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Transfusion of target antigens to preimmunized recipients: a new mechanism in transfusion-related acute lung injury. Blood Adv 2021; 5:3975-3985. [PMID: 34438443 PMCID: PMC8945619 DOI: 10.1182/bloodadvances.2020003843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/04/2021] [Indexed: 01/13/2023] Open
Abstract
The recipients’ preformed alloantibodies may initiate TRALI reaction in recipients transfused with soluble antigen. The antibody interaction with absorbed antigen on ECs leads to endothelial barrier dysfunction and lung injury.
Transfusion-related lung injury (TRALI) is a serious side effect of blood transfusion. Exclusion of antibody carriers from the donor pool has significantly decreased the number of cases, but TRALI remains the leading cause of transfusion-related morbidity and mortality in industrialized countries. Here, we show that proteins released from donor cells during processing of blood components are capable of inducing a new type of reverse TRALI when transfused to preimmunized recipients. First, we show that soluble neutrophil surface protein CD177 in complex with proteinase 3 (sCD177/PR3) is not only present in human plasma but also in packed red blood cell (PRBC) supernatant. Filtration or storage enhances the concentration of sCD177/PR3 in PRBCs. Second, we show that sCD177/PR3 specifically binds to PECAM-1 on stimulated (but not on unstimulated) endothelial cells (ECs). Third, we provide evidence that the sCD177/PR3/PECAM-1 complex is functional. In the presence of monoclonal or human antibodies against CD177 or PR3, ECs produce reactive oxygen species and become apoptotic. Albumin flux through an EC monolayer increases significantly whenever antibodies and the cognate antigens are present. Finally, we describe a clinical case in which anti-CD177 present in a transfusion recipient precipitated TRALI after the transfusion of CD177-positive, but not CD177-negative, PRBCs. In conclusion, we introduce a new TRALI mechanism based on the specific binding of transfused, soluble antigens to activated ECs in preimmunized recipients. We suggest that further studies and clinical work-up of TRALI should also include antibody investigation of the recipient.
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Traum A, Hofmann C, Haas S, Schmidt S, Bein G, Sachs UJ, Bayat B. Characterization of CD177-reactive iso- and auto-antibodies. Transfusion 2021; 61:1916-1922. [PMID: 33734454 DOI: 10.1111/trf.16359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND CD177 is a surface protein on neutrophils and a main mediator for the surface expression of proteinase 3 (PR3). Its functions are largely unknown. At least three types of antibodies have been described to target CD177: isoantibodies, which are formed in CD177-null individuals as a result of an immune reaction following transfusion or pregnancy; autoantibodies present in sera from patients with autoimmune neutropenia; and antineutrophil cytoplasmic antibodies in sera from patients with glomerulonephritis with polyangiitis. In this study, we aimed to compare the binding characteristics of auto- and iso-antibodies to optimize their detectability in the neutrophil serology laboratory. STUDY DESIGN AND METHODS The reactivity of iso- and auto-antibodies against CD177 was studied using granulocytes, "native" CD177/PR3 complex, and recombinant CD177 or PR3. RESULTS All iso- and auto-antibodies were reactive with CD177/PR3 when immobilized with monoclonal antibody (moab) 7D8. Seventy-five percent of autoantibodies, but none of the isoantibodies, did not react with CD177/PR3 immobilized with moab MEM166. The majority of autoantibodies did not react with recombinant CD177, whereas most isoantibodies tested positive. DISCUSSION Our results suggest that iso- and auto-antibodies against CD177 target different epitopes. Isoantibodies mainly target CD177 alone, while the majority of autoantibodies target a native epitope present on the neutrophil surface, but absent from recombinant CD177 which lacks PR3. Moab MEM166 binds to the native epitope and hinders the binding of CD177 autoantibodies. The results may help to design diagnostic strategies, especially for the identification of autoantibodies.
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Affiliation(s)
- Annalena Traum
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Christine Hofmann
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Sabine Haas
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Silke Schmidt
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
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Farruggia P, Fioredda F, Puccio G, Onofrillo D, Russo G, Barone A, Bonanomi S, Boscarol G, Finocchi A, Ghilardi R, Giordano P, Ladogana S, Lassandro G, Luti L, Lanza T, Mandaglio R, Marra N, Martire B, Mastrodicasa E, Motta M, Notarangelo LD, Pillon M, Porretti L, Serafinelli J, Trizzino A, Tucci F, Veltroni M, Verzegnassi F, Ramenghi U, Dufour C. Idiopathic neutropenia of infancy: Data from the Italian Neutropenia Registry. Am J Hematol 2019; 94:216-222. [PMID: 30456824 DOI: 10.1002/ajh.25353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/27/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023]
Abstract
Autoimmune neutropenia of infancy (AIN) is characterized by low risk of severe infection, tendency to spontaneously resolve and typically onset at ≤4-5 years of age; it is due to auto-antibodies whose detection is often difficult. In case of negativity of 4 antineutrophils autoantibody tests, after having excluded ethnic, postinfection, drug induced, or congenital neutropenia, according to the Italian guidelines the patients will be defined as affected by "idiopathic neutropenia" (IN). We describe the characteristics of 85 IN patients enrolled in the Italian neutropenia registry: they were compared with 336 children affected by AIN. The 2 groups were clinically very similar and the main differences were detection age (later in IN), length of disease (longer in IN) and, among recovered patients, age of spontaneous recovery: the median age at resolution was 2.13 years in AINs and 3.03 years in INs (P = .00002). At bivariate analysis among AIN patients earlier detection age (P = .00013), male sex (P = .000748), absence of leucopenia (P = .0045), and absence of monocytosis (P = .0419) were significantly associated with earlier recovery; in the IN group only detection age (P = .013) and absence of monocytosis (P = .0333) were significant. At multivariate analysis detection age and absence of monocytosis were independently significant (P = 6.7e-05 and 4.4e-03, respectively) in the AIN group, whereas in the IN group only detection age stayed significant (P = .013).
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Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Francesca Fioredda
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion; University of Palermo; Palermo Italy
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology; Spirito Santo Hospital; Pescara Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology; University Hospital; Parma Italy
| | - Sonia Bonanomi
- MBBM Foundation, Department of Pediatrics; University of Milano - Bicocca; Monza Italy
| | - Gianluca Boscarol
- Department of Pediatrics; Central Teaching Hospital Bolzano; Bolzano Italy
| | | | - Roberta Ghilardi
- Department of Pediatrics; Ospedale Maggiore Policlinico IRCCS; Milan Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Saverio Ladogana
- Department of Hematology; IRCCS Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Laura Luti
- Pediatric Hematology Oncology; Bone Marrow Transplant, Azienda Ospedaliero Universitaria Pisana, S. Chiara Hospital; Pisa Italy
| | - Tiziana Lanza
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | | | | | - Baldassare Martire
- Pediatric Science and Surgery Department; Pediatric Onco-Hematology Unit, Hospital Policlinico- Giovanni XXIII; Bari Italy
| | - Elena Mastrodicasa
- Pediatric Oncology Hematology Unit; S. Maria Della Misericordia Hospital; Perugia Italy
| | - Milena Motta
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Lucia Dora Notarangelo
- Onco-Haematology and Bone Marrow Transplantation Unit; Children's Hospital; Brescia Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Department; University of Padova; Padova
| | - Laura Porretti
- Flow Cytometry Service; Laboratory of Clinical Chemistry and Microbiology, IRCCS “Ca‘ Granda” Foundation, Maggiore Hospital Policlinico; Milan Italy
| | | | - Angela Trizzino
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Fabio Tucci
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Federico Verzegnassi
- Institute for Maternal and Child Health (I.R.C.C.S) Burlo Garofolo; Trieste Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences; University of Torino; Italy
| | - Carlo Dufour
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
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Xia W, Ye X, Xu X, Chen D, Deng J, Chen Y, Ding H, Shao Y, Wang J, Liu J, Li H, Huang YF, Fu Y, Santoso S. The prevalence of leucocyte alloantibodies in blood donors from South China. Transfus Med 2016; 25:385-92. [PMID: 26876912 DOI: 10.1111/tme.12276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/29/2015] [Accepted: 01/02/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Several studies had demonstrated that leucocyte antibodies including anti-human leucocyte antigen (anti-HLA) antibodies (class I and class II) and anti-human neutrophil antigen (anti-HNA) antibodies (HNA-1, -2 and -3) present in the blood products are responsible for transfusion-related acute lung injury (TRALI). Therefore, selection of blood products exclusive of anti-HLA and anti-HNA antibodies may lower the risk of TRALI reaction. However, the prevalence of leucocyte antibodies among blood donors in China is currently not known. STUDY DESIGN AND METHODS Blood samples were collected from 454 male and 560 female donors (143 nulliparous and 417 multiparous female). HLA class I and II antibodies were analyzed by bead assays. Anti-HNA-1 and -2 antibodies were screened by the LABScreen assay (One Lambda Inc.), and HNA-3 were detected by antigen capture assay, and confirmed by the granulocyte agglutination test (GAT). RESULTS Screening of the total cohort showed higher prevalence of HLA antibodies in female compared with male donors (19.64 vs. 4.63%). We found antibodies against HLA class I (13.21%) and HLA class II (11.43%) in 560 female donors. The most frequent antibodies against HLA class I and II in parous females (n = 69) reacted with were A*11 (28.81%), B*07 (42.37%), Cw*07 (20.34%) and DRB1*04 (40.43%) molecules. Among 778 donors (randomly selected from 1014 donors), we found three donors with neutrophil reactive antibodies, two against HNA-2 and one without known specificity. Anti-HNA-3 antibodies were not found so far. CONCLUSION In this study, we found alloimmunization against HLA class I, II and HNA in 4.63, 24.70 and 0.39%, respectively, in our female blood donors, indicating that the use of plasma containing blood products from parous female blood donors without HLA antibodies pre-testing may increase the risk of TRALI reaction. Although immunization against HNA seems to be a rare event in China, further observation is necessary to decide the necessity of HNA antibodies screening in our blood donors.
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Affiliation(s)
- W Xia
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Ye
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - X Xu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - D Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Deng
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Chen
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Ding
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - Y Shao
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Wang
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - J Liu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - H Li
- Department of Biotechnology, Guangdong Food and Drug Vocational College, Guangzhou, China
| | - Y F Huang
- Department of Surgery, Guangzhou First Municipal People's Hospital Affiliated to Guangzhou Medical College, Guangzhou, China
| | - Y Fu
- Institute of Blood Transfusion, Guangzhou Blood Center, Guangzhou, China
| | - S Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University, Giessen, Germany
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Amakishi E, Irie Y, Nishizawa K, Kamada H, Nakajima F, Matsuyama N, Ishii H, Matsukura H, Yasui K, Hirayama F. Evaluation of HNA-expressing cell line-based antigen capture systems and a solid-phase system for detecting HNA-1a antibodies. Int J Hematol 2015; 101:386-91. [PMID: 25644150 DOI: 10.1007/s12185-015-1751-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/26/2022]
Abstract
Granulocyte immunofluorescence and granulocyte agglutination tests are standard methods for detecting human neutrophil antigen (HNA) antibodies (Abs); however, these require a typed panel of neutrophils, which can be time-consuming to develop, and it remains difficult to determine antibody specificity in some cases. We established and evaluated four detection systems for HNA-1a Abs based on an HNA-1a-expressing cell line (KY cells) and antigen capture. We additionally evaluated a commercial solid-phase system. Eleven HNA-1a antibody-positive samples, including the World Health Organization Reference Reagent, and 40 serum samples derived from male blood donors were used as positive and negative control samples, respectively. Although specificity was >0.90 in all systems evaluated, the sensitivity varied among the systems. The KY cell-based monoclonal antibody specific immobilisation of granulocyte antigens (KY-MAIGA) system using certain, but not all, monoclonal Abs, and the solid-phase system revealed higher sensitivity than other systems. In conclusion, the KY-MAIGA and commercial solid-phase systems were superior in terms of specific and sensitive detection of HNA-1a Abs.
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Affiliation(s)
- Etsuko Amakishi
- Japanese Red Cross Kinki Block Blood Center, 7-5-17, Saitoasagi, Ibaraki, Osaka, 567-0085, Japan
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Farruggia P, Dufour C. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians. Ther Adv Hematol 2015; 6:15-24. [PMID: 25642312 DOI: 10.1177/2040620714556642] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3-4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management.
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Affiliation(s)
- Piero Farruggia
- Pediatric Onco-Hematology Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospitals, Piazza N. Leotta 4, Palermo, Italy
| | - Carlo Dufour
- Clinical and Experimental Hematology Unit, G. Gaslini Children's Hospital, Genoa, Italy
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Hirayama F. Approach of using established and new laboratory tests to more comprehensively investigate noninfectious and nonhemolytic transfusion reactions--along with the experience in Japan. Vox Sang 2013; 105:183-95. [PMID: 23763621 DOI: 10.1111/vox.12057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/03/2013] [Accepted: 05/09/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Noninfectious and nonhaemolytic transfusion reactions are the most common type of transfusion reactions. Several new tests have been made, helping diagnosis and understanding of their pathogenesis. This manuscript provides a review of the literature on currently available tests in association with the approach in Japan. MATERIALS & METHODS Primarily by using key words, more than 100 pertinent articles in the Medline database were identified and reviewed. RESULTS Numbers of laboratory tests are available including those for plasma protein levels, plasma protein antibodies, leucocyte and platelet antibodies, serum N-terminal-pro-brain natriuretic peptide levels, serum tryptase levels and genetic microchimerism. Cross-match tests, such as basophil activation test and neutrophil activation test, are also available to determine a causal relationship between the reaction and transfusion. CONCLUSIONS Several tests should help to confirm diagnosis and determine causal relationship between adverse reactions and transfusion and to gain an insight into the mechanism of the reaction in some cases, although some of the recently developed tests have not been completely validated.
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Affiliation(s)
- F Hirayama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
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Werth S, Bayat B, Tjahjono Y, Eskandar J, Berghöfer H, Bein G, Sachs UJ, Santoso S. Rapid enzyme-linked immunosorbent assay for the detection of antibodies against human neutrophil antigens -1a, -1b, and -1c. Transfusion 2012; 53:193-201. [PMID: 22554254 DOI: 10.1111/j.1537-2995.2012.03675.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several methods exist for the detection of neutrophil antibodies; most of them, however, require fresh neutrophils. In this study, an enzyme-linked immunosorbent assay (ELISA) using recombinant HNA-1 antigens (rHNAs) was developed to detect HNA-1a, -1b, and -1c alloantibodies in serum samples. STUDY DESIGN AND METHODS Soluble rHNA-1a, -1b, and -1c were isolated from culture supernatant of transfected insect cells. Purified rHNA antigens were immobilized on microtiter wells using antibody against V5-Tag protein. Sera were added, and bound antibodies were detected by enzyme-labeled secondary antibodies. In parallel, monoclonal antibody-immobilized granulocyte antigen (MAIGA) was performed with two different monoclonal antibodies (MoAbs) against FcγRIIIb (3G8 and BW209). RESULTS Fifteen MAIGA-positive sera containing HNA-1a alloantibodies were tested in ELISA. Thirteen of 15 (86.7%) MAIGA-positive sera captured by MoAbs 3G8 and/or BW209 reacted specifically with rHNA-1a. Four (26.7%) HNA-1a sera showed additional reaction with rHNA-1c. When anti-HNA-1b alloantibodies were analyzed in ELISA, 13 of 15 (86.7%) showed specific positive reaction with rHNA-1b, and 12 of 15 (80.0%) cross-reacted with rHNA-1c. Two HNA-1c sera reacted specifically with rHNA-1c. Immunoprecipitation analysis of all ELISA-negative HNA-1a and -1b sera did not show any specific band indicating false-positive reaction of these sera in MAIGA assay. CONCLUSIONS These results suggested that rapid ELISA using recombinant neutrophil antigens may provide a valuable method for rapid screening of human alloantibodies against HNA-1a, -1b, and -1c in patients with neutropenia and in blood donors.
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Affiliation(s)
- Silke Werth
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
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Fung YL, Minchinton RM, Fraser JF. Neutrophil antibody diagnostics and screening: review of the classical versus the emerging. Vox Sang 2011; 101:282-90. [PMID: 21933191 DOI: 10.1111/j.1423-0410.2011.01511.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Severe transfusion-related acute lung injury (TRALI) events have been linked to donor-derived neutrophil antibodies. The journey to developing mass donor neutrophil antibody screening platforms is challenged by the fragility of neutrophils and their unique-specific antigenic characteristics. MATERIAL AND METHODS This article critically evaluates the capabilities and potential of five emerging antibody screening platforms designed to detect neutrophil reactive antibodies relevant to TRALI. They are compared with established neutrophil serological methods. RESULTS Data from two recombinant antigen platforms and a method using human neutrophil antigens-expressing KY cells indicated high specificity. Two mixed cellular flow cytometric assays have the advantage of presenting native conformation of the human polymorphonuclear neutrophil antigenic epitopes. CONCLUSIONS To date, the number and specificity of test sera applied to each platform is small. This needs to be substantially increased and further rigorous serological evaluation is yet needed to compare the sensitivity and specificity limits of each new platform with classical methods. With a limited world supply of TRALI-relevant test sera, a collaborative effort of laboratories with neutrophil and TRALI investigation expertise is required.
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Affiliation(s)
- Y L Fung
- The Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Qld, Australia
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Bayat B, Tjahjono Y, Werth S, Berghöfer H, Reil A, Kroll H, Sachs UJ, Santoso S. Implication of transfected cell lines for the detection of alloantibodies against human neutrophil antigen-3. Transfusion 2011; 52:613-21. [DOI: 10.1111/j.1537-2995.2011.03303.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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