HLA antibodies. These data suggest that the development of platelet-specific antibodies may play an important role in the immunological rejection of isologous platelets, and should be considered in the selection of donors for patients who are refractory to platelets from random donors.
为研究对人类血小板输注的抗体反应，9例骨髓衰竭的血小板减少症患者每周两次接受6单位（3×10¹¹）随机血小板浓缩物。输血前，采用淋巴细胞毒性、血小板聚集或毛细血管白细胞凝集技术均未检测到这些患者存在预先存在的抗体。接受18 - 78单位血小板后，他们对进一步输注随机血小板产生了不应性，且可检测到同种抗体。可识别出两种抗体反应模式。在3例患者中，血清对一组标准细胞无淋巴细胞毒性，该组标准细胞中第一和第二系列的所有已知HLA抗原至少出现一次。然而，它们分别使所研究供者群体中的30%、24%和60%的血小板发生聚集。聚集活性可被抗人IgG抑制，但不能被抗人IgA或抗人IgM抗血清抑制。聚集抗体可被供者血小板吸收，但不能被淋巴细胞或粒细胞吸收。这3例患者中2例的抗体使与其HLA单倍型均匹配的各自同胞的血小板发生聚集。输注这2个同胞的血小板未使血小板计数增加，而输注来自聚集阴性供者的血小板则使血小板计数增加。其余6例患者的血清对15% - 100%的标准细胞组有淋巴细胞毒性。他们也有聚集抗体，该抗体可被血小板和淋巴细胞吸收，提示它们是HLA抗体。这些数据表明，血小板特异性抗体的产生可能在同种血小板的免疫排斥中起重要作用，在为对随机供者血小板不应性的患者选择供者时应予以考虑。
