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Arslan S, Al Malki MM. New strategies for mismatched unrelated donor (MMUD) hematopoietic cell transplant (HCT). HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:74-82. [PMID: 36485163 PMCID: PMC9819983 DOI: 10.1182/hematology.2022000398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
With increasing numbers of patients with hematologic malignancies requiring allogeneic hematopoietic cell transplant (HCT), including minority racial and ethnic groups, the limited availability of matched related donors and matched unrelated donors remains a significant obstacle. Hence, the use of alternative donors such as haploidentical and mismatched unrelated donors (MMUDs) is on the rise. Herein, we present case studies to outline a rational and stepwise approach with a focus on the use of MMUD for HCT in patients with hematologic malignancies. We also review novel approaches used to reduce the incidence of severe graft-versus-host disease and improve HCT outcomes in patients undergoing MMUD HCT.
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Pandey P, Pande A, Mandal S, Devra AK, Sinha VK, Bhat AP, Mishra S. Effects of different sensitization events on HLA alloimmunization in renal transplant cases; a retrospective observation in 1066 cases. Transpl Immunol 2022; 75:101680. [PMID: 35908630 DOI: 10.1016/j.trim.2022.101680] [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: 05/28/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Patients awaiting solid organ transplantation may develop anti-HLA antibodies after sensitization events such as transfusions, pregnancies, or previous transplantations. However, the effects of a particular sensitization event on HLA alloimmunization have not been well studied in parallel using cell-based assays and solid-phase assays. In this study, we evaluated and compare how different sensitization events affect the HLA antibody screening (HLA-Ab) and donor specific antibody (DSA) status in solid renal organ transplantation patients. METHODS HLA antibody (HLA-Ab) screening tests like complement-dependent cytotoxicity crossmatch (CDC-XM), flow cytometry crossmatch (FC-XM) & Luminex panel-reactive antibody (L-PRA) were performed in all 1066 patients (635 males and 431 females). If any of these tests turned out to be positive, a Luminex single antigen bead (L-SAB) assay was performed for DSA identification. Test positive rates and antibody strengths were analyzed according to the different sensitization events and gender. RESULTS In this study, HLA-Ab screening tests positive rates (L-PRA, FC-XM and CDC-XM) were significantly higher in patients with previous transplantation (73.91%, 86.95% and 56.52% p < 0.001), previous pregnancy (57.46%, 70.14% and 18.85% p < 0.001) or blood transfusion (27.33%, 35.55% and 7.33% p < 0.001) compared with patients without a sensitizing event (6.17%, 13.58% & 1.09). In this study, re-transplantation group showed significantly stronger antibody strength (DSA) than non sensitized group (class I & II MFI 11418.04, 17,837.78 vs class I & II MFI 2659, 3329; P < 0.001) and those with single sensitization events of transfusion (class I & II MFI 11418.04, 17,837.78 vs class I & II MFI 5598.82, 5436.12; P < 0.001) or pregnancy (class I & II MFI 11418, 17,837 vs class I & II MFI 8580.12, 7556.08; P < 0.001). CONCLUSIONS Pregnancy and blood transfused had high allo-immunization rate for class I HLA antigens. While re-transplantation patients had high allo-immunization rate for both the HLA classes (HLA- class I & HLA- class II). Re-transplantation group showed significantly stronger antibody strength, followed by pregnancy and then transfusion.
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Affiliation(s)
- Prashant Pandey
- Department of Transfusion Medicine, Histocompatibility & Molecular Biology, Jaypee Hospital, Noida, UP 201301, India
| | - Amit Pande
- Department of Histocompatibility & Molecular Biology, Jaypee Hospital, Noida, UP 201301, India.
| | - Saikat Mandal
- Department of Transfusion Medicine, Jaypee Hospital, Noida, UP 201301, India
| | - Amit Kumar Devra
- Department of Urology and kidney transplant, Jaypee Hospital, Noida, UP 201301, India.
| | - Vijay Kumar Sinha
- Department of Nephrology and kidney transplant, Jaypee Hospital, Noida, UP 201301, India.
| | - Anil Prasad Bhat
- Department of Nephrology and kidney transplant, Jaypee Hospital, Noida, UP 201301, India.
| | - Smriti Mishra
- Department of Histocompatibility & Molecular Biology, Jaypee Hospital, Noida, UP 201301, India
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3
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Priyadarsini AJ, Dhawan HK, Sharma RR, Saikia B, Minz RW. Prevalance of Anti-HLA antibodies in parous female blood donors: A pilot study from tertiary care hospital of North India. Asian J Transfus Sci 2021; 15:16-20. [PMID: 34349452 PMCID: PMC8294446 DOI: 10.4103/ajts.ajts_30_19] [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: 03/07/2019] [Revised: 10/28/2019] [Accepted: 08/30/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND: Various studies have implicated that plasma causing transfusion-related acute lung injury is from alloimmunized females. The frequency of sensitization to human leukocyte antigen (HLA) was found to correlate with their parity score. No literature on the prevalence of anti-HLA antibodies in Indian blood donors is available to date. Hence, this pilot study was done to know the frequency of HLA alloimmunization in Indian blood donors. MATERIALS AND METHODS: A total of 192 consenting voluntary blood donors from blood donation camps were enrolled in the study. Test group: Parous female donors (n = 96) and control group: Nulliparous female donors (n = 48) and male donors (n = 48). HLA alloimmunization was tested on the Luminex platform by screening assay to detect IgG antibodies to HLA Class I and II molecules of human origin. A mean fluoresence index of more than 2000 was considered as a positive reaction, considering the high sensitivity of Luminex assay. RESULTS: Sixty-three out of 192 donors (32.8%) tested positive for anti-HLA antibodies, out of which 23 donors were in the control group (23.9%), and 40 donors were in the test group (41.7%); P = 0.002. On gender-based comparison, 9 out of 48 male donors (18.7%), as compared to 54 out of 144 female donors (37.5%), tested positive for HLA antibodies (P = 0.02). Based on an increase in parity score, the frequency of HLA alloimmunization was found to be significantly correlated (P = 0.002). A decrease in the trend of HLA alloimmunization was observed as the duration from the last pregnancy increased. A higher frequency of HLA alloimmunization was observed in female donors with a history of transfusion and bad obstetric history. CONCLUSION: The present study substantiates that plasma from parous female donors has a higher chance of containing anti-HLA antibodies as compared to nulliparous female and male donors.
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Affiliation(s)
| | | | | | - Biman Saikia
- Department of Immunopathology, PGIMER, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, PGIMER, Chandigarh, India
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4
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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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5
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Davidow EB, Blois SL, Goy-Thollot I, Harris L, Humm K, Musulin S, Nash KJ, Odunayo A, Sharp CR, Spada E, Thomason J, Walton J, Wardrop KJ. Association of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS). Part 1: Definitions and clinical signs. J Vet Emerg Crit Care (San Antonio) 2021; 31:141-166. [PMID: 33792171 DOI: 10.1111/vec.13044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/06/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To use a systematic, evidence-based consensus process to develop definitions for transfusion reactions in dogs and cats. DESIGN Evidence evaluation of the literature was carried out for identified transfusion reaction types in dogs and cats. Reaction definitions were generated based on synthesis of human and veterinary literature. Consensus on the definitions was achieved through Delphi-style surveys. Draft recommendations were made available through industry specialty listservs and comments were incorporated. RESULTS Definitions with imputability criteria were developed for 14 types of transfusion reactions. CONCLUSIONS The evidence review and consensus process resulted in definitions that can be used to facilitate future veterinary transfusion reaction research.
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Affiliation(s)
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | | | | | - Karen Humm
- Department of Clinical Science and Services, The Royal Veterinary College, London, UK
| | - Sarah Musulin
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Katherine J Nash
- VetMED Emergency and Specialty Veterinary Hospital, Phoenix, AZ, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN, USA
| | - Claire R Sharp
- School of Veterinary Medicine, Murdoch University, Perth, Australia
| | - Eva Spada
- Department of Veterinary Medicine, University of Milan, Lodi, Italy
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University, Mississippi State, MS, USA
| | | | - K Jane Wardrop
- Veterinary Clinical Sciences, Washington State University, Pullman, WA, USA
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6
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Persson G, Picard C, Marin G, Isgaard C, Stæhr CS, Molinari N, Chiaroni J, Lebech M, Hviid TVF, Di Cristofaro J. Maternal HLA Ib Polymorphisms in Pregnancy Allo-Immunization. Front Immunol 2021; 12:657217. [PMID: 33859649 PMCID: PMC8042285 DOI: 10.3389/fimmu.2021.657217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
During pregnancy the formation of alloreactive anti-human leukocyte antigen (HLA) antibodies are a major cause of acute rejection in organ transplantation and of adverse effects in blood transfusion. The purpose of the study was to identify maternal HLA class Ib genetic factors associated with anti-HLA allo-immunization in pregnancy and the degree of tolerance estimated by IgG4 expression. In total, 86 primiparous women with singleton pregnancies were included in the study. Maternal blood samples and umbilical cord samples were collected at delivery. Clinical data were obtained. Maternal blood serum was screened for HLA class I and II antibodies, identification of Donor Specific Antibody (DSA), activation of complement measured by C1q and IgG4 concentrations. Mothers were genotyped for HLA class Ib (HLA-E, -F and -G). Anti-HLA class I and II antibodies were identified in 24% of the women. The maternal HLA-E*01:06 allele was significantly associated with a higher fraction of anti-HLA I immunization (20.0% vs. 4.8%, p = 0.048). The maternal HLA-G 3’-untranslated region UTR4-HLA-G*01:01:01:05 haplotype and the HLA-F*01:03:01 allele were significantly associated with a low anti-HLA I C1q activation (16.7% vs. 57.1%, p = 0.028; 16.7% vs. 50.0%, p = 0.046; respectively). Both HLA‑G and HLA-F*01:03:01 showed significantly higher levels of IgG4 compared with the other haplotypes. The results support an association of certain HLA class Ib alleles with allo-immunization during pregnancy. Further studies are needed to elucidate the roles of HLA-E*01:06, HLA-F*01:03 and HLA‑G UTR4 in reducing the risk for allo-immunization.
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Affiliation(s)
- Gry Persson
- Centre for Immune Regulation and Reproductive Immunology (CIRRI), Department of Clinical Biochemistry, The ReproHealth Research Consortium ZUH, Zealand University Hospital, Roskilde, Denmark
| | - Christophe Picard
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France.,Immunogenetics Laboratory, Etablissement français du Sang PACA Corse, Marseille, France
| | - Gregory Marin
- Unité de Recherche Clinique, Biostatistique et Epidémiologie, Département de l'Information Médicale (DIM) Hôpital La Colombière, Montpellier, France
| | - Cecilie Isgaard
- Centre for Immune Regulation and Reproductive Immunology (CIRRI), Department of Clinical Biochemistry, The ReproHealth Research Consortium ZUH, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Seefeldt Stæhr
- Centre for Immune Regulation and Reproductive Immunology (CIRRI), Department of Clinical Biochemistry, The ReproHealth Research Consortium ZUH, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Molinari
- Unité de Recherche Clinique, Biostatistique et Epidémiologie, Département de l'Information Médicale (DIM) Hôpital La Colombière, Montpellier, France
| | - Jacques Chiaroni
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France
| | - Morten Lebech
- Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark
| | - Thomas Vauvert F Hviid
- Centre for Immune Regulation and Reproductive Immunology (CIRRI), Department of Clinical Biochemistry, The ReproHealth Research Consortium ZUH, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Di Cristofaro
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France
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7
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Budeyri A, Kocamer Simsek B, Yardimci MM, Anlatici R, Cankus MC. Management of a Multi-Level Forearm Microsurgical Reconstruction and the Following Transfusion-Related Acute Lung Injury. Cureus 2020; 12:e10385. [PMID: 33062506 PMCID: PMC7550022 DOI: 10.7759/cureus.10385] [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] [Indexed: 11/16/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by acute respiratory distress following blood transfusion. This case-based technical report documents a case on the management of a multi-level forearm microsurgical reconstruction and the following TRALI syndrome that developed shortly after blood transfusion in a 29-year-old male. Multilevel microsurgical revascularization was performed via saphenous vein autograft arterial reconstruction from the proximal 1/3 ulnar artery to the ulnar side of the deep superficial palmar arterial arch. TRALI was resolved with intensive care unit monitoring and treatment. There are several reports of TRALI in literature, as well as proposed mechanisms of pathogenesis, however, no case on the management of a multilevel forearm arterial reconstruction via a long saphenous vein autograft and associated TRALI syndrome have been reported.
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Affiliation(s)
- Aydin Budeyri
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR.,The Shoulder Center, Baylor University Medical Center at Dallas, Dallas, USA
| | | | | | - Recep Anlatici
- Department of Plastic Surgery, Sanko University, Gaziantep, TUR
| | - Mehmet C Cankus
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR
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Andolina JR, Walia R, Oliva J, Baran A, Liesveld J, Becker MW, Busacco A, Coppage M. Non-donor specific anti-human leukocyte antigen (HLA) antibodies are not associated with poor outcome in hematopoietic stem cell transplant recipients. Hum Immunol 2020; 81:407-412. [PMID: 32471661 DOI: 10.1016/j.humimm.2020.05.006] [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: 01/06/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/15/2022]
Abstract
Testing for anti-human leukocyte antigen (HLA) antibodies has now become standard practice in allogeneic hematopoietic stem cell transplantation (HSCT), and anti-HLA antibodies (both donor specific and non-donor specific) are being identified and have many potential consequences. Most studies suggest that donor-specific HLA antibodies lead to adverse outcomes, though little is reported on non-donor specific anti-HLA antibodies. We present the results of a retrospective cohort analysis of 157 patients who received HSCT at the University of Rochester over a period of four years. We identified 45 patients (28.7%) who had detectable anti-HLA antibodies, while only one patient (0.6%) had donor-specific anti-HLA antibodies. Patients with prior pregnancies and multiple transfusions were at increased risk to develop antibodies. In our cohort, the presence of non-donor specific anti-HLA antibodies did not significantly impact overall survival, progression free survival, graft failure, or transplant-related mortality.
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Affiliation(s)
- J R Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States.
| | - R Walia
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States
| | - J Oliva
- Department of Medicine, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States
| | - A Baran
- Department of Medicine, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States
| | - J Liesveld
- Department of Medicine, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States
| | - M W Becker
- Department of Medicine, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States
| | - A Busacco
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, United States
| | - M Coppage
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, United States
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9
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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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10
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Belizaire R, Mack J, Kadauke S, Kim Y, Saidman S, Makar RS. Red blood cell alloantibodies are associated with increased alloimmunization against human leukocyte antigens. Transfusion 2019; 59:2256-2263. [DOI: 10.1111/trf.15306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Roger Belizaire
- Department of Pathology, Division of Transfusion MedicineBrigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Johnathan Mack
- Ottawa Hospital Research InstituteUniversity of Ottawa Ottawa Ontario
| | - Stephan Kadauke
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Yeowon Kim
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Susan Saidman
- Department of Pathology, Histocompatibility LaboratoryMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
| | - Robert S. Makar
- Department of Pathology, Blood Transfusion ServiceMassachusetts General Hospital and Harvard Medical School Boston Massachusetts
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11
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Maternal HLA-G*01:01:01:04 protects from anti-HLA-class II immunization in pregnant women. Hum Immunol 2018; 80:120-125. [PMID: 30414459 DOI: 10.1016/j.humimm.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 12/11/2022]
Abstract
Factors determining anti-HLA immunization are poorly understood, although anti-HLA immunization following pregnancy is well described. The HLA-G molecule has been extensively described for its implication in immunological tolerance, especially during pregnancy. Transplant studies show an association between HLA-G haplotypes and alloimmunization. Our aim was to investigate the association of HLA-G haplotypes with anti-HLA class I and II immunization in a cohort of women having experienced one or more pregnancies and with no transfusion history. Maternal blood samples (n=270) collected at delivery and formerly screened for anti-HLA antibodies, HLA-A and HLA-B antigens, were screened by NGS for HLA-G gene polymorphism. Univariate analysis further confirmed that the number of pregnancies was significantly associated with anti-HLA class I immunization, whereas no other variable remained significant after Bonferroni correction. Our results showed however that anti-HLA class II immunization was associated with the number of children whereas the HLA-G*01:01:01:04 allele was protective against this immunization.
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12
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Janssen MP, van Tilborgh AJW, de Vooght KMK, Bokhorst AG, Wiersum-Osselton JC. Direct costs of transfusion reactions - an expert judgement approach. Vox Sang 2017; 113:143-151. [PMID: 29124766 DOI: 10.1111/vox.12614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures. MATERIALS AND METHODS Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates. RESULTS The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction. CONCLUSION In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.
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Affiliation(s)
- M P Janssen
- Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J W van Tilborgh
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - K M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A G Bokhorst
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands.,Sanquin Blood Supply, Amsterdam, The Netherlands
| | - J C Wiersum-Osselton
- TRIP National Hemovigilance and Biovigilance Office, Leiden, The Netherlands.,Sanquin Blood Supply, Amsterdam, The Netherlands
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13
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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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Unraveling the role of maternal anti-HLA class I antibodies in fetal and neonatal thrombocytopenia—Antibody specificity analysis using epitope data. J Reprod Immunol 2017; 122:1-9. [DOI: 10.1016/j.jri.2017.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
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15
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Cerci Gurbuz B, Soyoz M, Ozkale Okyay D, Kilicaslan Ayna T, Pirim I. Comparison of Anti-HLA Antibody Production According to Gestational Periods in Pregnant Women. Transplant Proc 2017; 49:464-466. [PMID: 28340813 DOI: 10.1016/j.transproceed.2017.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To evaluate paternal anti-HLA antibody profiles, sera samples were collected from pregnant women in different trimesters and the panel-reactive antibody (PRA) specificities were identified. METHODS From 2013 to 2015, serum samples were obtained from 41 pregnant women who had registered at the Izmir Tepecik Education and Research Hospital Gynecology Clinic. Anti-HLA antibodies were screened by using the panel reactive antibody screening and identification tests. Sera samples were obtained at the first, second, and third trimesters. The primary outcome was to determine the anti-HLA antibody production term during pregnancy; the secondary outcome was identification of anti-HLA antibodies. RESULTS None of the women had a sensitization history except during pregnancy. We observed that 54% of the women produced paternal antibodies, either class I or II. Class I PRA positivity of the women who had a first or second pregnancy was the same in all 3 trimesters, whereas class II positivity was increased in the third trimester. Class II and both class I and II positivity increased in the third trimester; class I positivity was decreased in the third trimester. PRA positivity could be affected by the history of pregnancy and could be raised, but no impact was observed from the history of abortion and miscarriage (odds ratios, 1.9, 0.4, and 0.5 [95% confidence intervals, 0.5-7.8, 0.1-2.0, and 0.3-0.7], respectively; P > .05). The most frequently detected antibodies were A2, B7, DR7, DR4, DR11, DR13, DQ2, and DQ8. CONCLUSIONS Anti-HLA antibodies against paternal HLA antigens were detected more in multiparous women than in primiparous women. Anti-HLA antibody detection ratios did not change until the third trimester and were followed by a specific increase in class II anti-HLA antibody production.
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Affiliation(s)
- B Cerci Gurbuz
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey.
| | - M Soyoz
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
| | - D Ozkale Okyay
- University of Health Science Tepecik Training and Research Hospital, Clinic of Gynecology, Izmir, Turkey
| | - T Kilicaslan Ayna
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
| | - I Pirim
- Izmir Katip Celebi University Faculty of Medicine, Department of Medical Biology and Genetics, Izmir, Turkey; University of Health Science Tepecik Training and Research Hospital, Tissue Typing Laboratory, Izmir, Turkey
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16
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Picascia A, Grimaldi V, Sabia C, Napoli C. Comprehensive assessment of sensitizing events and anti-HLA antibody development in women awaiting kidney transplantation. Transpl Immunol 2016; 36:14-9. [DOI: 10.1016/j.trim.2016.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
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17
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van Stein D, Beckers EAM, Peters AL, Porcelijn L, Middelburg RA, Lardy NM, van Rhenen DJ, Vlaar APJ. Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques. Vox Sang 2016; 111:71-8. [DOI: 10.1111/vox.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- D. van Stein
- Department of Internal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - E. A. M. Beckers
- Department of Internal Medicine-Hematology; Maastricht University Medical Center; Maastricht The Netherlands
| | - A. L. Peters
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - L. Porcelijn
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - R. A. Middelburg
- Center for clinical transfusion research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - N. M. Lardy
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - D. J. van Rhenen
- South West Region; Sanquin Blood Bank; Rotterdam The Netherlands
| | - A. P. J. Vlaar
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
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18
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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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19
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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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20
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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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21
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AuBuchon JP. TRALI: reducing its risk while trying to understand its causes. Transfusion 2014; 54:3021-5. [DOI: 10.1111/trf.12822] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James P. AuBuchon
- Puget Sound Blood Center; Seattle WA
- Medicine and Laboratory Medicine; University of Washington; Seattle WA
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22
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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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Peña JRA, Saidman SL, Girouard TC, Meister E, Dzik WH, Makar RS. Anti-HLA alloantibodies in surgical patients refractory to platelet transfusion. Am J Hematol 2014; 89:E133-7. [PMID: 24816643 DOI: 10.1002/ajh.23757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Abstract
Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products.
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Affiliation(s)
- Jeremy Ryan A. Peña
- Division of Laboratory and Transfusion Medicine; Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Susan L. Saidman
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Timothy C. Girouard
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Erin Meister
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Walter H. Dzik
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Robert S. Makar
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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24
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Müller MC, van Stein D, Binnekade JM, van Rhenen DJ, Vlaar AP. Low-risk transfusion-related acute lung injury donor strategies and the impact on the onset of transfusion-related acute lung injury: a meta-analysis. Transfusion 2014; 55:164-75. [DOI: 10.1111/trf.12816] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Marcella C.A. Müller
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA); Academic Medical Center; Amsterdam The Netherlands
| | - Danielle van Stein
- Department of Transfusion Medicine; Sanquin Blood Bank South West Region; Rotterdam The Netherlands
| | - Jan M. Binnekade
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Dick J. van Rhenen
- Department of Transfusion Medicine; Sanquin Blood Bank South West Region; Rotterdam The Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA); Academic Medical Center; Amsterdam The Netherlands
- Department of Internal Medicine; Academic Medical Center; Amsterdam The Netherlands
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25
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De Clippel D, Baeten M, Torfs A, Emonds MP, Feys HB, Compernolle V, Vandekerckhove P. Screening for HLA antibodies in plateletpheresis donors with a history of transfusion or pregnancy. Transfusion 2014; 54:3036-42. [DOI: 10.1111/trf.12727] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 01/04/2023]
Affiliation(s)
| | | | - Anneleen Torfs
- Laboratory for Histocompatibility and Immunogenetics; Belgian Red Cross-Flanders; Gent Belgium
| | - Marie-Paule Emonds
- Laboratory for Histocompatibility and Immunogenetics; Belgian Red Cross-Flanders; Gent Belgium
| | - Hendrik B. Feys
- Transfusion Research Center; Belgian Red Cross-Flanders; Gent Belgium
| | | | - Philippe Vandekerckhove
- Blood Service; Belgian Red Cross-Flanders; Gent Belgium
- Department of Public Health and Primary Care; Catholic University of Leuven; Leuven Belgium
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26
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Lashley LEELO, van der Hoorn MLP, Haasnoot GW, Roelen DL, Claas FHJ. Uncomplicated oocyte donation pregnancies are associated with a higher incidence of human leukocyte antigen alloantibodies. Hum Immunol 2014; 75:555-60. [PMID: 24530746 DOI: 10.1016/j.humimm.2014.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/03/2014] [Accepted: 02/04/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fetuses in pregnancies conceived after oocyte donation (OD) have a higher degree of antigeneic dissimilarity with the mother compared to semi-allogeneic fetuses after natural conception. We questioned whether this leads to higher level of HLA antibody formation in OD pregnancies. METHOD Uncomplicated pregnancies after OD were compared with pregnancies conceived either spontaneously or by IVF. We calculated the number of HLA- and epitope mismatches. Maternal sera were screened for HLA antibodies with ELISA; child HLA specific antibody production was determined using CDC and Luminex with single antigen beads for class I and II. RESULTS A significantly (p<0.0001) higher incidence of HLA antibody production was observed in women conceiving after OD (69%) compared to non-donor pregnancies (24-25%). The antibody formation was positively correlated with the number of fetomaternal antigen (Spearman's rho 0.95, p<0.0001) and epitope mismatches (Spearman's rho 0.91, p<0.0001). The number of HLA-DR mismatches between women and child was an independent risk factor for the production of HLA class I specific alloantibodies. CONCLUSION Women conceiving after OD have a higher risk of developing child-specific HLA antibodies; the higher the number of immunogenetic differences, the higher the chance these antibodies are formed. The high incidence of antibody production also strongly depends upon the number of HLA-DR mismatches. Despite the stronger antibody response, OD was associated with uncomplicated pregnancy in cases included in this study.
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Affiliation(s)
| | | | - Geert W Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Masson E, Vidal C, Deschamps M, Bongain S, Thevenin C, Dupont I, Rietmulher D, Pouthier F, Mongaillard G, Chabod J, Ferrand C, Tiberghien P, Rebibou JM. Incidence and risk factors of anti-HLA immunization after pregnancy. Hum Immunol 2013; 74:946-51. [DOI: 10.1016/j.humimm.2013.04.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 03/01/2013] [Accepted: 04/10/2013] [Indexed: 12/23/2022]
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28
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Sigle JP, Thierbach J, Infanti L, Muriset M, Hunziker G, Chassot K, Niederhauser C, Gowland P, Holbro A, Sunic K, Buser A, Fontana S. Anti-leucocyte antibodies in platelet apheresis donors with and without prior immunizing events: implications for TRALI prevention. Vox Sang 2013; 105:244-52. [DOI: 10.1111/vox.12045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/29/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
| | - J. Thierbach
- Regional Blood Transfusion Service of the Swiss Red Cross; St. Gallen; Switzerland
| | - L. Infanti
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - M. Muriset
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - G. Hunziker
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - K. Chassot
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - C. Niederhauser
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - P. Gowland
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
| | - A. Holbro
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - K. Sunic
- Regional Blood Transfusion Service of the Swiss Red Cross; St. Gallen; Switzerland
| | - A. Buser
- Regional Blood Transfusion Service of the Swiss Red Cross; Basel; Switzerland
| | - S. Fontana
- Regional Blood Transfusion Service of the Swiss Red Cross; Bern; Switzerland
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29
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Gandhi MJ, Carrick DM, Jenkins S, De Goey S, Ploeger NA, Wilson GA, Lee JH, Winters JL, Stubbs JR, Toy P, Norris PJ. Lot-to-lot variability in HLA antibody screening using a multiplexed bead-based assay. Transfusion 2013; 53:1940-7. [PMID: 23305156 DOI: 10.1111/trf.12064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Identifying antibodies to HLA (anti-HLA) by solid-phase assays is used to screen blood donors to mitigate transfusion-related acute lung injury risk. Various cutoffs for detection assays have been proposed in the literature; however, these do not take into consideration lot-to-lot variability of commercially available assays. STUDY DESIGN AND METHODS Samples from 93 nontransfused males were tested using five different lots of a multiplex bead-based anti-HLA detection kit. A subset of 17 samples was tested on 5 days using a single lot. An additional 96 samples from donations with varied anti-HLA levels were tested using kits from two different lots. Results were reported as a normalized background (NBG) ratio. RESULTS For the 93 nontransfused donors, NBG values generated using the reference lot were significantly higher than those obtained with three of the four comparator lots. However, for the 96 samples with low-, moderate-, and higher-level anti-HLA, Class I (CL-I) values were 1.4 times lower and Class II (CL-II) values were 1.2 times lower using the reference versus comparator lot. For CL-I antibodies the between-lot standard deviation (SD) was 1.36 (95% confidence interval [CI], 1.19-1.60), while the between-day SD was 1.27 (95% CI, 1.08-1.52). Similarly, for CL-II antibodies the between-lot SD was 0.81 (95% CI, 0.70-0.95), while the between-day SD was 0.50 (95% CI, 0.43-0.60). CONCLUSIONS There is interlot variability in the tested HLA detection assay as well as significant bias between lots. It may be reasonable to develop a new cutoff when a new lot is obtained.
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Affiliation(s)
- Manish J Gandhi
- Department of Laboratory Medicine and Pathology, Department of Biomedical Statistics & Informatics, Department of Anesthesiology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota; Westat, Inc., Rockville, Maryland; One Lambda, Inc., Canoga Park, California; Deparment of Laboratory Medicine, University of California at San Francisco, Blood Systems Research Institute, San Francisco, California
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30
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On the role of HLA antibodies in hematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2012; 81:1-11. [DOI: 10.1111/tan.12040] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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31
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Makar RS, Powers A, Stowell CP. Reducing Transfusion-Related Acute Lung Injury Risk: Evidence for and Approaches to Transfusion-Related Acute Lung Injury Mitigation. Transfus Med Rev 2012; 26:305-20. [DOI: 10.1016/j.tmrv.2012.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schmidt AE, Adamski J. Pathology consultation on transfusion-related acute lung injury (TRALI). Am J Clin Pathol 2012; 138:498-503. [PMID: 23010703 DOI: 10.1309/ajcpff6jkxm7byoi] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a serious condition characterized by respiratory distress, hypoxia, and bilateral pulmonary infiltrates, which occur within 6 hours of transfusion. Several theories have been proposed to explain the underlying pathologic mechanisms of TRALI. Immune-mediated TRALI accounts for over 80% of reported cases and is mediated by donor antibodies to HLAs and/or human neutrophil antigens (HNA). Immune-mediated TRALI is most commonly associated with donor plasma transfusion or other blood products from multiparous women, which has led many countries to reduce or exclude women from donating high-volume plasma products. This policy change has resulted in a decrease in the incidence of TRALI and highlighted the importance of nonimmune-mediated TRALI, which is thought to be caused by bioreactive lipids and other biologic response modifiers that accumulate during storage of blood products. When TRALI is suspected, clinical consultation with a transfusion medicine specialist helps differentiate it from other transfusion reactions with similar characteristics.
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Affiliation(s)
- Amy E. Schmidt
- Department of Pathology, University of Alabama at Birmingham
| | - Jill Adamski
- Department of Pathology, University of Alabama at Birmingham
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Verduin EP, Schonewille H, Brand A, Haasnoot GW, Claas FH, Lindenburg IT, Lopriore E, Oepkes D, Roelen DL, Doxiadis II. High anti-HLA response in women exposed to intrauterine transfusions for severe alloimmune hemolytic disease is associated with mother-child HLA triplet mismatches, high anti-D titer, and new red blood cell antibody formation. Transfusion 2012; 53:939-47. [DOI: 10.1111/j.1537-2995.2012.03862.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Müller MCA, Juffermans NP. Transfusion-related acute lung injury: a preventable syndrome? Expert Rev Hematol 2012; 5:97-106. [PMID: 22272709 DOI: 10.1586/ehm.11.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Recent insights into the pathophysiology of TRALI have led to various preventive strategies. Strategies in donor management range from antibody testing of sensitized donors to the deferral of female plasma donors altogether. However, knowledge on the efficacy of measures to reduce TRALI is limited. In addition, the various measures may lead to a substantial loss of donors, hampering steady blood supply. Thereby, consensus among countries and blood-collecting facilities regarding the optimal strategy to prevent TRALI is lacking. In this review, the advantages and disadvantages of various preventive measures to prevent TRALI are discussed, related to both patient factors as well as blood component-processing strategies, including transfusion policy, donor management and practices of preparation and storage conditions of blood components.
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Affiliation(s)
- Marcella C A Müller
- Department of Intensive Care & Laboratory of Experimental Intensive Care & Anesthesiology, Academic Medical Center Amsterdam, The Netherlands.
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Williams D, Rao M, Carey P. Impact of a transfusion-related acute lung injury reduction strategy on apheresis platelet collections. J Clin Apher 2012; 27:205-11. [PMID: 22535678 DOI: 10.1002/jca.21230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 03/13/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most blood centers in the US have implemented transfusion-related acute lung injury (TRALI) mitigation strategies for apheresis platelet (AP) donations based on theoretical impact of donor loss. The aim of this study is to determine the actual impact of a TRALI mitigation strategy in a US blood center. STUDY DESIGN AND METHODS Daily collection events and resulting products were retrospectively obtained before and after implementation of a TRALI reduction strategy (HLA antibody testing female AP donors four or more pregnancies) for comparison. The retention rate of reassigned donors was determined by reviewing whole blood (WB) and/or apheresis red blood cell (AR) donations post reassignment. Data were obtained to compare donor frequency and split rate from reassigned (historical data) and new AP donors. RESULTS Mean daily collections (27.7 vs. 30.0) and total products (12,211 vs. 12,957) were significantly higher after implementation, but the number of products/collection event was lower (1.49 vs. 1.40). Mean collections/donor/year (4.0 vs. 1.8) and split rate (36% vs. 27%) were historically higher for reassigned (n = 45) versus new AP donors (n = 1,090). Seventy-three of 112 donors (65%) testing positive for HLA antibodies returned for WB or AR donations, 31 of 45 (69%) active AP donors returned. CONCLUSIONS Donor loss may not be adequate to estimate impact on AP inventory, as donation characteristics may differ between new donors and those reassigned. We show successful implementation of a TRALI mitigation strategy by increasing collection goals and AP donor recruitment efforts beyond donor loss. Retaining the majority of reassigned donors is feasible.
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Affiliation(s)
- Dennis Williams
- Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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Middelburg RA, Beckers EAM, Porcelijn L, Lardy N, Wiersum-Osselton JC, Schipperus MR, Vrielink H, Briët E, van der Bom JG. Allo-exposure status and leucocyte antibody positivity of blood donors show a similar relation with TRALI. Transfus Med 2012; 22:128-32. [PMID: 22380759 DOI: 10.1111/j.1365-3148.2012.01140.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The fraction of transfusion-related acute lung injury (TRALI) cases preventable by deferral of allo-exposed donors has previously been estimated, under the assumption this indirectly estimated the contribution of leucocyte antibodies to the occurrence of TRALI. Our aim was to estimate the fraction preventable by deferral of leucocyte antibody positive donors and to investigate the validity of allo-exposure as a marker for leucocyte antibodies. METHODS All donors involved in a series of previously published TRALI patients were tested for leucocyte antibodies. The observed number of antibody positive donors was compared to the expected number. From this comparison we estimated the contribution of leucocyte antibodies to the occurrence of TRALI and compared this to the previously reported estimate for allo-exposed donors. RESULTS Sixty-one TRALI patients were included. Of 288 involved donors 43 were expected and 67 were observed to be leucocyte antibody positive. The observed percentage of positive donors was 8.3% (95% confidence interval (CI): 5.1-11.5%) in excess of the expected. Overall 59% (95% CI: 34-85%) of TRALI cases was estimated to be preventable by the exclusion of all leucocyte antibody positive donors. For plasma-poor products this was 16% (95% CI: -5.0 to 36%). CONCLUSIONS These estimates were similar to those previously published for allo-exposed donors. This suggests allo-exposure status can effectively be used in donor deferral strategies.
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Affiliation(s)
- R A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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Yoshihara S, Taniguchi K, Ogawa H, Saji H. The role of HLA antibodies in allogeneic SCT: is the 'type-and-screen' strategy necessary not only for blood type but also for HLA? Bone Marrow Transplant 2012; 47:1499-506. [PMID: 22231464 DOI: 10.1038/bmt.2011.249] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of HLA antibodies in SCT has drawn increasing attention because of the significantly increased number of patients who receive HLA-mismatched SCT, including cord blood transplantation, haploidentical SCT and unrelated SCT. Technical advancements in the methods of HLA Ab testing have realized rapid, accurate and objective identification, as well as quantification of specific HLA antibodies. Recent clinical studies have suggested that the presence of donor-specific HLA antibodies (DSA) in patients is associated with graft failure in HLA-mismatched SCT when the above-listed stem cell sources are used and results in different impacts. Of note, most of the 'HLA-matched' unrelated SCT actually involve HLA mismatches in HLA-DP and the presence of antibodies against this locus has been reported to be associated with graft failure. Thus, HLA Ab should be examined as a work-up for all patients who undergo SCT from 'alternative donors.' The simplest route for preventing HLA Ab-mediated graft failure in Ab-positive patients is to avoid donors who possess the target Ag of HLA antibodies. If SCT from such donors must be performed, treatment for DSA before SCT may improve the chances of successful donor engraftment.
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Affiliation(s)
- S Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
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Hyun J, Park K, Yoo Y, Lee B, Han B, Song E, Park M. Effects of Different Sensitization Events on HLA Alloimmunization in Solid Organ Transplantation Patients. Transplant Proc 2012; 44:222-5. [DOI: 10.1016/j.transproceed.2011.12.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lucas G, Win N, Calvert A, Green A, Griffin E, Bendukidze N, Hopkins M, Browne T, Poles A, Chapman C, Massey E. Reducing the incidence of TRALI in the UK: the results of screening for donor leucocyte antibodies and the development of national guidelines. Vox Sang 2011; 103:10-7. [DOI: 10.1111/j.1423-0410.2011.01570.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bercovitz RS, Kelher MR, Khan SY, Land KJ, Berry TH, Silliman CC. The pro-inflammatory effects of platelet contamination in plasma and mitigation strategies for avoidance. Vox Sang 2011; 102:345-53. [PMID: 22092073 DOI: 10.1111/j.1423-0410.2011.01559.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Plasma and platelet concentrates are disproportionately implicated in transfusion-related acute lung injury (TRALI). Platelet-derived pro-inflammatory mediators, including soluble CD40 ligand (sCD40L), accumulate during storage. We hypothesized that platelet contamination induces sCD40L generation that causes neutrophil [polymorphonuclear leucocyte (PMN)] priming and PMN-mediated cytotoxicity. MATERIALS AND METHODS Plasma was untreated, centrifuged (12,500 g) or separated from leucoreduced whole blood (WBLR) prior to freezing. Platelet counts and sCD40L concentrations were measured 1-5 days post-thaw. The plasma was assayed for PMN priming activity and was used in a two-event in vitro model of PMN-mediated human pulmonary microvascular endothelial cell (HMVEC) cytotoxicity. RESULTS Untreated plasma contained 42±4·2×10(3)/μl platelets, which generated sCD40L accumulation (1·6-eight-fold vs. controls). Priming activity and HMVEC cytotoxicity were directly proportional to sCD40L concentration. WBLR and centrifugation reduced platelet and sCD40L contamination, abrogating the pro-inflammatory potential. CONCLUSION Platelet contamination causes sCD40L accumulation in stored plasma that may contribute to TRALI. Platelet reduction is potentially the first TRALI mitigation effort in plasma manufacturing.
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Gatault P, Jollet I, Rabot N, Boulanger MD, Taupin JL, Barbet C, Baron C, Thierry A, Halimi JM, Lebranchu Y, Touchard G, Büchler M. Mothers without HLA antibodies before transplantation have a low risk of alloimmunization post-transplantation. ACTA ACUST UNITED AC 2011; 78:241-8. [DOI: 10.1111/j.1399-0039.2011.01757.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delaney M, Warner P, Nelson K, Gleckler C, Price T, Madeleine M. Humoral immunomodulatory effect of influenza vaccine in potential blood donors: implications for transfusion safety. Transfus Med 2011; 21:378-84. [DOI: 10.1111/j.1365-3148.2011.01097.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rios JA, Schlumpf KS, Kakaiya RM, Triulzi DJ, Roback JD, Kleinman SH, Murphy EL, Gottschall JL, Carey PM. Blood donations from previously transfused or pregnant donors: a multicenter study to determine the frequency of alloexposure. Transfusion 2011; 51:1197-206. [PMID: 21182532 PMCID: PMC3606016 DOI: 10.1111/j.1537-2995.2010.02991.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) mitigation strategies include the deferral of female donors from apheresis platelet (PLT) donations and the distribution of plasma for transfusion from male donors only. We studied the implications of these policies in terms of component loss at six blood centers in the United States. STUDY DESIGN AND METHODS We collected data from allogeneic blood donors making whole blood and blood component donations during calendar years 2006 through 2008. We analyzed the distribution of donations in terms of the sex, transfusion and pregnancy histories, and blood type. RESULTS A TRALI mitigation policy that would not allow plasma from female whole blood donors to be prepared into transfusable plasma components would result in nearly a 50% reduction in the units of whole blood available for plasma manufacturing and would decrease the number of type AB plasma units that could be made from whole blood donations by the same amount. Deferral of all female apheresis PLT donors, all female apheresis PLT donors with histories of prior pregnancies, or all female apheresis PLT donors with histories of prior pregnancies and positive screening test results for antibodies to human leukocyte antigens (HLAs) will result in a loss of 37.1, 22.5, and 5.4% of all apheresis PLT donations, respectively. CONCLUSION A TRALI mitigation policy that only defers female apheresis PLT donors with previous pregnancies and HLAs would result in an approximately 5% decrease in the inventory of apheresis PLTs, but would eliminate a large proportion of components that are associated with TRALI.
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Affiliation(s)
- Jorge A Rios
- New England Region, American Red Cross Blood Services, Dedham, Massachusetts, USA
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Carrick DM, Johnson B, Kleinman SH, Vorhaben R, Chance SC, Lee JH, Roback JD, Pandey S, Sun Y, Busch MP, Norris PJ. Agreement among HLA antibody detection assays is higher in ever-pregnant donors and improved using a consensus cutoff. Transfusion 2011; 51:1105-16. [PMID: 21087285 PMCID: PMC3089710 DOI: 10.1111/j.1537-2995.2010.02938.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND HLA antibodies might contribute to the pathogenesis of transfusion-related acute lung injury (TRALI). HLA antibody detection methods include ELISA, flow cytometry, and multiplex bead-based assays, as well as the older lymphocytotoxicity assay, and it is not obvious how to compare results across platforms. STUDY DESIGN AND METHODS Five hundred twenty-five serum samples were selected from 7841 donors in the Leukocyte Antibody Prevalence Study (LAPS) repository based on risk for the development of HLA antibodies, using the number of pregnancies as the risk factor. Subjects included 81 males and females with 0 (n = 187), 1 (n = 67), or 2+ pregnancies (n = 190). Replicate frozen serum aliquots were sent blinded to four different HLA antibody assay manufacturers for detection using five different assays. RESULTS The flow cytometry and multiplex bead based-assays typically resulted in a larger proportion of HLA antibody positive samples compared with ELISA based assays. Latent variable analysis was used to derive a new set of consensus cutoffs, which yielded similar sensitivities across test platforms and increased concordance amongst assays. Assay agreement was higher in ever pregnant females than in males and never-pregnant females. CONCLUSIONS Different assays resulted in varied positivity rates when the manufacturer's suggested cutoffs were used, demonstrating that care needs to be taken when comparing clinical outcomes data generated using different HLA antibody assays and testing platforms. The method used here, involving latent variable analysis, presents one possible approach to calculating comparable cutoffs that result in broad agreement across assays with respect to positivity designation.
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Affiliation(s)
- Danielle M Carrick
- Blood Systems Research Institute and Blood Centers of the Pacific, San Francisco, California 94118, USA
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Middelburg RA, van Stein D, Atsma F, Wiersum-Osselton JC, Porcelijn L, Beckers EAM, Briët E, van der Bom JG. Alloexposed blood donors and transfusion-related acute lung injury: a case-referent study. Transfusion 2011; 51:2111-7. [PMID: 21985044 DOI: 10.1111/j.1537-2995.2011.03118.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Donor white blood cell (WBC) antibodies are thought to increase the risk of transfusion-related acute lung injury (TRALI). WBC antibodies can be present in blood products from donors who have been alloexposed. Alloexposed donors are increasingly excluded from donating plasma, but can still donate plasma-poor products. We aimed to quantify the contribution of alloexposed donors to the occurrence of TRALI for different blood product types. STUDY DESIGN AND METHODS We performed a case-referent study including all reported TRALI patients and all Dutch blood donors. Data on alloexposure status of donors of all TRALI cases reported between January 2004 and October 2008, in the Netherlands, were compared to information on the total donor population. RESULTS Alloexposure status of all 223 involved donors was compared to the expected status. The overall percentage of TRALI cases that could have been prevented by the deferral of all alloexposed donors (i.e., population-attributable risk [PAR]) was 51% (95% confidence interval [CI], 14%-88%). In 19 recipients of exclusively plasma-poor products (mostly red blood cells [RBCs]), alloexposure of the donors was not associated with TRALI, while in 28 recipients of both plasma-poor and plasma-rich products (>200 mL plasma), the PAR was 94% (95% CI, 34%-100%). CONCLUSIONS Alloexposed donors conferred an increased risk of TRALI in recipients of plasma-rich products, but not in recipients of plasma-poor products. Although WBC antibodies are an important risk factor for TRALI, among RBC recipients another risk factor must be more important.
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Affiliation(s)
- Rutger A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Vassallo RR, Adamson JW, Gottschall JL, Snyder EL, Lee W, Houghton J, Elfath MD. In vitro and in vivo evaluation of apheresis platelets stored for 5 days in 65% platelet additive solution/35% plasma. Transfusion 2011; 50:2376-85. [PMID: 20497516 DOI: 10.1111/j.1537-2995.2010.02693.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the United States, apheresis platelets (PLTs) are suspended in autologous plasma. PLT additive solutions, long used in Europe, decrease recipient allergic reactions and may reduce the risk of transfusion-related acute lung injury. We evaluated Amicus-collected PLTs stored in platelet additive solution (PAS) III (InterSol) for 5 days. STUDY DESIGN AND METHODS In Study 1, 71 subjects donated two products on a single day-one each stored in 100% plasma or 65% PAS III/35% plasma. Products underwent standard in vitro testing on Days 1 and 5. In Study 2, 43 additional subjects provided Amicus products stored for 5 days in 65% PAS III/35% plasma for in vivo radiolabeled recovery and survival determinations. The effect of approximately 2500cGy Day 1 gamma irradiation was evaluated in a subset of products. RESULTS PAS III PLTs (n=70) had a median Day 5 pH(22°C) of 7.2 (lower 95%, 95% tolerance limit, 6.9). Mean Day 5 recovery and survival of radiolabeled PAS III PLTs (n=33) were, respectively, 80.5 and 72.1%, of fresh autologous PLTs. With 95% confidence, these values were at least 66% of fresh PLT recovery and 58% of survival. All in vitro variables remained within ranges seen in licensed products for irradiated and nonirradiated PAS III PLTs. CONCLUSION Leukoreduced Amicus PLTs stored in 65% PAS III/35% plasma in PL-2410 containers maintained pH ≥6.9 throughout 5 days' storage. Radiolabeled PLT recovery and survival values met US Food and Drug Administration statistical criteria. Gamma-irradiated PAS III PLTs demonstrated no significant adverse effects due to irradiation in in vitro testing.
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Affiliation(s)
- Ralph R Vassallo
- American Red Cross Blood Services, Penn-Jersey Region, Philadelphia, Pennsylvania 19123, USA. usa.redcross.org
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Makar RS, Saidman SL, Stowell CP, Lee H, Powers A. Analysis of cutoffs for screening sensitized blood donors for HLA alloantibodies using a cytometric microbead assay. Transfusion 2011; 51:166-74. [DOI: 10.1111/j.1537-2995.2010.02771.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aung FM, Cano P, Fernandez-Vina M, Lichtiger B. Results of HLA antibody testing using ELISA vs the fluorescent bead method and retrospective review of data for recipients of packed RBCs and platelets from male HLA-immunized donors. Am J Clin Pathol 2011; 135:90-5. [PMID: 21173129 DOI: 10.1309/ajcp98jnyhgcgmhk] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We reviewed HLA antibody testing results using an enzyme-linked immunosorbent assay (ELISA) for all male blood donors at our institution during a 3.5-month period to look for HLA immunization. Confirmatory testing of 33 blood samples positive for HLA class I and/or II antibodies was performed using the fluorescent bead method. A retrospective review of recipients of packed RBCs and platelets processed from these 33 HLA-immunized male donors were conducted to identify transfusion-related acute lung injury and cognate antigens. The agreement rates between the methods for HLA class I and II antibodies were 21% (7/33) and 6% (2/33), respectively. We noted HLA antibodies in the male donors corresponding to cognate antigens in 2 recipients of packed RBCs and in 3 recipients of platelets. Of 8 donors positive for HLA antibodies, 5 did not have a history of blood transfusion. We conclude that ELISA was too sensitive and had a high false-positive rate for the detection of HLA class II antibodies.
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Gottschall JL, Triulzi DJ, Curtis B, Kakaiya RM, Busch MP, Norris PJ, Glynn SA, Carrick D, Wright DJ, Kleinman S. The frequency and specificity of human neutrophil antigen antibodies in a blood donor population. Transfusion 2010; 51:820-7. [PMID: 20977484 DOI: 10.1111/j.1537-2995.2010.02913.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) has been associated with both human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. HNA antibody frequency, specificity, and demographic associations have not been well defined in the blood donor population. STUDY DESIGN AND METHODS A subset of 1171 donors (388 nontransfused males, 390 HLA antibody-negative females with three or more pregnancies, and 393 HLA antibody-positive females with three or more pregnancies) from a larger Leukocyte Antibody Prevalence Study was tested for immunoglobulin (Ig)G and IgM HNA antibody using a granulocyte immunofluorescence flow cytometry assay. Additional testing on selected samples included monoclonal antibody immobilization of granulocyte antigen-flow cytometry and granulocyte genotyping. RESULTS Eight samples were HNA antibody positive (prevalence, 0.7%; 95% confidence interval [CI], 0.3%-1.3%]). Three HNA antibodies (one IgG and two IgM) were found in nontransfused males (prevalence, 0.8%; 95% CI, 0.2%-2.2%); all were panreactive or nonspecific. One HLA antibody-negative previously pregnant female had an IgG HNA antibody with HNA-1a specificity (prevalence, 0.3%; 95% CI, 0.01%-1.4%). Four HLA antibody-positive previously pregnant females demonstrated HNA antibodies, three IgG and one IgM (prevalence, 1%; 95% CI, 0.3%-2.6%). Two of these were HNA-1a specific, one HNA-4a specific, and one nonspecific. CONCLUSIONS HNA antibodies occur with low frequency in the donor population and are present in both male and female donors. Despite the implementation of TRALI reduction strategies, HNA antibodies are still present in donor blood products. Although our data do not create a case for urgent implementation of donor HNA antibody testing, future new developments for high-throughput HNA antibody screening, including for HNA-3a, may warrant reconsideration.
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Middelburg R, Porcelijn L, Lardy N, Briët E, Vrielink H. Prevalence of leucocyte antibodies in the Dutch donor population. Vox Sang 2010; 100:327-35. [DOI: 10.1111/j.1423-0410.2010.01420.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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