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Guz K, Łopacz P, Uhrynowska M, Piaskowska K, Szczepaniak B, Krzemienowska M, Purchla-Szepioła S, Główka A, Głodkowska-Mrówka E, Orzińska A. Anti-HNA testing of allo-exposed COVID-19 convalescent plasma donors including genetic human neutrophil antigen screening to prevent anti-HNA antibody-mediated transfusion-related acute lung injury. Transfusion 2024. [PMID: 39044618 DOI: 10.1111/trf.17962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/05/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Transfusion-related acute lung injury caused by antibodies against human neutrophil antigens (HNA) is a serious but rare complication associated with blood transfusion. The presence of such antibodies is most probable in donors with a transfusion/pregnancy history. During the COVID-19 pandemic period convalescent plasma (CP) containing neutralizing antibodies against SARS-CoV-2 was widely used for COVID-19 patients as a therapy in the absence of any treatment. The aim of the study was to work out a simple diagnostic algorithm of anti-HNA testing of allo-exposed CP donors including genetic HNA screening. MATERIALS AND METHODS A total of 457 anti-HLA-negative allo-exposed CP donors were genotyped for HNA-1a/1b, HNA-3a/3b, and HNA-2, and only donors with homozygous HNA-1a/1a; HNA-3b/3b; or HNA-2null genotypes were tested for anti-HNA antibody using LabScreenMulti (One Lambda) and homozygous HNA-1b/1b using the granulocyte immunofluorescence test (GIFT) but verified using LabScreenMulti. RESULTS Testing of 83 homozygous HNA-3b/3b; HNA-2null; or HNA-1a/1a donors revealed anti-HNA-3a antibody in one case. Testing of 181 HNA-1b/1b donors using GIFT gave 10 ambiguous results verified using LabScreenMulti which confirmed anti-HNA-1a antibody in one case. The frequency of FCGR3B*01 and *04 encoding HNA-1a was 0.34; FCGR3B*02, *03, and *05 encoding HNA-1b-0.66; SLC44A2*01 encoding HNA-3a-0.80; and SLC44A2*02 encoding HNA-3b-0.20. In 3.7% cases the HNA-2null genotype was revealed. DISCUSSION Due to applying HNA genotyping as a primary test before anti-HNA antibody testing the serological work was limited only to HNA-homozygous donors revealing two anti-HNA immunized donors. The distribution of HNA genotypes in the cohort was similar to other Caucasian populations.
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Affiliation(s)
- Katarzyna Guz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Patrycja Łopacz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Małgorzata Uhrynowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Karolina Piaskowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Beata Szczepaniak
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Magdalena Krzemienowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Sylwia Purchla-Szepioła
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Anna Główka
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Eliza Głodkowska-Mrówka
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Agnieszka Orzińska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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2
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Huang M, Wang X, Wang L, Chen G. Transfusion-Related acute lung injury (TRALI) caused by antibodies to HLA-DRB1* 07:01 and HLA-DQB1*02:02: A case report. Clin Case Rep 2023; 11:e8284. [PMID: 38107079 PMCID: PMC10724081 DOI: 10.1002/ccr3.8284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/05/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is characterized by non-cardiogenic pulmonary edema and acute hypoxemia. There are few reports of HLA-II antibodies causing TRALI in China.
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Affiliation(s)
- Menggentuya Huang
- Department of Blood TransfusionThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xingtong Wang
- Senior Department of Burn and Plastic SurgeryThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Li Wang
- Department of Blood TransfusionThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Guanyi Chen
- Department of Blood TransfusionThe Fourth Medical Center of Chinese PLA General HospitalBeijingChina
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3
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Bayat B, Lowack J, Audrain M, Croisille L, Curtis B, Dangerfield R, Esmaeili B, Grabowski C, Keller M, Kim H, Kroll H, Kvanka MM, Kwok J, Moritz E, Nathalang O, Nelson D, Nielsen KR, Pahn G, Poles A, Porcelijn L, Sachs UJ, Schönbacher M, Körmöczi GF, Kupatawintu P, Takahashi D, Uhrynowska M, Flesch B, Fung YL. World human neutrophil antigens investigation survey. Vox Sang 2023; 118:763-774. [PMID: 37608544 DOI: 10.1111/vox.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Human neutrophil antigens (HNAs) are categorized into five systems: HNA-1 to HNA-5. Given the importance of neutrophils in immunity, we sought to create awareness of the role of HNA diagnostic services in managing immune neutropenia and transfusion-related acute lung injury. To provide health communities all around the world with access to these services, we conducted a survey to create a directory of these HNA diagnostic services. MATERIALS AND METHODS An Excel table-based survey was created to capture information on the laboratory's location and was emailed to 55 individuals with known or possible HNA investigation activity. The collected data were then summarized and analysed. RESULTS Of contacted laboratories, the surveys were returned from 23 (38.2%) laboratories; 17 have already established HNA diagnostic (of them 12 were regular participants of the International Granulocyte Immunobiology Workshop [ISBT-IGIW]), 4 laboratories were in the process of establishing their HNA investigation and the remaining 2 responder laboratories, did not conduct HNA investigations. In established laboratories, investigation for autoimmune neutropenia (infancies and adults) was the most frequently requested, and antibodies against HNA-1a and HNA-1b were the most commonly detected. CONCLUSION The directory of survey respondents provides a resource for health professionals wanting to access HNA diagnostic services. The present study offers a comprehensive picture of HNA diagnostics (typing and serology), identifying weak points and areas for improvement for the first time. Identifying more laboratories involved in HNA diagnostics with limited access to international societies in the field will globally improve HNA diagnostics.
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Affiliation(s)
- Behnaz Bayat
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Jonas Lowack
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Marie Audrain
- Service d'Immunologie, Laboratoire de Biologie, Nantes, France
| | | | - Brian Curtis
- Platelet & Neutrophil Immunology Lab, Versiti, Milwaukee, Wisconsin, USA
| | - Rebecca Dangerfield
- American Red Cross Neutrophil Immunology Laboratory, St Paul, Minnesota, USA
| | - Behnaz Esmaeili
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Claudia Grabowski
- Institut für Transfusionsmedizin Dessau, DRK-Blutspendedienst NSTOB, Dessau, Germany
| | - Margaret Keller
- American Red Cross Neutrophil Immunology Laboratory, St Paul, Minnesota, USA
| | - Hyungsuk Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Hartmut Kroll
- Institut für Transfusionsmedizin Dessau, DRK-Blutspendedienst NSTOB, Dessau, Germany
| | | | - Janette Kwok
- Division of Transplantation and Immunogenetic, Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Elyse Moritz
- Clinical and Experimental Oncology, Escola Paulista de Medicinia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Oytip Nathalang
- Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Derrick Nelson
- Specialized Laboratory Services, South African National Blood Service, Johannesburg, South Africa
| | | | - Gail Pahn
- Platelet & Granulocyte Reference Laboratory, Australian Red Cross Lifeblood, Brisbane, Australia
| | - Anthony Poles
- Department of Histocompatibility & Immunogenetics, NHS Blood & Transplant, Bristol, UK
| | - Leendert Porcelijn
- Platelet/Leucocyte Serology Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Ulrich J Sachs
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Marlies Schönbacher
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Günther F Körmöczi
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Brigitte Flesch
- Laboratory for Immunogenetics/HLA, DRK Blutspendedienst West, Bad Kreuznach, Germany
| | - Yoke-Lin Fung
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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4
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Chen DW, Kang T, Xu XZ, Xia WJ, Ye X, Wu YB, Xu YR, Liu J, Ren H, Deng J, Chen YK, Ding HQ, Aslam M, Zelek WM, Morgan BP, Kapur R, Santoso S, Fu YS. Mechanism and intervention of murine transfusion-related acute lung injury caused by anti-CD36 antibodies. JCI Insight 2023; 8:165142. [PMID: 36809299 PMCID: PMC10070104 DOI: 10.1172/jci.insight.165142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Anti-CD36 Abs have been suggested to induce transfusion-related acute lung injury (TRALI) upon blood transfusion, particularly in Asian populations. However, little is known about the pathological mechanism of anti-CD36 Ab-mediated TRALI, and potential therapies have not yet been identified. Here, we developed a murine model of anti-CD36 Ab-mediated TRALI to address these questions. Administration of mouse mAb against CD36 (mAb GZ1) or human anti-CD36 IgG, but not GZ1 F(ab')2 fragments, induced severe TRALI in Cd36+/+ male mice. Predepletion of recipient monocytes or complement, but not neutrophils or platelets, prevented the development of murine TRALI. Moreover, plasma C5a levels after TRALI induction by anti-CD36 Abs increased more than 3-fold, implying a critical role of complement C5 activation in the mechanism of Fc-dependent anti-CD36-mediated TRALI. Administration of GZ1 F(ab')2, antioxidant (N-acetyl cysteine, NAC), or C5 blocker (mAb BB5.1) before TRALI induction completely protected mice from anti-CD36-mediated TRALI. Although no significant amelioration in TRALI was observed when mice were injected with GZ1 F(ab')2 after TRALI induction, significant improvement was achieved when mice were treated postinduction with NAC or anti-C5. Importantly, anti-C5 treatment completely rescued mice from TRALI, suggesting the potential role of existing anti-C5 drugs in the treatment of patients with TRALI caused by anti-CD36.
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Affiliation(s)
- Da-Wei Chen
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Tian Kang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiu-Zhang Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Wen-Jie Xia
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Xin Ye
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yong-Bin Wu
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yao-Ri Xu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Jing Liu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Hui Ren
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Jing Deng
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Yang-Kai Chen
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Hao-Qiang Ding
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
| | - Muhammad Aslam
- Department of Cardiology and Angiology, Justus Liebig University, Giessen, Germany
| | - Wioleta M Zelek
- Dementia Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - B Paul Morgan
- Dementia Research Institute, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Rick Kapur
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sentot Santoso
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Yong-Shui Fu
- Institute of Blood Transfusion, Guangzhou Blood Centre, Guangzhou, Guangdong, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, China
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5
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Rophina M, Bhoyar RC, Imran M, Senthivel V, Divakar MK, Mishra A, Jolly B, Sivasubbu S, Scaria V. Genetic landscape of human neutrophil antigen variants in India from population-scale genomes. HLA 2023; 101:262-269. [PMID: 36502377 DOI: 10.1111/tan.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Antibodies against human neutrophil antigens (HNAs) play a significant role in various clinical conditions such as neonatal alloimmune neutropenia, transfusion-related acute lung injury, and other nonhemolytic transfusion reactions. This study aims to identify the genotype and allele frequencies of HNAs in the healthy Indian population. Ten genetic variants in four human genes encoding alleles of HNAs class I-V approved by the International Society of Blood Transfusion-Granulocyte Immunobiology Working Party were used in the analysis. Genetic variants from whole genome sequences of 1029 healthy Indian individuals corresponding to HNA alleles were analyzed. The frequencies of the variants were compared with global population datasets using an in-house computational pipeline. In HNA class I, allele frequencies of FCGR3B*01, FCGR3B*02, and FCGR3B*03 encoding HNA-1a, HNA-1b, and HNA-1c were 0.07, 0.8, and 0.13, respectively. HNA class 3 alleles namely SLC44A2*01 (encoding HNA-3a) and SLC44A2*02 (encoding HNA-3b) were found at allele frequencies of 0.78 and 0.22, respectively. The frequencies of ITGAM*01 encoding HNA-4a and ITGAM*02 encoding HNA-4a were 0.95 and 0.05, respectively. Furthermore, allele frequencies of HNA class 5 alleles were 0.32 for ITGAL*01 (encoding HNA-5a) and 0.68 for ITGAL*02 (encoding HNA-5b). Interestingly, it was also found that rs2230433 variant deciding the HNA class 5 alleles, was highly prevalent (78.2%) in the Indian population compared with other global populations. This study presents the first comprehensive report of HNA allele and genotype frequencies in the Indian population using population genome datasets of 1029 individuals. Significant difference was observed in the prevalence of HNA5a and HNA5b in India in comparison to other global populations.
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Affiliation(s)
- Mercy Rophina
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Rahul C Bhoyar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Vigneshwar Senthivel
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Mohit Kumar Divakar
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Anushree Mishra
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Bani Jolly
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Sridhar Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Vinod Scaria
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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6
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Yuan Y, Dennington PM, Daly J, Baidya S, Tung JP. The impact of revised definitions for transfusion-associated circulatory overload and transfusion-related acute lung injury on haemovigilance reporting. Vox Sang 2023; 118:199-206. [PMID: 36654528 DOI: 10.1111/vox.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are serious adverse transfusion reactions. Standardized surveillance definitions are important to ensure consistent reporting of cases. Recently, revised definitions have been developed for TACO and TRALI, the latter of which has not yet been widely implemented. This study aimed to assess the impact of the new TACO and TRALI definitions on haemovigilance reporting. MATERIALS AND METHODS The Australian Red Cross Lifeblood Adverse Transfusion Reaction database was accessed to identify all cases of suspected or confirmed TACO and TRALI referred from 1 July 2015 to 30 June 2019. Cases were assessed against both the former and new definitions and the results were compared. RESULTS A total of 73 cases were assessed. There were 48 TACO cases identified. Only 26 of 48 cases strictly met the former 2011 International Society of Blood Transfusion (ISBT) definition of TACO; 6 cases did not meet the definition and 16 cases lacked sufficient clinical details. In comparison, 46 cases met the revised 2018 ISBT definition, with only 2 cases having insufficient details. There were 24 cases of TRALI according to the existing 2004 Canadian Consensus Conference (CCC) definition compared with 25 cases according to the proposed 2019 revised definition. CONCLUSION The revised TACO definition captured more cases than the former definition. No significant differences were observed in the number of TRALI cases under the proposed new definition. This is the first study to provide validation data for the revised TRALI definition.
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Affiliation(s)
- Yin Yuan
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia.,WEHI, Melbourne, Australia
| | - Peta M Dennington
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - James Daly
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - Shoma Baidya
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia
| | - John-Paul Tung
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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7
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Human neutrophil antigen-1, -3, -4, and -5 allele and genotype frequencies in the Croatian blood donor population and their clinical significance. Transfus Clin Biol 2023; 30:111-115. [PMID: 36243306 DOI: 10.1016/j.tracli.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Human neutrophil antigens (HNAs) and antibodies play an important role in allo- and autoimmunity associated with immune neutropenia and transfusion reactions. The aim of this study was to determine the HNA-1, -3, -4 and -5 allele and genotype frequencies in the Croatian blood donor population to assess the role of HNA-1, -3, -4, and -5 alleles in the development of neonatal alloimmune neutropenia and antibody-mediated transfusion-related acute lung injury. MATERIAL AND METHODS A total of 371 blood samples from unselected healthy blood donors were analyzed. Samples from all 371 donors were genotyped for HNA-1, samples from 160 donors were genotyped for HNA-3, and samples from 142 donors were genotyped for HNA-4 and HNA-5 using the polymerase chain reaction with sequence-specific primers (PCR-SSP) method. RESULTS The frequencies of the FCGR3B*01, FCGR3B*02 and FCGR3B*03 HNA-1 alleles were 0.393, 0.607 and 0.022, and of the SLC44A2*01 and SLC44A2*02 HNA-3 alleles 0.781 and 0.219, respectively. The frequencies of the ITGAM*01 and ITGAM*02 HNA-4 alleles were 0.796 and 0.204, and of the ITGAL*01 and ITGAL*02 HNA-5 alleles 0.718 and 0.282, respectively. CONCLUSION These are the first results on the HNA allele and genotype frequencies in the Croatian blood donor population. We observed no deviations from previous reports on Caucasian populations. Determination of the HNA antigen frequencies in the population is important to estimate the risk of alloimmunization to HNA, especially the risk of fetal-maternal incompatibility and alloantibody production by transfusion of the HNA incompatible blood components.
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8
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Le A, Liu W, Wu C, Hu P, Zou J, Wu Y, Kuang L. Polymorphonuclear neutrophil activation by Src phosphorylation contributes to HLA-A2 antibody-induced transfusion-related acute lung injury. Mol Immunol 2022; 150:9-19. [PMID: 35914412 DOI: 10.1016/j.molimm.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/18/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
Human leukocyte antigen (HLA)-A2 antibody contributes to the pathogenesis of transfusion-related acute lung injury (TRALI) via polymorphonuclear neutrophil (PMN) activation, but the signaling pathways involved this process remain largely undefined. In this study, we sought to study the signaling pathways involved in the pathogenesis of HLA-A2-induced TRALI. Lipopolysaccharide (LPS), and the plasma from the HLA-A2 antibody-positive donors were utilized to establish a rat model of TRALI. Human pulmonary endothelial cells (HPMECs) were in vitro co-cultured with HLA-A2 antibody-treated PMNs and then treated with LPS to induce a cytotoxicity model. The effects of HLA-A2 antibody on HPMEC injury were evaluated in this model. Besides, dasatinib was used to block the Src phosphorylation to explore whether Src involved in the TRALI or HPMEC injury induced by HLA-A2 antibody. The HLA-A2 antibody plus LPS induced TRALI and stimulated PMN activation in rats. HLA-A2 antibody-induced TRALI could be attenuated via depletion of PMN. HLA-A2 antibody activated NF-κB and NLRP3 inflammasome. In addition, HLA-A2 antibody aggravated the HPMEC injuries and the release of PMN surfaces makers, but dasatinib treatment reversed this effect, indicating that HLA-A2 antibody activated PMNs and exacerbated TRALI by stimulating phosphorylation of Src followed by activation of NF-κB and NLRP3 inflammasome, which was validated in vivo. In summary, HLA-A2 induced PMNs by activating NF-κB/NLRP3 inflammasome via phosphorylated-Src elevation, thereby exacerbating TRALI. This study highlights promising target for the treatment of antibody-mediated TRALI.
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Affiliation(s)
- Aiping Le
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
| | - Wei Liu
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Chenggao Wu
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Piaoping Hu
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Juan Zou
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Yize Wu
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Linju Kuang
- Departments of Blood Transfusion, The First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
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9
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Hendriana D, Maulydia M, Airlangga P, Siregar MT. Transfusion-related acute lung injury (TRALI) management in post-partum bleeding patient: A case report. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Tung JP, Chiaretti S, Dean MM, Sultana AJ, Reade MC, Fung YL. Transfusion-related acute lung injury (TRALI): Potential pathways of development, strategies for prevention and treatment, and future research directions. Blood Rev 2022; 53:100926. [DOI: 10.1016/j.blre.2021.100926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023]
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11
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Korkmaz E, Korkut S, Akkoyun N. A Retrospective Analysis of Transfusion Reactions at a Tertiary Care Center: An Institutional Hemovigilance Study. J Contin Educ Nurs 2021; 52:581-588. [PMID: 34870535 DOI: 10.3928/00220124-20211108-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The goal of our study was to determine the frequency and type of transfusion reactions (TRs) as well as other hemovigilance activities reported at a tertiary care hospital in Turkey over a period of 3 years. METHOD In this retrospective study, the notification sheets of TRs reported to the institution's local hemovigilance system between December 2017 and December 2020 were analyzed. RESULTS A total of 89,187 units of blood components were administered to patients during this period. A total of 197 TRs were reported to the hemovigilance system. The overall frequency of TRs was 0.22%. The most common TRs were allergic reactions (49.2%) and febrile nonhemolytic transfusion reactions (37.6%), respectively. Most of the adverse events were reported by clinical nurses. CONCLUSION Our study showed that the frequency of TRs was low, and most were manageable reactions. We found that reporting of all TRs and continuous nursing education can help to strengthen the hemovigilance system. [J Contin Educ Nurs. 2021;52(12):581-588.].
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Simtong P, Sudwilai Y, Cheunta S, Leelayuwat C, Romphruk AV. Prevalence of leucocyte antibodies in non-transfused male and female platelet apheresis donors. Transfus Med 2021; 31:186-192. [PMID: 33949000 DOI: 10.1111/tme.12781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In our study group of Thai PLT apheresis donors, we assessed the prevalence of anti-leucocyte antibodies. BACKGROUND Antibodies against human leucocyte antigens (anti-HLA), neutrophil antigens (anti-HNA), and major histocompatibility complex class I related chain A (anti-MICA) in blood products can lead to transfusion-related acute lung injury (TRALI). To reduce the risk of TRALI, some blood centres are implementing strategies based on screening platelet (PLT) apheresis donors for the presence of anti-leucocyte antibodies. METHODS/MATERIALS Blood samples were collected from non-transfused individuals, 340 males and 63 females (50 nulliparous and 13 parous). Anti-HLA class I and II and anti-MICA were analysed using the Luminex assay, and anti-HNA-3 was detected using the granulocyte agglutination test. RESULTS Anti-HLA was found in 14 of 403 subjects (3.5%). Ten subjects (2.5%) tested positive for HLA class I, 2 (0.5%) for HLA class II, and 2 (0.5%) for both HLA class I and HLA class II. Anti-HLA class I or II were detected in 2 of 13 (15.4%) parous females and only anti-HLA class I was found in 4 (8.0%) nulliparous females. Six of 327 subjects tested (1.8%), all males, were positive for anti-MICA. Anti-HNA-3 was not found in any of the 403 individuals. CONCLUSIONS Screening for anti-HLA class I and II should be implemented for Thai PLT apheresis donors. Although immunisation against HNA and MICA seems to be a rare event in Thais, further work is necessary to decide whether our PLT apheresis donors should be screened for HNA and MICA antibodies.
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Affiliation(s)
- Piyapong Simtong
- Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Yupaporn Sudwilai
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siriluk Cheunta
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chanvit Leelayuwat
- Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Amornrat V Romphruk
- The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Schulz U. Antikörper gegen humane Leukozytenantigene (HLA) bei männlichen Apheresespendern ohne klassische Alloimmunisierung. TRANSFUSIONSMEDIZIN 2020. [DOI: 10.1055/a-1119-1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Im Rahmen von Präventivmaßnahmen zur Vermeidung von TRALI (transfusionsassoziierte akute Lungeninsuffizienz) wurden in einer Studie 15 523 männliche und weibliche Apheresespenderinnen und -spender mit und ohne positiver Immunisierungsanamnese (IA) auf HLA-Klasse-I-, HLA-Klasse-II- und HNA-Antikörper (AK) untersucht. Unsere Ergebnisse zeigten, dass bei 3,85% der männlichen Spender ohne IA HLA-AK und bei 0,10% HNA-AK auftraten. Diese Beobachtung stellt die seit Beginn der HLA-Ära vor 50 Jahren klar bewiesene Aussage infrage, dass HLA-AK nur durch eine Alloimmunisierung infolge von Schwangerschaften, Transfusionen oder Transplantationen entstehen können. Wir diskutieren mehrere mögliche Kausalitäten dieser positiven Reaktionen:Große Aufmerksamkeit richteten wir auf den Ausschluss möglicher falsch positiver Reaktionen, da der LABScreen Multi als höchst sensitiv eingeschätzt wird. Nach Validierung eines neuen positiven Normalized-Background-Cut-offs (NBG: Normalized Background) und der Nachtestung von Rückstellproben der als positiv getesteten männlichen Spender konnten 50% der HLA-Klasse-I- und 43% der HLA-Klasse-II-AK nicht bestätigt werden. Dennoch blieben 1,5% der getesteten männlichen Spender für HLA-Klasse I und 0,5% für HLA-Klasse II positiv. Handelt es sich hier ausschließlich um HLA-spezifische oder um heterophile AK? Welche klinische Bedeutung haben diese AK bei der Prävalenz von TRALI oder für die Transplantationsimmunologie?
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Affiliation(s)
- Undine Schulz
- Institut für Transfusionsmedizin Cottbus, DRK-Blutspendedienst Nord-Ost gGmbH, Cottbus
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14
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Schönbacher M, Aichinger N, Weidner L, Jungbauer C, Grabmer C, Schuha B, Rohde E, Mayr W, Körmöczi G. Leukocyte-Reactive Antibodies in Female Blood Donors: The Austrian Experience. Transfus Med Hemother 2020; 48:99-108. [PMID: 33976610 DOI: 10.1159/000509946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/05/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Antibody-mediated transfusion-related acute lung injury (TRALI) is caused by antibodies against human leukocyte antigens (HLAs) or human neutrophil antigens (HNAs), and is one of the most serious complications associated with transfusion medicine. Prevention strategies like testing allo-exposed female blood donors have not yet been introduced nationwide in Austria. To assess the need and feasibility of routine leukocyte antibody testing, the prevalence of leukocyte-reactive antibodies in an Austrian female donor population was been determined using classical cell-based methods which were compared with a high-throughput bead-based method. Methods Sera from 1,022 female blood donors were screened using a granulocyte aggregation test (GAT) and a white blood cell immunofluorescence test (WIFT) after retesting and specification of positive samples by granulocyte immunofluorescence test (GIFT) and monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA). Potential HLA reactivities were confirmed using the microbeads assay LabScreenTM Mixed. The results in 142 donor sera and 38 well-defined reference sera were investigated by the microbeads assay LabScreenTM Multi and compared with classical cell-based methods. Results Reactivity with either granulocytes and/or lymphocytes was detected in 79 sera (7.7%), with the majority being HLA-specific. Antibodies against HNA were obtained in 7 samples (0.7%). The aggregating potential of the detected antibodies was observed in 9 cases (0.9%). Most of the leukocyte-reactive antibodies occurred at a donor age of between 35 and 59 years (n = 61). LabScreen Multi showed good agreement (κ = 0.767) for HNA antibody detection by cell-based assays, but double/multiple specificities (100% of 7 anti-HNA-1b sera) as well as false-negative results (40% of 15 HNA-3-specific sera) occurred. Discussion Leukocyte-reactive antibody screening is advised in Austrian female donors for safe blood transfusion, including single-donor convalescent plasma treatment of COVID-19 that may be implemented soon. For the introduction of LabScreen Multi, the combination with GAT should be considered to ensure correct anti-HNA-3a detection.
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Affiliation(s)
- Marlies Schönbacher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicole Aichinger
- Department of Transfusion Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Lisa Weidner
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Christof Jungbauer
- Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Christoph Grabmer
- Department of Transfusion Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Beate Schuha
- Department of Transfusion Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Wolfgang Mayr
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.,Austrian Red Cross, Blood Service for Vienna, Lower Austria and Burgenland, Vienna, Austria
| | - Günther Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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15
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Contemporary resuscitation of hemorrhagic shock: What will the future hold? Am J Surg 2020; 220:580-588. [PMID: 32409009 PMCID: PMC7211588 DOI: 10.1016/j.amjsurg.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Resuscitation of the critically ill patient with fluid and blood products is one of the most widespread interventions in medicine. This is especially relevant for trauma patients, as hemorrhagic shock remains the most common cause of preventable death after injury. Consequently, the study of the ideal resuscitative product for patients in shock has become an area of great scientific interest and investigation. Recently, the pendulum has swung towards increased utilization of blood products for resuscitation. However, pathogens, immune reactions and the limited availability of this resource remain a challenge for clinicians. Technologic advances in pathogen reduction and innovations in blood product processing will allow us to increase the safety profile and efficacy of blood products, ultimately to the benefit of patients. The purpose of this article is to review the current state of blood product based resuscitative strategies as well as technologic advancements that may lead to safer resuscitation.
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16
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Kuldanek SA, Kelher M, Silliman CC. Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update. Expert Rev Hematol 2019; 12:773-785. [PMID: 31282773 PMCID: PMC6715498 DOI: 10.1080/17474086.2019.1640599] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
Introduction: Despite mitigation strategies that include the exclusion of females from plasma donation or the exclusion of females with a history of pregnancy or known anti-leukocyte antibody, transfusion-related acute lung injury (TRALI) remains a leading cause of transfusion-related morbidity and mortality. Areas covered: The definition of TRALI is discussed and re-aligned with the new Berlin Diagnostic Criteria for the acute respiratory distress syndrome (ARDS). The risk factors associated with TRALI are summarized as are the mitigation strategies to further reduce TRALI. The emerging basic research studies that may translate to clinical therapeutics for the prevention or treatment of TRALI are discussed. Expert opinion: At risk patients, including the genetic factors that may predispose patients to TRALI are summarized and discussed. The re-definition of TRALI employing the Berlin Criteria for ARDS will allow for increased recognition and improved research into pathophysiology and mitigation to reduce this fatal complication of hemotherapy.
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Affiliation(s)
- Susan A. Kuldanek
- The Division of Transfusion Medicine, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pathology, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Marguerite Kelher
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Christopher C. Silliman
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Vitalant Research Institute, Vitalant Mountain Division, Denver, CO, USA
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17
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Vlaar APJ, Toy P, Fung M, Looney MR, Juffermans NP, Bux J, Bolton-Maggs P, Peters AL, Silliman CC, Kor DJ, Kleinman S. A consensus redefinition of transfusion-related acute lung injury. Transfusion 2019; 59:2465-2476. [PMID: 30993745 PMCID: PMC6850655 DOI: 10.1111/trf.15311] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI. STUDY DESIGN AND METHODS An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases. RESULTS In the redefinition, the term "possible TRALI" has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies. CONCLUSIONS Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.
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Affiliation(s)
- Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Pearl Toy
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | - Mark R Looney
- Departments of Medicine and Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Juergen Bux
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion Office, Manchester Blood Centre, Manchester, United Kingdom
| | - Anna L Peters
- Division Vital Functions, Department of Anesthesiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Christopher C Silliman
- School of Medicine, Pediatrics and Surgery, University of Colorado Denver, Denver, Colorado
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steve Kleinman
- Department of Pathology, University British Columbia, Vancouver, British Columbia, Canada
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18
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Kopko PM, Bux J, Toy P. Antibodies associated with TRALI: differences in clinical relevance. Transfusion 2018; 59:1147-1151. [PMID: 30548883 DOI: 10.1111/trf.15094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Patricia M Kopko
- Department of Pathology, University of California, San Diego, San Diego, California
| | | | - Pearl Toy
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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19
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Roubinian N. TACO and TRALI: biology, risk factors, and prevention strategies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:585-594. [PMID: 30570487 PMCID: PMC6324877 DOI: 10.1182/asheducation-2018.1.585] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related morbidity and mortality. These adverse events are characterized by acute pulmonary edema within 6 hours of a blood transfusion and have historically been difficult to study due to underrecognition and nonspecific diagnostic criteria. However, in the past decade, in vivo models and clinical studies utilizing active surveillance have advanced our understanding of their epidemiology and pathogenesis. With the adoption of mitigation strategies and patient blood management, the incidence of TRALI and TACO has decreased. Continued research to prevent and treat these severe cardiopulmonary events is focused on both the blood component and the transfusion recipient.
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Affiliation(s)
- Nareg Roubinian
- Blood Systems Research Institute, San Francisco, CA; Kaiser Permanente Northern California Medical Center and Division of Research, Oakland, CA; and Department of Laboratory Medicine, University of California, San Francisco, CA
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20
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Time from venipuncture to cell isolation: Impact on granulocyte-reactive antibody testing. Clin Biochem 2018; 63:72-78. [PMID: 30447182 DOI: 10.1016/j.clinbiochem.2018.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Classical neutrophil-reactive antibody testing depends on the quick isolation of neutrophils from freshly taken whole blood. To allow a better logistic preparation before testing, the influence of time interval between venipuncture and cell isolation has been evaluated in this study. MATERIALS AND METHODS Neutrophils and whole leukocytes were isolated from EDTA whole blood immediately (T0) as well as 4, 8 and 24 h after blood donation (T4, T8 and T24). These cells were tested against reference sera containing antibodies against HNA-1b, -2, -3a and HLA class I using granulocyte aggregation test (GAT), microscopic granulocyte immunofluorescence test (GIFT) and flow-cytometric white blood cell immunofluorescence test (Flow-GIFT/WIFT). RESULTS GAT was the most error-prone test displaying overall weaker aggregation strengths already at T4 (overall accuracy OA = 0.72, κ = 0.58). GIFT results showed good agreement at T4 (OA = 0.86, κ = 0.79) and remained stable until T8, while test results were slightly impaired at T24 (OA = 0.71, κ = 0.55). Flow-GIFT/WIFT was identified as the most robust screening method, remaining stable even at T24. Calculated ratios (sample/negative control) decreased non-significantly and remained highly above the cut-off in all samples. CONCLUSION Acceptable time limits for cell isolation are different for each screening method investigated. For GAT, cell isolation should be performed within 4 h, while GIFT tolerates a neutrophil isolation delay of 8 h. Flow-GIFT/WIFT isolation can be performed even after 24 h without impairment of the results. Using the latter test as a stand-alone pre-screening test, whole blood can be used from donors who are not directly accessible.
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21
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Flesch BK, Reil A. Molecular Genetics of the Human Neutrophil Antigens. Transfus Med Hemother 2018; 45:300-309. [PMID: 30498408 PMCID: PMC6257083 DOI: 10.1159/000491031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Antibodies to human neutrophil antigens (HNAs) have been implicated in transfusion-related acute lung injury and allo- and autoimmune neutropenia. To date, five HNA systems are assigned, and during the last decades enormous efforts have been undertaken to identify the underlying genes and to characterize the antigens. This review of the literature will provide the current genetic, molecular and functional information on HNAs. RECENT FINDINGS New information on alleles and antigens has been added to nearly each of the five HNA systems. HNA-1d has been added as the antithetical epitope to HNA-1c that is located on the glycoprotein encoded by FCGR3B*02 but not by FCGR3B. FCGR3B*04 and *05 now are included as new alleles. A CD177*787A>T substitution was demonstrated as the main reason for the HNA-2-negative phenotype on neutrophils. The target glycoprotein of HNA-3 antibodies could be identified as choline transporter-like protein 2 (CTL2) encoded by SLC44A2. The conformation sensitive epitope discriminates between arginine and glutamine at position 152 resulting in HNA-3a and HNA-3b. An additional Leu151Phe substitution can impair HNA-3a antibody binding. Recently an alloantibody against HNA-4b which discriminates from HNA-4a by an Arg61His exchange of the glycoprotein encoded by the ITGAM gene was reported in neonatal alloimmune neutropenia. An update of the current HNA nomenclature based on the new findings was provided in 2016 by the ISBT Granulocyte Immunobiology Working Party nomenclature subcommittee. CONCLUSIONS The molecular basis of each of the five HNA antigen systems has been decoded during the past decades. This enables reliable molecular typing strategies, antibody detection and specification as well as development of new assays based on recombinant antigens. However, research on HNA alleles, antigens, and antibodies is not finally terminated and also in the future will add new findings.
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22
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Nguyen XD, Schulze TJ, Bugert P, Lauber-Härtl S, Schulz-Linkholt M, González-Schulze K, Reil A, Dengler T, Panzer S, Seifried E. Granulocyte antibodies in male blood donors: can they trigger transfusion-related acute lung injury? Transfusion 2018; 58:1894-1901. [PMID: 29707799 DOI: 10.1111/trf.14630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND White blood cell-associated antibodies can lead to transfusion-related acute lung injury (TRALI). Female donors with a history of pregnancies have been identified as a main cause for these antibodies. Male or female donors without a history of pregnancy are considered as safe donors. STUDY DESIGN AND METHODS Following the identification of two TRALI cases associated with blood products from male donors, we investigated the frequency of granulocyte-specific and human leukocyte antigen (HLA) antibodies in the entire blood donor population using a high throughput automated flow-cytometry-based granulocyte immunofluorescence test (Flow-GIFT). We investigated sera from 14,343 whole blood donors (female, n = 6974, 48.7%; male, n = 7369, 51.3%) using automated Flow-GIFT. Of the female blood donors, 60.4% had a history of pregnancy. Positive sera were retested by the standard granulocyte immunofluorescence test and granulocyte agglutination test. For the detection of HLA Class I and II immunoglobulin G antibodies, we used a commercial screening enzyme-linked immunosorbent assay. RESULTS We detected in 924 (21.9%) of the 4212 females with a history of pregnancy antibodies against granulocyte antigens (n = 62, 1.5%), HLA Class I and/or II antigens (n = 864, 20.5%). Notably, in 3.5% (n = 96) of 2762 females without a history of pregnancy and in 2.1% (n = 154) of 7369 males antibodies against granulocyte antigens (n = 13, 0.47% and n = 45, 0.6%), HLA Class I and/or II (n = 83, 3% and n = 109, 1.4%, respectively), were also detected. CONCLUSION Human neutrophil antigen antibodies are rare in male and females without a history of pregnancy compared to females with a history of pregnancy, but their relevance is not negligible.
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Affiliation(s)
- Xuan-Duc Nguyen
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Torsten J Schulze
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.,German Red Cross Blood Service NSTOB, Institute Springe, Springe, Germany
| | - Peter Bugert
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Stephanie Lauber-Härtl
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Monika Schulz-Linkholt
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Karen González-Schulze
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | | | - Thomas Dengler
- Institute of Transfusion Medicine and Immunohematology, Baden-Baden, German Red Cross Blood Service Baden-Württemberg-Hessen, Baden-Baden, Germany
| | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg-Hessen, Goethe University Hospital, Frankfurt am Main, Germany
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23
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Ou GJ, Su PC, Yu H, Ji X, Liu F, Wang SL, Kong YJ, Li L, Wang J, Liu Z, Flegel WA. HNA-3a and HNA-3b antigens among 9 ethnic populations and the Han population in Southwest China. J Transl Med 2018. [PMID: 29540240 PMCID: PMC5853077 DOI: 10.1186/s12967-018-1447-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Human neutrophil antigen 3 (HNA-3) is encoded by the SLC44A2 gene. Antibodies against HNAs can cause severe, often fatal, transfusion reactions, known as transfusion-related acute lung injury, and neonatal neutropenia. We explored the 2 common HNA-3 variants in 9 ethnic populations residing in Sichuan and Yunnan provinces of China as compared to the Han population. Methods We genotyped for SLC44A2 (rs2288904) by polymerase chain reaction sequence-based typing among blood donors, for a total of 2206 individuals in Yunnan and 376 in Sichuan. Results The SLC44A2*02 allele (HNA-3b antigen) frequency varied between 0.24 and 0.33 for all 9 ethnic populations in Yunnan, including Zhuang, Derung, Hani, Lisu, Bai, Miao, Dai, Naxi, and Yi. Specifically, the Yi ethnicity did not present an unusually great SLC44A2*02 frequency at any of the 4 locations examined in Yunnan. Except of the Yi ethnicity in Sichuan (0.40), the Han ethnicity, as the majority population group, had the greatest SLC44A2*02 frequency with 0.39 in Yunnan and 0.35 in Sichuan. Conclusion The ethnic populations in Southwest China are not at an increased risk for anti-HNA3a compared to the Han population, with the possible exception of Yi in Sichuan. Our data, however, corroborated the known high prevalence of SLC44A2*02 in Han populations. Hence, the Han populations in Yunnan, Sichuan and elsewhere in China are at a comparatively great risk for developing HNA-3a antibodies.
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Affiliation(s)
- Guo-Jin Ou
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Pin-Can Su
- Transfusion Medicine Research Department, Yunnan Kunming Blood Center, Kunming, China
| | - Hao Yu
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Xin Ji
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Fan Liu
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Sheng-Lan Wang
- Blood Center of the Liangshan Autonomous Region, Sichuan, China
| | - Yu-Jie Kong
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Ling Li
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China
| | - Jue Wang
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China. .,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China.
| | - Zhong Liu
- Clinical Blood Transfusion Research Center, Institute of Blood Transfusion, CAMS & PUMC, No. 26 Hua-Cai Road, Chenghua District, Chengdu, 610052, Sichuan, China. .,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, Sichuan, China.
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Affiliation(s)
- Y. L. Fung
- School of Health & Sports Sciences; University of Sunshine Coast; Sunshine Coast QLD Australia
| | - J.P. Tung
- Research and Development; Australian Red Cross Blood Service; Kelvin Grove QLD Australia
- Critical Care Research Group; University of Queensland and The Prince Charles Hospital; Brisbane QLD Australia
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25
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Andreu G, Boudjedir K, Muller JY, Pouchol E, Ozier Y, Fevre G, Gautreau C, Quaranta JF, Drouet C, Rieux C, Mertes PM, Clavier B, Carlier M, Sandid I. Analysis of Transfusion-Related Acute Lung Injury and Possible Transfusion-Related Acute Lung Injury Reported to the French Hemovigilance Network From 2007 to 2013. Transfus Med Rev 2018; 32:16-27. [DOI: 10.1016/j.tmrv.2017.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/13/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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26
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Liao X, Li H, Jiao W, Zhu C, Wang W, Mo Z, Yang Z, Zhu Z. Genotype frequencies of human neutrophil antigen-3 in the Chinese Zhuang and Dong populations. Int J Immunogenet 2017; 44:274-278. [PMID: 29057627 DOI: 10.1111/iji.12339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/01/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Abstract
Individuals with the human neutrophil antigen (HNA)-3b/3b type can produce HNA-3a antibodies, which have been reported to cause severe, sometimes fatal transfusion-related acute lung injury (TRALI). Our study aimed to determine the genotype frequency of HNA-3a/3b which will be helpful to estimate the potential risk for forming anti-HNA-3a, the clinically relevant antibody linked to TRALI in two different ethnic groups of southern China. Five hundred unrelated and healthy blood donors (284 male, 216 female; 300 Zhuangs, 200 Dongs) from the Guangxi Zhuang Autonomous Region were simultaneously typed for the HNA-3 allele using a polymerase chain reaction sequence-based typing (PCR-SBT) method. Genotype frequencies of HNA-3a/3a, HNA-3a/3b and HNA-3b/3b were 51.7%, 39.7% and 8.6% in the Zhuang population, and 44.0%, 49.0% and 7.0% in the Dong population, respectively. Homozygous HNA-3b/3b genotype frequency among the Zhuang population (8.6%) was significantly higher than previously reported in African Americans (0.4%), Brazilians (3.6%) and English Caucasians (2.9%) (p < .05). And the HNA-3b/3b genotype frequency among the Dong population was higher than African Americans (0.4%) (p < .05). This study showed Chinese Zhuang and Dong populations possessed a higher frequency of HNA-3b/3b genotype, suggesting that they may be at greater risk for developing anti-HNA-3a alloantibodies that may cause severe cases of TRALI. A molecular-based identification of the HNA-3b/3b genotype in all multiparous female blood donors was suggested to reduce the risk of TRALI following plasma and whole blood allogeneic transfusions.
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Affiliation(s)
- X Liao
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - H Li
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - W Jiao
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - C Zhu
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - W Wang
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - Z Mo
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - Z Yang
- Department of Blood Transfusion, The People's Hospital of Guanqxi Zhuang Autonomous Region, Nanning, China
| | - Z Zhu
- Blood Group Reference Laboratory, Shanghai Blood Center, Shanghai, China
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27
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Ido K, Aoyama Y, Nagasaki J, Koh S, Ichihara H, Harada H, Kawano K, Tani Y, Matsuyama N, Hirayama F, Kohsaki M, Takaku S, Mugitani A. Pulmonary Involvement of Acute Myeloid Leukemia Mimicking Transfusion-related Acute Lung Injury. Intern Med 2017; 56:2493-2496. [PMID: 28824064 PMCID: PMC5643180 DOI: 10.2169/internalmedicine.8505-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury (ALI) occurring during transfusion or within 6 hours of transfusion completion. A 66-year-old man suffering from acute myeloid leukemia developed acute respiratory distress syndrome after platelet transfusion. TRALI was diagnosed clinically, but an autopsy showed leukemic cells in diffuse pulmonary edema. Anti-human neutrophil antigen (HNA)-3a antibodies were detected in the donor serum, and the HNA-3 genotype of the patient was identified as a/a. This case was considered to represent pulmonary involvement of acute myeloid leukemia, rather than TRALI. A revision of the definition of TRALI accounting for hematological malignancies should therefore be considered.
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Affiliation(s)
- Kentaro Ido
- Department of Hematology, Fuchu Hospital, Japan
| | | | - Joji Nagasaki
- Department of Hematology, Osaka City University Graduate School of Medicine, Japan
| | - Shiro Koh
- Department of Hematology, Fuchu Hospital, Japan
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28
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Morsing KSH, Peters AL, van Buul JD, Vlaar APJ. The role of endothelium in the onset of antibody-mediated TRALI. Blood Rev 2017; 32:1-7. [PMID: 28823763 DOI: 10.1016/j.blre.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 12/11/2022]
Abstract
Transfusion Related Acute Lung Injury (TRALI) is one of the leading causes of mortality and morbidity following blood transfusion. The mechanisms behind the disease are not yet fully understood but seem to involve many different activating pathways and donor factors, in synergy with patient susceptibility. Studies have focused mostly on neutrophil activation, as aggregates of neutrophils and edema in lungs are found in post-mortem histological sections. This review aims to highlight the role of the endothelium in TRALI, as activated endothelium is the main promoter of leukocyte transmigration, and creates the barrier between blood and tissue. Since recent evidence suggests that a strong endothelial barrier prevents leukocyte transmigration and vascular leakage, we suggest that strengthening this barrier may be key to TRALI prevention.
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Affiliation(s)
- K S H Morsing
- Department of Plasma Proteins, Molecular Cell Biology Lab, Sanquin Research and Landsteiner Laboratory, Sanquin, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A L Peters
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J D van Buul
- Department of Plasma Proteins, Molecular Cell Biology Lab, Sanquin Research and Landsteiner Laboratory, Sanquin, Amsterdam, The Netherlands
| | - A P J Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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29
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Simtong P, Puapairoj C, Leelayuwat C, Santoso S, Romphruk AV. Assessment of HNA alloimmunisation risk in Northeastern Thais, Burmese and Karen. Transfus Med 2017; 28:47-55. [PMID: 28589653 DOI: 10.1111/tme.12431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/27/2017] [Accepted: 05/17/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study aimed to determine human neutrophil antigen (HNA) frequency, estimate possible HNA incompatibilities and predict the risk of HNA alloimmunisation in the Northeastern Thai, Burmese and Karen populations. BACKGROUND Alloantibodies against HNA are implicated in a number of clinical conditions, including immune-mediated neutropenia and transfusion reactions. METHODS A total of 400 unrelated healthy Thais, 261 Burmese and 249 Karen was included in this study. DNA samples were typed for HNA-1, -3, -4 and -5 systems using polymerase chain reactions with sequence-specific primers (PCR-SSP). RESULTS In this cohort, HNA-1a was more prevalent than HNA-1b. Accordingly, the possible risk of HNA-1a alloimmunisation against HNA-1a is lower than HNA-1b (0·0802-0·1351 vs 0·2293-0·2497). This is in contrast to the situation reported in Caucasian and African populations. The predicted risk of HNA-3 incompatibility in Thais, Burmese and Karen were 28·09%, 30·66% and 22·77%, respectively. The possible risks of HNA-3a alloimmunisation were 0·0493 in Thais, 0·0608 in Burmese and 0·0196 in Karen, respectively. No individuals were found to be homozygous for HNA-4bb. The probability of developing alloantibodies against HNA-4a was low in these populations and every population in Asia. In contrast, the overall frequency of HNA-5bb homozygous individuals was high in this study, peaking at 0·192. CONCLUSIONS This is the first study that reported the allele frequencies of HNA-1, -3, -4, and -5 in a large sample of healthy unrelated individuals from ethnic Thais, Burmese and Karen. Our results indicated the high possible risk of HNA-1, -3 and -5 alloimmunisation in these populations.
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Affiliation(s)
- P Simtong
- Biomedical Sciences Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - C Puapairoj
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - C Leelayuwat
- Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - S Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - A V Romphruk
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
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30
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T regulatory cells and dendritic cells protect against transfusion-related acute lung injury via IL-10. Blood 2017; 129:2557-2569. [PMID: 28202460 DOI: 10.1182/blood-2016-12-758185] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/09/2017] [Indexed: 12/30/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related fatalities and is characterized by acute respiratory distress following blood transfusion. Donor antibodies are frequently involved; however, the pathogenesis and protective mechanisms in the recipient are poorly understood, and specific therapies are lacking. Using newly developed murine TRALI models based on injection of anti-major histocompatibility complex class I antibodies, we found CD4+CD25+FoxP3+ T regulatory cells (Tregs) and CD11c+ dendritic cells (DCs) to be critical effectors that protect against TRALI. Treg or DC depletion in vivo resulted in aggravated antibody-mediated acute lung injury within 90 minutes with 60% mortality upon DC depletion. In addition, resistance to antibody-mediated TRALI was associated with increased interleukin-10 (IL-10) levels, and IL-10 levels were found to be decreased in mice suffering from TRALI. Importantly, IL-10 injection completely prevented and rescued the development of TRALI in mice and may prove to be a promising new therapeutic approach for alleviating lung injury in this serious complication of transfusion.
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31
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Fujita M, Kawabata H, Oka T, Hishizawa M, Kitano T, Kondo T, Yamashita K, Yurugi K, Hirai H, Maekawa T, Takaori-Kondo A. A Rare Case of Adult Autoimmune Neutropenia Successfully Treated with Prednisolone. Intern Med 2017; 56:1415-1419. [PMID: 28566608 PMCID: PMC5498209 DOI: 10.2169/internalmedicine.56.7619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Autoimmune neutropenia (AIN) is a rare disorder that may cause life-threatening infections. In adults, most cases are secondary to other pathological conditions, and primary AIN is extremely rare. We herein report a case involving a 57-year-old woman diagnosed with AIN. A granulocyte immunofluorescence test detected autoantibodies against human neutrophil antigens in her serum, while various examinations revealed no other causes of neutropenia, suggesting her AIN was primary. She was refractory to granulocyte-colony-stimulating factor but responded to prednisolone. Her neutrophil count remained normal after gradual discontinuation of prednisolone. Diagnostic procedures and optimal treatments for this disorder need to be established.
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Affiliation(s)
- Mari Fujita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroshi Kawabata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Tomomi Oka
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Masakatsu Hishizawa
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Toshiyuki Kitano
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Kohei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Kimiko Yurugi
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Hideyo Hirai
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Taira Maekawa
- Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
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32
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Toy P, Kleinman SH, Looney MR. Proposed revised nomenclature for transfusion-related acute lung injury. Transfusion 2016; 57:709-713. [DOI: 10.1111/trf.13944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/10/2016] [Accepted: 10/21/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Pearl Toy
- Department of Laboratory Medicine; University of California at San Francisco; San Francisco California
| | - Steven H. Kleinman
- Department of Pathology; University of British Columbia; Vancouver British Columbia Canada
| | - Mark R. Looney
- Departments of Medicine and Laboratory Medicine; University of California at San Francisco; San Francisco California
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33
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Xia W, Simtong P, Santoso S. Neutrophil alloantigens and alloantibodies in different populations. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Piyapong Simtong
- Biomedical Sciences Program; Graduate School; Khon Kaen University; Khon Kaen Thailand
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University; Giessen Germany
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34
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Dunbar NM, Yazer MH, Bravo MD, Kamel HT, Gorlin J, Norris PJ, Williamson PC, Vassallo RR. An association between ABO group and HLA antibody detection. Transfusion 2016; 57:313-318. [PMID: 27807878 DOI: 10.1111/trf.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND US blood centers can screen female plateletpheresis donors with a history of one or more pregnancies for both Class I and Class II anti-HLA antibodies using one of two platforms. One is a flow-based assay that yields a quantitative result and the other an enzyme-linked immunosorbent assay (ELISA) that yields either a positive or a negative result (above or below cutoff). STUDY DESIGN AND METHODS The results of HLA antibody screening tests were analyzed by donor ABO group. Results from large and small American blood collection centers using both platforms were analyzed. Positivity rates were compared by chi-square test and the results stratified by parity using the Mann-Whitney test. RESULTS No differences in parity were noted among donors of different ABO groups, but a significantly higher rate of HLA antibody positivity was observed among group O donors for the ELISA (31% of group O donors vs. 21% of non-group O donors, p < 0.0001). The higher rate of positivity was primarily due to Class I reactivity. This difference in antibody frequency was not observed at centers using the flow-based assay. CONCLUSION Centers using the ELISA may have a higher rate of permanent deferral from plateletpheresis donation among group O female donors. Although the reasons for the higher rate of reactivity on Class I ELISA testing are unknown, this could result from test system characteristics or differences in group O donor antibody strength or specificity.
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Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mark H Yazer
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | | | - Jed Gorlin
- Innovative Blood Resources/Memorial Blood Centers, St Paul, Minnesota
| | | | | | - Ralph R Vassallo
- Blood Systems, Inc., Scottsdale, Arizona.,Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Lebanon, New Hampshire
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35
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Schulz U, Reil A, Kiefel V, Bux J, Moog R. Evaluation of a new microbeads assay for granulocyte antibody detection. Transfusion 2016; 57:70-81. [PMID: 27774621 DOI: 10.1111/trf.13878] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To reduce the risk of transfusion-associated acute lung injury (TRALI), a high number of plasma donors were tested for human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. For HNA antibody detection, the gold standard is a combination of the granulocyte immunofluorescence test (GIFT) and the granulocyte agglutination test (GAT). However, these tests are not suitable for a high-throughput of samples. STUDY DESIGN AND METHODS To evaluate the new generation of the LABScreen MULTI assay (One Lambda, Inc.), which has special new beads for all the known HNA specificities, including HNA-3a, 97 sera samples containing well-defined HNA antibodies were used. For background testing, we used 91 samples from plasma donors previously identified by GAT, GIFT, and the monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA) assay. RESULTS Compared with previous tests, the new LABScreen MULTI assay was highly specific for the HNA-1a, HNA-1b, HNA-2, and HNA-3a antibody specificities required to prevent TRALI. Ninety-eight percent of the HNA-1a, HNA-1b, and HNA-2 antibodies could be detected as true positive; and 90% of the HNA-3a antibodies were recognized correctly as positive. False-positive reactions were identified in 5.5% of samples that previously tested negative. CONCLUSION The detection of HNA-3a antibody specificities could be integrated into the new LABScreen MULTI assay; however, we detected only 90%. In addition, we detected further HNA antibodies, such as HNA-1c, HNA-1d, and some HNA-3b and HNA-4a antibodies. The new generation of LABScreen MULTI is a great step toward feasible high-throughput testing for HNA antibodies. Nevertheless, GIFT and GAT remain the gold-standard methods for the differentiation of rare and currently unknown HNA specificities.
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Affiliation(s)
| | | | - Volker Kiefel
- Department of Transfusion Medicine, University of Rostock, Rostock, Germany
| | | | - Rainer Moog
- DRK Blood Service North-East, Cottbus, Germany
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36
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Chen Q, Srivastava K, Ardinski SC, Lam K, Huvard MJ, Schmid P, Flegel WA. Full-length nucleotide sequences of 30 common SLC44A2 alleles encoding human neutrophil antigen-3. Transfusion 2016; 56:729-36. [PMID: 26437811 PMCID: PMC4783217 DOI: 10.1111/trf.13300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/07/2015] [Accepted: 07/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human neutrophil antigen-3a (HNA-3a) alloantibodies can cause severe transfusion-related acute lung injury. The frequencies of the single-nucleotide polymorphisms (SNPs) indicative of the two clinically relevant HNA-3a/b antigens are known in many populations. In this study, we determined the full-length nucleotide sequence of common SLC44A2 alleles encoding the choline transporter-like protein-2 that harbors HNA-3a/b antigens. STUDY DESIGN AND METHODS A method was devised to determine the full-length coding sequence (CDS) and adjacent intron sequences from genomic DNA by eight polymerase chain reaction amplifications covering all 22 SLC44A2 exons. Samples from 200 African American, 96 Caucasian, two Hispanic, and four Asian blood donors were analyzed. We developed a decision tree to determine alleles (confirmed haplotypes) from the genotype data. RESULTS A total of 10 SNPs were detected in the SLC44A2 CDS. The noncoding sequences harbored an additional 28 SNPs (one in the 5'-untranslated region [UTR]; 23 in the introns; and four in the 3'-UTR). No SNP indicative of a nonfunctional allele was detected. The nucleotide sequences for 30 SLC44A2 alleles (haplotypes) were confirmed. There may be 66 haplotypes among the 604 chromosomes screened. CONCLUSIONS We found 38 SNPs, including one novel SNP, in 8192 nucleotides covering the CDS of the SLC44A2 gene among 302 blood donors. Population frequencies of these SNPs were established for African Americans and Caucasians. Because alleles encoding HNA-3b are more common than non-functional SLC44A2 alleles, we confirmed our previous postulate that African American donors are less likely to form HNA-3a antibodies compared to Caucasians.
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Affiliation(s)
- Qing Chen
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kshitij Srivastava
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Stefanie C Ardinski
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kevin Lam
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Michael J Huvard
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Pirmin Schmid
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Willy A Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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37
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Chen Q, Srivastava K, Liu Z, Xiao J, Huang C, Sun J, Li M, Flegel WA. Genotype frequency of human neutrophil antigen-3 polymorphisms in the Yi, Han, and Tibetan populations of China. Transfusion 2016; 56:737-42. [PMID: 26593331 PMCID: PMC4783214 DOI: 10.1111/trf.13413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/26/2015] [Accepted: 10/04/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Human neutrophil antigen-3 (HNA-3) alloantibodies can cause fatal transfusion-related acute lung injury (TRALI). Most frequencies of SLC44A2 alleles encoding the HNA-3a/b antigens have been established in Han individuals by polymerase chain reaction with sequence-specific priming (PCR-SSP). We sequenced SLC44A2 gene fragments and determined allele frequencies in three ethnicities of China. STUDY DESIGN AND METHODS Genomic DNA was extracted from 448 samples of 100 blood donors of Yi ethnicity in Xichang, Liangshan; 248 Han in Nanjing, Jiangsu; and 100 Tibetan in Lhasa, Tibet. A PCR-SSP was applied to determine the phase of two single-nucleotide polymorphisms (SNPs); SLC44A2 haplotypes were constructed. RESULTS In the 567 nucleotides of the SLC44A2 gene covered by our sequencing approach in Han individuals, we detected the known 331-44G>A (rs12972963) and 461G>A (rs2288904) polymorphisms. In the 243 nucleotides sequenced in Yi and Tibetan populations, we detected the known 461G>A and 503-15T>C (rs1560711) polymorphisms. A PCR-SSP for the common HNA-3a/b SNP was 100% concordant. The frequencies of the HNA-3a allele were 0.58, 0.66, and 0.69 in Yi, Han (Nanjing), and Tibetan, respectively (0.42, 0.34, and 0.31 for HNA-3b). CONCLUSIONS The Yi population of China had the highest frequency of blood donors at risk of harboring anti-HNA-3a compared to any population studied so far. We confirmed that the underlying SLC44A2*2 allele is more common in China than in any European or African populations.
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Affiliation(s)
- Qing Chen
- Jiangsu Province Blood Center, Nanjing
- Soochow University, Suzhou, Jiangsu, China
| | - Kshitij Srivastava
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Science & Peking Union Medical College, Chengdu, Sichuan, China
| | | | | | - Jun Sun
- Jiangsu Province Blood Center, Nanjing
| | - Min Li
- Institute of Dermatology, Chinese Academy of Medical Science & Peking Union Medical College
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, Jiangsu, China
| | - Willy Albert Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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Hauck-Dlimi B, Ruppel R, Zimmermann R, Strobel J, Reil A, Eckstein R, Zingsem J. Transfusion-related alloimmune neutropenia with no pulmonary complications: one donor-five cases. Transfusion 2015; 56:84-90. [PMID: 26388439 DOI: 10.1111/trf.13333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Neutrophil alloantibodies are well-known triggers of transfusion-related acute lung injury (TRALI) and also cause immune neutropenia. Alloimmune neutropenia due to transfusion is an isolated phenomenon that is only rarely identified. Its incidence is specified in the literature as being less than one in 10,000 transfused plasma-containing units. We expect that this phenomenon is underreported. STUDY DESIGN AND METHODS We observed five cases of alloimmune neutropenia with no respiratory complications with only one case initially reported as a suspected transfusion reaction. The other four cases were detected in the course of the subsequent lookback investigation. RESULTS The first case was reported as a potential transfusion reaction when a female patient showed a decrease in the white blood cell count after a platelet (PLT) transfusion. Examinations of the donor blood revealed an antibody against the human neutrophil antigen HNA-1b; the recipient was typed HNA-1b positive and HNA-1a negative. After examining the blood counts of other patients who previously received PLT concentrates from the same donor, we identified four other patients with an unreported decrease in the leukocyte and/or granulocyte count of more than approximately 50% after transfusion. CONCLUSION HNA antibodies are generally regarded as potential triggers of TRALI. Here we describe an HNA antibody that reproducibly caused transfusion-related neutropenia only without pulmonary complications. Factors predisposing patients to TRALI development are widely discussed. Our case suggests that antibody characteristics are also relevant in the development of TRALI. Current measures to prevent TRALI should also prevent transfusion-related alloimmune neutropenia.
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Affiliation(s)
| | - Renate Ruppel
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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Berthold T, Glaubitz M, Muschter S, Groß S, Palankar R, Reil A, Helm CA, Bakchoul T, Schwertz H, Bux J, Greinacher A, Delcea M. Human neutrophil antigen-3a antibodies induce neutrophil stiffening and conformational activation of CD11b without shedding of L-selectin. Transfusion 2015; 55:2939-48. [DOI: 10.1111/trf.13299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/27/2015] [Accepted: 06/29/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Tom Berthold
- Institute for Immunology and Transfusion Medicine; Universitätsmedizin Greifswald; Greifswald Germany
| | - Michael Glaubitz
- Nanostructure Group, ZIK HIKE-Center for Innovation Competence, Humoral Immune Reactions in Cardiovascular Diseases; Ernst-Moritz-Arndt-University Greifswald; Greifswald Germany
| | - Stefan Muschter
- Institute for Immunology and Transfusion Medicine; Universitätsmedizin Greifswald; Greifswald Germany
| | - Stefan Groß
- Department of Cardiology; Universitätsmedizin Greifswald; Greifswald Germany
- DZHK-German Centre for Cardiovascular Research; Greifswald Germany
| | - Raghavendra Palankar
- Nanostructure Group, ZIK HIKE-Center for Innovation Competence, Humoral Immune Reactions in Cardiovascular Diseases; Ernst-Moritz-Arndt-University Greifswald; Greifswald Germany
| | | | | | - Tamam Bakchoul
- Institute for Immunology and Transfusion Medicine; Universitätsmedizin Greifswald; Greifswald Germany
| | - Hansjörg Schwertz
- Institute for Immunology and Transfusion Medicine; Universitätsmedizin Greifswald; Greifswald Germany
- Lichtenberg-Professor for Experimental Hemostasis; Universitätsmedizin Greifswald
- Program in Molecular Medicine; University of Utah; Salt Lake City Utah
- Department of Surgery; University of Utah; Salt Lake City Utah
| | | | - Andreas Greinacher
- Institute for Immunology and Transfusion Medicine; Universitätsmedizin Greifswald; Greifswald Germany
| | - Mihaela Delcea
- Nanostructure Group, ZIK HIKE-Center for Innovation Competence, Humoral Immune Reactions in Cardiovascular Diseases; Ernst-Moritz-Arndt-University Greifswald; Greifswald Germany
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Kim KN, Kim DW, Jeong MA. The usefulness of a classification and regression tree algorithm for detecting perioperative transfusion-related pulmonary complications. Transfusion 2015; 55:2582-9. [DOI: 10.1111/trf.13202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/28/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine; Hanyang University Hospital; Seoul Republic of Korea
| | - Dong Won Kim
- Department of Anesthesiology and Pain Medicine; Hanyang University Hospital; Seoul Republic of Korea
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine; Hanyang University Hospital; Seoul Republic of Korea
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Bayat B, Tjahjono Y, Berghöfer H, Werth S, Deckmyn H, De Meyer SF, Sachs UJ, Santoso S. Choline Transporter-Like Protein-2: New von Willebrand Factor-Binding Partner Involved in Antibody-Mediated Neutrophil Activation and Transfusion-Related Acute Lung Injury. Arterioscler Thromb Vasc Biol 2015; 35:1616-22. [PMID: 25931511 DOI: 10.1161/atvbaha.115.305259] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/30/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In contrast to other antibodies involved in transfusion-related acute lung injury, anti-HNA-3a antibodies are incapable of inducing direct neutrophil activation and seem to interact with endothelial cells (ECs) primarily. In animal studies, anti-HNA-3a-mediated transfusion-related acute lung injury could be precipitated in the absence of neutrophils, but was stronger when neutrophils were present. In a different context the target protein of these antibodies, choline transporter-like protein-2 (CTL-2), was reported to interact with a protein of the inner ear carrying 2 von Willebrand factor (VWF) A-domains. These observations prompted us to investigate whether VWF might be involved in anti-HNA-3a-mediated neutrophil activation, and whether signaling via CD11b/CD18 is involved, as in various other experimental settings. APPROACH AND RESULTS Cell adhesion demonstrated specific binding of CTL-2 to VWF. Immunoprecipitation analysis of CTL-2/CD11b/CD18 coexpressing cells indicated that anti-HNA-3a colocalizes CTL-2 and CD11b/CD18 when VWF is present. Functional studies revealed that anti-HNA-3a-mediated neutrophil agglutination is an active, protein kinase C-dependent and partially Fc-dependent process. Agglutination and the production of reactive oxygen species seem to require the formation of a trimolecular complex between the target antigen (CTL-2), CD11b/CD18 and VWF. In line with these observations, anti-HNA-3a induced less severe transfusion-related acute lung injury and less neutrophil recruitment to the alveolar space in VWF knockout mice. CONCLUSIONS We introduce CTL-2 as a new binding partner for VWF. Interaction of neutrophils with VWF via CTL-2 allows anti-HNA-3a to induce signal transduction via CD11b/CD18, which leads to neutrophil activation and agglutination. In transfusion-related acute lung injury, this mechanism may further aggravate endothelial leakage.
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Affiliation(s)
- Behnaz Bayat
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Yudy Tjahjono
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Heike Berghöfer
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Silke Werth
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Hans Deckmyn
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Simon F De Meyer
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Ulrich J Sachs
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.)
| | - Sentot Santoso
- From the Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany (B.B., Y.T., H.B., S.W., U.J.S., S.S.); and Laboratory for Thrombosis Research, KU Leuven Kulak, Kortrijk, Belgium (H.D., S.F.D.M.).
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Peters AL, Van Stein D, Vlaar APJ. Antibody-mediated transfusion-related acute lung injury; from discovery to prevention. Br J Haematol 2015; 170:597-614. [PMID: 25921271 DOI: 10.1111/bjh.13459] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA-antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male-only strategy for plasma donation. This review focuses on pre-clinical and clinical studies investigating the pathophysiology of antibody-mediated TRALI.
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Affiliation(s)
- Anna L Peters
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
| | - Danielle Van Stein
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
Transfusion-related acute lung injury (TRALI) is defined as the onset or the worsening of respiratory distress within 6 h of the transfusion of a plasma-containing blood component. It is currently considered to be one of the leading causes of severe posttransfusion morbidity and acute mortality in countries with a high development index. Understanding of the pathogenesis of TRALI has resulted in the development of preventive measures that have contributed to reducing its incidence. Early recognition of the clinical symptoms allow the clinician to identify the syndrome and to undertake therapeutic measures that may reduce the morbidity and mortality associated with this complication.
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Warkentin TE, Greinacher A, Bux J. The transfusion-related acute lung injury controversy: lessons from heparin-induced thrombocytopenia. Transfusion 2015; 55:1128-34. [PMID: 25647304 DOI: 10.1111/trf.12994] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Theodore E Warkentin
- Department of Pathology and Molecular Medicine and the Department of Medicine, McMaster University, and Transfusion Medicine, Hamilton Regional Laboratory Medicine Program, Service of Clinical Hematology, Hamilton Health Sciences (General Site), Hamilton, Ontario, Canada
| | - Andreas Greinacher
- Institut Für Immunologie Und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Muller JY, Chiaroni J, Garraud O. Sécurité immunologique des transfusions. Presse Med 2015; 44:200-13. [DOI: 10.1016/j.lpm.2014.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 01/13/2023] Open
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Hussain S, Moiz B, Ausat FA, Khurshid M. Monitoring and reporting transfusion reactions as a quality indicator – a clinical audit. Transfus Apher Sci 2015; 52:122-7. [DOI: 10.1016/j.transci.2014.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 11/26/2013] [Accepted: 03/11/2014] [Indexed: 10/24/2022]
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Abstract
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
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Affiliation(s)
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland
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Heinzl MW, Schönbacher M, Dauber EM, Panzer S, Mayr WR, Körmöczi GF. Detection of granulocyte-reactive antibodies: a comparison of different methods. Vox Sang 2014; 108:287-93. [PMID: 25556963 DOI: 10.1111/vox.12227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/15/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Granulocyte-reactive antibodies can cause autoimmune and neonatal immune neutropenias as well as transfusion-related acute lung injury. The classical antibody-detection methods granulocyte aggregation test (GAT), granulocyte immunofluorescence test (GIFT) and monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA) are time-consuming and technically challenging. In recent years, flow cytometric white blood cell immunofluorescence test (Flow-WIFT) and the microbeads assay LabScreen® Multi have emerged and are still subject of evaluation. These serological tests were compared on a screening and specification level. MATERIALS AND METHODS For screening, the combination of GAT/GIFT was compared to Flow-WIFT testing 333 samples. Positive samples were further analysed with MAIGA and LabScreen® Multi. RESULTS Granulocyte aggregation test/GIFT detected 77 positive samples, Flow-WIFT found 108 granulocyte-reactive samples. Six Samples were only positive in GAT/GIFT, and 37 samples were only positive in Flow-WIFT (κ = 0.682). Antibody specification with MAIGA and the microbeads assay confirmed granulocyte-reactivity in 83 cases with 70 matching results (κ = 0.742). However, out of six detected human neutrophil antigen (HNA) reactivities only two specificities matched in both assays. CONCLUSION Flow-WIFT may be a valuable addition to GIFT for granulocyte-reactive antibody screening. MAIGA remains the most reliable laboratory method for antibody specification.
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Affiliation(s)
- M W Heinzl
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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Berthold T, Muschter S, Schubert N, Wesche J, Ameling S, Teumer A, Reil A, Bux J, Bakchoul T, Greinacher A. Impact of priming on the response of neutrophils to human neutrophil alloantigen-3a antibodies. Transfusion 2014; 55:1512-21. [DOI: 10.1111/trf.12898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/20/2014] [Accepted: 08/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tom Berthold
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
- Department of Functional Genomics; Interfaculty Institute for Genetics and Functional Genomics; University Medicine Greifswald; Greifswald Germany
| | - Stefan Muschter
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
- Department of Functional Genomics; Interfaculty Institute for Genetics and Functional Genomics; University Medicine Greifswald; Greifswald Germany
| | - Nicole Schubert
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
| | - Jan Wesche
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
| | - Sabine Ameling
- Department of Functional Genomics; Interfaculty Institute for Genetics and Functional Genomics; University Medicine Greifswald; Greifswald Germany
| | - Alexander Teumer
- Department of Functional Genomics; Interfaculty Institute for Genetics and Functional Genomics; University Medicine Greifswald; Greifswald Germany
| | - Angelika Reil
- German Red Cross Blood Donation Service West; Hagen Germany
| | - Jürgen Bux
- German Red Cross Blood Donation Service West; Hagen Germany
| | - Tamam Bakchoul
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
| | - Andreas Greinacher
- Department of Transfusion Medicine; Institute for Immunology and Transfusion Medicine; Greifswald Germany
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Anti-human leukocyte antigen antibodies are present in blood of blood donors: is therapy with blood preparations safe for graft recipients? Transplant Proc 2014; 46:2565-71. [PMID: 25380867 DOI: 10.1016/j.transproceed.2014.09.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood products infusions are often administrated to graft recipients. Post-transfusion reactions of anti-human leukocyte antigen antibodies (anti-HLA) are responsible for transfusion-related acute lung injury, but cases of graft rejection after blood product infusions were recently also proven. METHODS The aim of this study was to assess, with the use of the very sensitive Luminex technology and traditional lymphocytotoxic test, the prevalence and cytotoxic activity of anti-HLA in blood donors with different medical histories to evaluate a potential risk of post-transfusion immune complications. Data were analyzed according to different normalized background cutoffs (1.5, 2.2; and the high cutoffs-10.8 for I class and 6.9 for II class anti-HLA). RESULTS We observed that anti-HLA may be present in 36% of donors, and even in up to 73.6% of risk groups. Significant risk factors included female sex (23.9% to 64.2% for different cutoffs) and pregnancy history (30% to 72.5%), regardless of the cutoff used in analysis, whereas sera from female donors showed lower cytotoxicity (panel reactive antibodies). Anti-HLA were also detected in men (3.7% to 37%), in donors after a transfusion (0% to 62.5%), and even with no known risk factors (3.8% to 26.9%). CONCLUSIONS Luminex technology is a sensitive tool in anti-HLA detection, but consensus in measurement interpretation for blood donors is needed. Selection of blood products on the basis of medical history can be a useful alternative for routine testing of blood donors. The clinical significance of treatment of graft recipients with blood products requires further study; until then, more attention should be paid to possible complications.
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