挑战教条:红细胞导向的自身免疫作为输血后红细胞合免疫的风险因素
Josine A Oud1,2,3, Masja de Haas1,2,4, Karen M K de Vooght5
1Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.
British journal of haematology
|March 17, 2024
概括
阳性直接抗球蛋白测试 (DAT) 患者患红细胞合免疫的风险增加. 然而,由于免疫抑制条件,它们的绝对风险仍然与对照组相比较,这表明扩展匹配并不总是必要的.
科学领域:
- 免疫学 免疫学 免疫学
- 输血医学 输血医学
- 血液学 血液学 血液学
背景情况:
- 红细胞自身免疫性和共免疫性可能相互关联,影响输血策略.
- 量化这种关联对于在自身免疫患者中量化输血至关重要.
- 直接抗球蛋白试验 (DAT) 的阳性可能表明与免疫接种的风险增加.
研究的目的:
- 为了比较DAT阳性患者与对照患者的输血诱导红细胞合免疫发生率.
- 通过病例控制分析,评估DAT阳性和免疫接种之间的关联.
- 为了确定单独的DAT阳性是否需要扩展红细胞匹配策略.
主要方法:
- 事件新用户队列 47285 个以前没有输血,没有免疫接种的患者.
- 在输血后,DAT阳性和对照组之间的合免疫发病率的比较.
- 病例控制分析以调整诸如免疫调节剂和输血史等混因素.
主要成果:
- 在10个单位输血后,DAT阳性患者的累积合免疫发病率为4.5%,对照组为4.2%.
- 病例控制分析显示,在DAT阳性患者中,与免疫接种相对风险增加了1.7倍.
- 对输血暴露或Rh/K不匹配的调整没有改变观察到的风险.
结论:
- 具有DAT阳性的患者表现出对红细胞的内在较高的非免疫反应.
- 由于同时存在的免疫抑制,DAT阳性患者的绝对异免疫风险与对照人群相比较.
- 在没有公开的血液溶解或复杂抗体测试的情况下,孤立的DAT阳性不需要扩展红细胞匹配.
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