Densmore T L, Goodnough L T, Ali S, Dynis M, Chaplin H
Department of Pathology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri, USA.
Transfusion. 1999 Jan;39(1):103-6. doi: 10.1046/j.1537-2995.1999.39199116901.x.
Transfusion-related acute lung injury (TRALI) is a serious complication of plasma-containing blood components. Studies have implicated HLA antibodies along with biologically active lipids in stored blood in the pathogenesis of TRALI. It has been proposed that the exclusion of HLA-untested, multiparous donors of plasma-rich components, including plasma and single-donor apheresis platelets, would substantially reduce the risk of TRALI.
To investigate the feasibility of such an exclusion, 332 female plateletpheresis donors with a record of over 9000 donations, none of which were associated with TRALI, were studied.
Seventeen percent of female donors demonstrated HLA sensitization. Parity and HLA sensitization were significantly correlated (p<0.0001), with sensitized donors having an average of 2.9 (+/- 0.6 95% CI) prior pregnancies and unsensitized donors having an average of 1.8 (+/- 0.2 95% CI) prior pregnancies. The percentage of HLA-sensitized women with 0, 1 to 2, and > or = 3 pregnancies was 7.8, 14.6, and 26.3, respectively.
These findings confirm the hypothesis that multiparous women (> or = 3 pregnancies) represent an increased potential risk for TRALI. However, the exclusion of multiparous plateletpheresis donors would eliminate one-third of our female donor pool. Screening such donors for HLA sensitization may represent the optimal approach for identifying donors at risk for causing TRALI, but this still would result in the deferral of 8 percent of female plateletpheresis donors. At present, prospective screening to identify donors at risk for causing TRALI is not justified.
输血相关急性肺损伤（TRALI）是含血浆血液成分的一种严重并发症。研究表明，HLA抗体以及储存血液中的生物活性脂质与TRALI的发病机制有关。有人提出，排除未检测HLA的多产血浆成分捐献者，包括血浆和单采血小板，将大幅降低TRALI的风险。
为研究这种排除的可行性，对332名有超过9000次捐献记录且均未发生TRALI的女性血小板单采捐献者进行了研究。
17%的女性捐献者显示出HLA致敏。产次与HLA致敏显著相关（p<0.0001），致敏捐献者平均有2.9次（±0.6 95%CI）既往妊娠，未致敏捐献者平均有1.8次（±0.2 95%CI）既往妊娠。妊娠0次、1至2次和≥3次的HLA致敏女性的百分比分别为7.8%、14.6%和26.3%。
这些发现证实了多产女性（≥3次妊娠）发生TRALI的潜在风险增加这一假设。然而，排除多产血小板单采捐献者将使我们三分之一的女性捐献者库消失。对这类捐献者进行HLA致敏筛查可能是识别有导致TRALI风险的捐献者的最佳方法，但这仍会导致8%的女性血小板单采捐献者被推迟捐献。目前，进行前瞻性筛查以识别有导致TRALI风险的捐献者并不合理。
