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Adkins BD, Jacobs JW, Booth GS, Savani BN, Stephens LD. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clin Hematol Int 2024; 6:128-140. [PMID: 38817704 PMCID: PMC11086996 DOI: 10.46989/001c.94135] [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: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 06/01/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
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Affiliation(s)
- Brian D. Adkins
- PathologyThe University of Texas Southwestern Medical Center
| | | | - Garrett S. Booth
- Pathology, Microbiology, and ImmunologyVanderbilt University Medical Center
| | - Bipin N. Savani
- Internal Medicine, Division of Hematology/ OncologyVanderbilt University Medical Center
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2
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Tran JQ, Muench MO, Gaillard B, Darst O, Tomayko MM, Jackman RP. Polyinosinic: polycytidylic acid induced inflammation enhances while lipopolysaccharide diminishes alloimmunity to platelet transfusion in mice. Front Immunol 2023; 14:1281130. [PMID: 38146372 PMCID: PMC10749330 DOI: 10.3389/fimmu.2023.1281130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Alloimmune responses against platelet antigens, which dominantly target the major histocompatibility complex (MHC), can cause adverse reactions to subsequent platelet transfusions, platelet refractoriness, or rejection of future transplants. Platelet transfusion recipients include individuals experiencing severe bacterial or viral infections, and how their underlying health modulates platelet alloimmunity is not well understood. Methods This study investigated the effect of underlying inflammation on platelet alloimmunization by modelling viral-like inflammation with polyinosinic-polycytidylic acid (poly(I:C)) or gram-negative bacterial infection with lipopolysaccharide (LPS), hypothesizing that underlying inflammation enhances alloimmunization. Mice were pretreated with poly(I:C), LPS, or nothing, then transfused with non-leukoreduced or leukoreduced platelets. Alloantibodies and allogeneic MHC-specific B cell (allo-B cell) responses were evaluated two weeks later. Rare populations of allo-B cells were identified using MHC tetramers. Results Relative to platelet transfusion alone, prior exposure to poly(I:C) increased the alloantibody response to allogeneic platelet transfusion whereas prior exposure to LPS diminished responses. Prior exposure to poly(I:C) had equivalent, if not moderately diminished, allo-B cell responses relative to platelet transfusion alone and exhibited more robust allo-B cell memory development. Conversely, prior exposure to LPS resulted in diminished allo-B cell frequency, activation, antigen experience, and germinal center formation and altered memory B cell responses. Discussion In conclusion, not all inflammatory environments enhance bystander responses and prior inflammation mediated by LPS on gram-negative bacteria may in fact curtail platelet alloimmunization.
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Affiliation(s)
- Johnson Q. Tran
- Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Marcus O. Muench
- Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Betty Gaillard
- Vitalant Research Institute, San Francisco, CA, United States
| | - Orsolya Darst
- Vitalant Research Institute, San Francisco, CA, United States
| | - Mary M. Tomayko
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, United States
- Department of Pathology, Yale University School of Medicine, New Haven, CT, United States
| | - Rachael P. Jackman
- Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
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3
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Panch SR, Guo L, Vassallo R. Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management. Blood Rev 2023; 62:101135. [PMID: 37805287 DOI: 10.1016/j.blre.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Platelet transfusion refractoriness due to HLA alloimmunization presents a significant medical problem, particularly among multiply transfused patients with hematologic malignancies and those undergoing hematopoietic stem cell transplants. HLA compatible platelet transfusions also impose significant financial burden on these patients. Recently, several novel mechanisms have been described in the development of HLA alloimmunization and platelet transfusion refractoriness. We review the history of platelet transfusions and mechanisms of HLA-sensitization and transfusion refractoriness. We also summarize advances in the diagnosis and treatment of platelet transfusion refractoriness due to HLA alloimmunization.
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Affiliation(s)
- Sandhya R Panch
- Clinical Research Division, Fred Hutchinson Cancer Center, United States of America; BloodWorks NorthWest, United States of America.
| | - Li Guo
- BloodWorks NorthWest, United States of America; Division of Hematology and Oncology, University of Washington School of Medicine, United States of America
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4
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Adane T, Enawgaw B. Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion. Asian J Transfus Sci 2023; 17:264-272. [PMID: 38274979 PMCID: PMC10807525 DOI: 10.4103/ajts.ajts_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/01/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
In many fields of clinical medicine and blood transfusion, the human leukocyte antigen (HLA) system is crucial. Alloimmunization happens as a result of an immune response to foreign antigens encountered during blood transfusion. This gives rise to alloantibodies against red blood cells (RBCs), HLA, or human platelet antigen (HPA). HLA alloimmunization following allogeneic transfusion was shown to be a result of contaminating white blood cells (WBCs) present in the product. It is a common complication of transfusion therapy that leads to difficulties in clinical intolerance and refractoriness to platelet transfusion during patient management. Single-donor platelets, prophylactic HLA matching, leukoreduction, and irradiation of cellular blood products are some of the mechanisms to prevent HLA alloimmunization during a blood transfusion. Now, the best approach to reduce the occurrence of primary HLA alloimmunization is the removal of WBCs from the blood by filtration.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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5
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Kaidarova Z, Di Germanio C, Custer B, Norris PJ. Risk of HLA antibody generation after receipt of Mirasol versus standard platelets in the MIPLATE randomized trial. Transfusion 2023; 63:791-797. [PMID: 36840440 DOI: 10.1111/trf.17286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Human leukocyte antigen (HLA) alloimmunization can occur after platelet transfusion. These antibodies can complicate future platelet transfusions or organ transplantation. Animal data suggest that Mirasol pathogen reduction treatment (PRT) can prevent alloimmunization after transfusion. STUDY DESIGN AND METHODS The MIPLATE trial enrolled 330 of a planned 660 participants with hematological malignancies at risk for grade 2 or greater bleeding. The study was halted early for futility after a planned interim analysis. Participants were randomized to receive PRT versus standard control platelets. Serum samples were collected from participants at baseline (pretransfusion), weekly for the first 4 weeks, then at days 42 and 56. HLA antibody levels were determined using a commercial multianalyte bead-based assay. HLA antibody levels were analyzed using low, medium, and high cutoffs based on prior studies. RESULTS The rate of alloimmunization was low in both arms of the study, particularly at the high HLA antibody cutoff (total of 6 of 277 subjects at risk, or 2.2%). The risk of alloimmunization did not differ between study arms, nor did the risk of immune refractoriness to platelet transfusion. CONCLUSIONS The data do not support the conclusion that Mirasol exerted a protective effect against alloimmunization after platelet transfusion in the MIPLATE trial.
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Affiliation(s)
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, California, USA
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6
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Garraud O, Hamzeh-Cognasse H, Chalayer E, Duchez AC, Tardy B, Oriol P, Haddad A, Guyotat D, Cognasse F. Platelet transfusion in adults: An update. Transfus Clin Biol 2023; 30:147-165. [PMID: 36031180 DOI: 10.1016/j.tracli.2022.08.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 106 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.
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Affiliation(s)
- O Garraud
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France.
| | | | - E Chalayer
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - A C Duchez
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - B Tardy
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - P Oriol
- CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - A Haddad
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Sacré-Cœur Hospital, Beirut, Lebanon; Lebanese American University, Beirut, Lebanon
| | - D Guyotat
- Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - F Cognasse
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
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7
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Novel platelet products including cold-stored platelets. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:421-423. [PMID: 36485096 PMCID: PMC9820915 DOI: 10.1182/hematology.2022000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews 3 products: pathogen-inactivated platelets, cold-stored platelets, and cryoplatelets. These are all coming to a transfusion service near you in the next few years. The article reviews the limitations of these new products and highlights the gaps in our understanding of their place in patient treatment.
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van Osch TLJ, Pongracz T, Geerdes DM, Mok JY, van Esch WJE, Voorberg J, Kapur R, Porcelijn L, Kerkhoffs JH, van der Meer PF, van der Schoot CE, de Haas M, Wuhrer M, Vidarsson G. Altered Fc glycosylation of anti-HLA alloantibodies in hemato-oncological patients receiving platelet transfusions. J Thromb Haemost 2022; 20:3011-3025. [PMID: 36165642 PMCID: PMC9828502 DOI: 10.1111/jth.15898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The formation of alloantibodies directed against class I human leukocyte antigens (HLA) continues to be a clinically challenging complication after platelet transfusions, which can lead to platelet refractoriness (PR) and occurs in approximately 5%-15% of patients with chronic platelet support. Interestingly, anti-HLA IgG levels in alloimmunized patients do not seem to predict PR, suggesting functional or qualitative differences among anti-HLA IgG. The binding of these alloantibodies to donor platelets can result in rapid clearance after transfusion, presumably via FcγR-mediated phagocytosis and/or complement activation, which both are affected by the IgG-Fc glycosylation. OBJECTIVES To characterize the Fc glycosylation profile of anti-HLA class I antibodies formed after platelet transfusion and to investigate its effect on clinical outcome. PATIENTS/METHODS We screened and captured anti-HLA class I antibodies (anti-HLA A2, anti-HLA A24, and anti-HLA B7) developed after platelet transfusions in hemato-oncology patients, who were included in the PREPAReS Trial. Using liquid chromatography-mass spectrometry, we analyzed the glycosylation profiles of total and anti-HLA IgG1 developed over time. Subsequently, the glycosylation data was linked to the patients' clinical information and posttransfusion increments. RESULTS The glycosylation profile of anti-HLA antibodies was highly variable between patients. In general, Fc galactosylation and sialylation levels were elevated compared to total plasma IgG, which correlated negatively with the platelet count increment. Furthermore, high levels of afucosylation were observed for two patients. CONCLUSIONS These differences in composition of anti-HLA Fc-glycosylation profiles could potentially explain the variation in clinical severity between patients.
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Affiliation(s)
- Thijs L. J. van Osch
- Immunoglobulin Research laboratory, Department of Experimental ImmunohematologySanquin ResearchAmsterdamThe Netherlands
- Department of Biomolecular Mass Spectrometry and ProteomicsUtrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht UniversityUtrechtThe Netherlands
| | - Tamas Pongracz
- Center for Proteomics and MetabolomicsLeiden University Medical CenterLeidenThe Netherlands
| | | | | | | | - Jan Voorberg
- Department of Molecular HematologyAmsterdam University Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - Rick Kapur
- Department of Experimental Immunohematology|Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology DiagnosticsSanquin Diagnostic ServicesAmsterdamThe Netherlands
| | - Jean‐Louis H. Kerkhoffs
- Department of Clinical Transfusion ResearchSanquin ResearchAmsterdamThe Netherlands
- Department of HematologyHaga Teaching HospitalThe HagueThe Netherlands
| | - Pieter F. van der Meer
- Department of HematologyHaga Teaching HospitalThe HagueThe Netherlands
- Department of ImmunologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Product and Process DevelopmentSanquin Blood BankAmsterdamThe Netherlands
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology|Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - Masja de Haas
- Department of Immunohematology DiagnosticsSanquin Diagnostic ServicesAmsterdamThe Netherlands
- Department of Clinical Transfusion ResearchSanquin ResearchAmsterdamThe Netherlands
- Departement of HematologyLeiden University Medical CenterLeidenThe Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and MetabolomicsLeiden University Medical CenterLeidenThe Netherlands
| | - Gestur Vidarsson
- Immunoglobulin Research laboratory, Department of Experimental ImmunohematologySanquin ResearchAmsterdamThe Netherlands
- Department of Biomolecular Mass Spectrometry and ProteomicsUtrecht Institute for Pharmaceutical Sciences and Bijvoet Center for Biomolecular Research, Utrecht UniversityUtrechtThe Netherlands
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9
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Garraud O, Chiaroni J. An overview of red blood cell and platelet alloimmunisation in transfusion. Transfus Clin Biol 2022; 29:297-306. [PMID: 35970488 DOI: 10.1016/j.tracli.2022.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Post-transfusion alloimmunisation is the main complication of all those observed after one or more transfusion episodes. Alloimmunisation is observed after the transfusion of red blood cell concentrates but also of platelet concentrates. Besides alloimmunisation due to antigens carried almost exclusively by red blood cells such as those of the Rhesus-Kell system, alloimmunisation often raises against HLA antigens; the main responsibility for that, apart from platelet transfusions, lies with residual leukocytes in the products transfused, hence the central importance of effective leukoreduction right from the blood product preparation stage. Alloimmunization is not restricted to transfusion, but it is also observed during pregnancies, carrying out microtransfusions of blood from the fetus immunizing the mother through the placenta (in a retrograde way). Preexisting maternal-fetal immunization can complicate a transfusion program and intensify the creation of alloantibodies in several blood and tissue group systems. The occurrence of autoantibodies, created by several pathogenic reasons, can also interfere with the propensity of certain recipients of blood components to produce alloantibodies. The genetic condition of individuals is in fact strongly linked to the ability or not to recognize antigenic variants foreign to their own biological program and mount an alloimmune response. Some hemoglobin diseases, in carriers of which transfusions can be iterative and lifelong, are complicated by frequent alloimmunizations and amplification of the complications of these alloimmunizations, imposing even stricter transfusion rules. This review details the mechanisms favoring the occurrence of alloimmunization and the immunological principles for the production of molecular and cellular tools for alloimmunization. It concludes with the main preventive measures available to limit the occurrence of these frequent complications of varying severity but sometimes severe.
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Affiliation(s)
- Olivier Garraud
- Sainbiose-Inserm_U1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France.
| | - Jacques Chiaroni
- Etablissement Français du Sang Provence-Alpes-Côte d'Azur-Corse, 13005 Marseille, France; Biologie des Groupes Sanguins, EFS, CNRS, ADES, Aix Marseille University, 13005 Marseille, France
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10
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Platelet Transfusion-Insights from Current Practice to Future Development. J Clin Med 2021; 10:jcm10091990. [PMID: 34066360 PMCID: PMC8125287 DOI: 10.3390/jcm10091990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Since the late sixties, therapeutic or prophylactic platelet transfusion has been used to relieve hemorrhagic complications of patients with, e.g., thrombocytopenia, platelet dysfunction, and injuries, and is an essential part of the supportive care in high dose chemotherapy. Current and upcoming advances will significantly affect present standards. We focus on specific issues, including the comparison of buffy-coat (BPC) and apheresis platelet concentrates (APC); plasma additive solutions (PAS); further measures for improvement of platelet storage quality; pathogen inactivation; and cold storage of platelets. The objective of this article is to give insights from current practice to future development on platelet transfusion, focusing on these selected issues, which have a potentially major impact on forthcoming guidelines.
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11
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Brixner V, Bug G, Pohler P, Krämer D, Metzner B, Voss A, Casper J, Ritter U, Klein S, Alakel N, Peceny R, Derigs HG, Stegelmann F, Wolf M, Schrezenmeier H, Thiele T, Seifried E, Kapels HH, Döscher A, Petershofen EK, Müller TH, Seltsam A. Efficacy of UVC-treated, pathogen-reduced platelets versus untreated platelets: a randomized controlled non-inferiority trial. Haematologica 2021; 106:1086-1096. [PMID: 33538149 PMCID: PMC8018132 DOI: 10.3324/haematol.2020.260430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Pathogen reduction (PR) technologies for blood components have been established to reduce the residual risk of known and emerging infectious agents. THERAFLEX UV-Platelets, a novel ultraviolet C (UVC) light-based PR technology for platelet concentrates, works without photoactive substances. This randomized, controlled, double-blind, multicenter, non-inferiority trial was designed to compare the efficacy and safety of UVC-treated platelets to that of untreated platelets in thrombocytopenic patients with hematologic-oncologic diseases. The primary objective was to determine non-inferiority of UVC-treated platelets, assessed by the 1-hour corrected count increment (CCI) in up to eight per-protocol platelet transfusion episodes. Analysis of the 171 eligible patients showed that the defined non-inferiority margin of 30% of UVC-treated platelets was narrowly missed as the mean differences in 1-hour CCI between standard platelets versus UVC-treated platelets for intention-to-treat and per-protocol analyses were 18.2% (95% Confidence Interval [CI]: 6.4-30.1) and 18.7% (95% CI: 6.3-31.1), respectively. In comparison to the control, the UVC group had a 19.2% lower mean 24-hour CCI and was treated with an about 25% higher number of platelet units, but the average number of days to the next platelet transfusion did not differ significantly between both treatment groups. The frequency of low-grade adverse events was slightly higher in the UVC group and the frequencies of refractoriness to platelet transfusion, platelet alloimmunization, severe bleeding events, and red blood cell transfusions were comparable between groups. Our study suggests that transfusion of pathogen-reduced platelets produced with the UVC technology is safe but non-inferiority was not demonstrated. (clinicaltrials gov. Identifier: DRKS00011156).
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Affiliation(s)
- Veronika Brixner
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | - Gesine Bug
- Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main
| | | | - Doris Krämer
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Bernd Metzner
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Andreas Voss
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Jochen Casper
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Ulrich Ritter
- Department of Hematology and Oncology, Municipal Hospital Bremen, Bremen
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital, Mannheim
| | - Nael Alakel
- Medical Clinic I, Department of Hematology and Oncology, University Hospital, Carl Gustav Carus Faculty of Medicine, Dresden
| | - Rudolf Peceny
- Department of Hematology and Oncology, Municipal Hospital, Osnabrück
| | - Hans G Derigs
- Department of Hematology and Oncology, Municipal Hospital Frankfurt-Hoechst, Frankfurt/Main
| | | | - Martin Wolf
- Department of Hematology and Oncology, Municipal Hospital, Kassel
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg - Hessia, Ulm
| | - Thomas Thiele
- Institute for Immunology and Transfusion Medicine, University Medicine, Greifswald
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | | | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany; Bavarian Red Cross Blood Service, Nuremberg.
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12
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Pathogen-reduced PRP blocks T-cell activation, induces Treg cells, and promotes TGF-β expression by cDCs and monocytes in mice. Blood Adv 2020; 4:5547-5561. [PMID: 33166410 DOI: 10.1182/bloodadvances.2020002867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023] Open
Abstract
Alloimmunization against platelet-rich plasma (PRP) transfusions can lead to complications such as platelet refractoriness or rejection of subsequent transfusions and transplants. In mice, pathogen reduction treatment of PRP with UVB light and riboflavin (UV+R) prevents alloimmunization and appears to induce partial antigen-specific tolerance to subsequent transfusions. Herein, the in vivo responses of antigen-presenting cells and T cells to transfusion with UV+R-treated allogeneic PRP were evaluated to understand the cellular immune responses leading to antigen-specific tolerance. Mice that received UV+R-treated PRP had significantly increased transforming growth factor β (TGF-β) expression by CD11b+ CD4+ CD11cHi conventional dendritic cells (cDCs) and CD11bHi monocytes (P < .05). While robust T-cell responses to transfusions with untreated allogeneic PRP were observed (P < .05), these were blocked by UV+R treatment. Mice given UV+R-treated PRP followed by untreated PRP showed an early significant (P < .01) enrichment in regulatory T (Treg) cells and associated TGF-β production as well as diminished effector T-cell responses. Adoptive transfer of T-cell-enriched splenocytes from mice given UV+R-treated PRP into naive recipients led to a small but significant reduction of CD8+ T-cell responses to subsequent allogeneic transfusion. These data demonstrate that pathogen reduction with UV+R induces a tolerogenic profile by way of CD11b+ CD4+ cDCs, monocytes, and induction of Treg cells, blocking T-cell activation and reducing secondary T-cell responses to untreated platelets in vivo.
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13
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Saris A, Pavenski K. Human Leukocyte Antigen Alloimmunization and Alloimmune Platelet Refractoriness. Transfus Med Rev 2020; 34:250-257. [PMID: 33127210 DOI: 10.1016/j.tmrv.2020.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Despite significant advancements in the production of platelet products, storage, and transfusion, transfusion refractoriness remains a significant clinical problem, affecting up to 14% of hematological patients receiving platelet transfusions. Human leukocyte antigen (HLA) alloimmunization is a major cause of immune platelet refractoriness, and its rate can be significantly reduced by implementation of leukoreduction. Despite promising preclinical results, pathogen reduction does not reduce HLA alloimmunization. Patients with HLA alloimmune refractoriness are usually managed with HLA-selected platelet transfusions. In this review, we describe the pathophysiology of HLA alloimmunization and alloimmune refractoriness, as well as options to prevent and treat these transfusion complications. We discuss the evidence supporting these options and point out the outstanding gaps. Finally, we review the possible future directions for prevention and treatment of alloimmune refractoriness.
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Affiliation(s)
- Anno Saris
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Katerina Pavenski
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
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Pagano MB, Allen ES, Chou ST, Dunbar NM, Gniadek T, Goel R, Harm SK, Hopkins CK, Jacobson J, Lokhandwala PM, Metcalf RA, Raval JS, Schwartz J, Shan H, Spinella PC, Storch E, Cohn CS. Current advances in transfusion medicine: a 2019 review of selected topics from the AABB Clinical Transfusion Medicine Committee. Transfusion 2020; 60:1614-1623. [PMID: 32472580 DOI: 10.1111/trf.15848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION. STUDY DESIGN AND METHODS CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine. CONCLUSION This synopsis provides easy access to relevant topics and may be useful as an educational tool.
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Affiliation(s)
- Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Ruchika Goel
- Transfusion Medicine Division, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine and Mississippi Valley Regional Blood Center, Springfield, Illinois, USA
| | - Sarah K Harm
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont
| | | | - Jessica Jacobson
- Department of Pathology, New York University Grossman School of Medicine, New York, New York
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan A Metcalf
- Clinical Pathology Division, Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jay S Raval
- Transfusion Medicine Service, Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Transfusion Medicine & Cellular Therapy, Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Hua Shan
- Department of Pathology, Stanford University, Stanford, California
| | - Philip C Spinella
- Division of Pediatric Critical Care, Washington University in St Louis, St Louis, Missouri, USA
| | - Emily Storch
- Office of Blood Research and Review, Food and Drug Administration, Silver Spring, Maryland
| | - Claudia S Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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Hu X, Cai H, Zheng L, Luo Y, Zhou J, Hui Y, Dai Z, Lin H, Li D, Xiao Y, Huang L, Zhou J. Clinical and immunological features of platelet transfusion refractoriness in young patients with de novo acute myeloid leukemia. Cancer Med 2020; 9:4941-4948. [PMID: 32419364 PMCID: PMC7367618 DOI: 10.1002/cam4.3140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 12/20/2022] Open
Abstract
Platelet transfusion is important in the prevention and treatment of bleeding in patients with acute myeloid leukemia (AML) after receiving intensive chemotherapy. However, platelet transfusion refractoriness (PTR) is an intractable clinical issue occurred in these patients. And its clinical and immunological features remain largely unknown. The potential causes and clinical features of PTR were retrospectively analyzed in 560 patients who were diagnosed as de novo AML in Tongji Hospital from June 2012 through June 2018. A high‐throughput antibody screening for the detection of human leukocyte antigen (HLA) and its serotypes was performed in 133 newly diagnosed AML patients. PTR occurred in 11.8% of the de novo AML patients. The median age for patients with PTR was 46 years (range, 15‐70). It frequently manifested in female patients and in patients with splenomegaly, M4 subtype, c‐Kit gene mutation, and rearrangements of RUNX1‐RUNX1T1 or CBFB‐MYH11, commonly referred to as core binding factor AML (CBF‐AML). Notably, CBF‐AML was independently associated with the occurrence of PTR. PTR predominantly developed in patients who had CBF‐AML (P < .001) and in patients who further had better minimal residual disease (MRD) reduction (≥3‐log) before the second consolidation chemotherapy (P = .007). HLA‐I antibodies were detected in the serum of 9.0% of AML patients and markedly enriched in patients with PTR (P < .001) and in patients with CBF‐AML (P = .018). HLA‐B was the most frequently identified serum epitope in PTR patients. Patients with CBF‐AML had higher tendency to develop HLA‐I antibodies and PTR, which depicted novel features of PTR in AML and might provide insights into its efficient managements.
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Affiliation(s)
- Xuelian Hu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haodong Cai
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lu Zheng
- Lishui City People's Hospital, Zhejiang, China
| | - Yi Luo
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Hui
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhenyu Dai
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Haolong Lin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dengju Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Lu W, Delaney M, Flegel WA, Ness P, Ratcliffe N, Triulzi DJ, Yazer MH, Ziman A, Dunbar NM. How do you… decide which platelet bacterial risk mitigation strategy to select for your hospital-based transfusion service? Transfusion 2020; 60:675-681. [PMID: 32027394 PMCID: PMC7131880 DOI: 10.1111/trf.15693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 01/12/2023]
Abstract
The United States Food and Drug Administration Final Guidance for Industry titled, "Bacterial Risk Control Strategies for Blood Collection Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion" provides nine strategies for platelet bacterial risk mitigation. Even if it is assumed all strategies are comparable in terms of safety and efficacy, the decision of which to implement remains challenging. Some additional factors that warrant evaluation before selecting a strategy include the financial impact, process for implementation, logistics upon implementation, institutional acceptance by blood bank staff, administration and clinicians, and effect on platelet availability. To assist with this difficult choice, a panel of transfusion service physicians who have expertise on the topic and have already selected strategies for their transfusion services were recruited to provide varied perspectives. In addition, the use of a decision-making tool that objectively evaluates defined criteria for assessment of the nine strategies is described.
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Affiliation(s)
- Wen Lu
- Robert Tomsich Pathology & Laboratory Medicine
Institute, Cleveland Clinic, Cleveland, Ohio
| | - Meghan Delaney
- Pathology and Laboratory Medicine, Children’s
National Medical Center, Washington, DC
| | - Willy A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center,
National Institutes of Health, Bethesda
| | - Paul Ness
- Department of Pathology, Johns Hopkins University School of
Medicine, Baltimore, Maryland
| | - Nora Ratcliffe
- Pathology & Laboratory Medicine, White River Junction
VA Medical Center, White River Junction, Vermont
| | - Darrell J. Triulzi
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Mark H. Yazer
- Centralized Transfusion Service, University of Pittsburgh,
Pittsburgh, Pennsylvania
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service,
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine,
University of California Los Angeles, Los Angeles, California
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Jackman RP, Heitman JW, Muench MO. A small allelic variant in donor class I MHC is sufficient to induce alloantibodies following transfusion of standard or pathogen-reduced platelets in mice. Vox Sang 2020; 115:367-376. [PMID: 32201962 DOI: 10.1111/vox.12897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/10/2019] [Accepted: 01/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Alloimmunization targeting major histocompatibility (MHC) antigens is common following platelet transfusion. Pathogen reduction of platelets can block alloimmunization to MHC in mice and induce partial antigen-specific tolerance to subsequent transfusions. This study utilized small allelic variants to evaluate the relative contributions of class I and class II MHC to the alloresponse against untreated or pathogen-reduced platelets. MATERIALS AND METHODS C57BL/6 (B6) Kbm1 and B6 IAbm12 mice with small variants in the class I Kb and class II IAb alleles, respectively, were used as platelet donors for wild-type B6 recipients. Both untreated and pathogen-reduced platelet-rich plasma (PRP) transfusions were evaluated for immunogenicity by measuring antibody responses and ex vivo cytokine production. RESULTS Both the Kbm1 and IAbm12 alleles induced antibody responses, though the response to Kbm1 was greater. Pathogen reduction blocked the antibody responses to IAbm12 , but not to Kbm1 . Both the Kbm1 and IAbm12 alleles primed ex vivo cytokine responses that were blocked with pathogen reduction, though responses to IAbm12 were broader and larger (Kbm1 responses: IFN-γ, TNFα, and MIP-1β; IAbm12 responses: IFN-γ, TNFα, IL-1β, IL-10, IL-13, and GM-CSF). Pathogen-reduced Kbm1 PRP did not appear to induce any tolerance to subsequent untreated Kbm1 PRP transfusions. CONCLUSION Minor allelic variants in both the class I and class II MHC are capable of inducing an alloresponse to transfusion. The Kbm1 PRP induced alloantibodies even with pathogen reduction and did not show signs of inducing the partial tolerance to subsequent transfusions observed with a larger MHC mismatch.
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Affiliation(s)
- Rachael P Jackman
- Vitalant Research Institute, San Francisco, California, USA.,University of California, San Francisco, California, USA
| | - John W Heitman
- Vitalant Research Institute, San Francisco, California, USA
| | - Marcus O Muench
- Vitalant Research Institute, San Francisco, California, USA.,University of California, San Francisco, California, USA
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Hendrickson JE, Mendoza H, Ross R, Siddon AJ, Gowda L, Hauser RG, Schulz WL, Tormey CA. Investigation of increased platelet alloimmunization screening in the era of pathogen‐reduced platelets treated with psoralen/UV light. Transfusion 2020; 60:650-651. [DOI: 10.1111/trf.15691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Rebecca Ross
- Yale University School of Medicine New Haven Connecticut
| | | | - Lohith Gowda
- Yale University School of Medicine New Haven Connecticut
| | | | - Wade L. Schulz
- Yale University School of Medicine New Haven Connecticut
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Prevalence and risk factors of having antibodies to class I and II human leukocyte antigens in older haploidentical allograft candidates. Sci Rep 2020; 10:2367. [PMID: 32047235 PMCID: PMC7012824 DOI: 10.1038/s41598-020-59417-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/29/2020] [Indexed: 02/04/2023] Open
Abstract
The effect of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) has been recognized as a factor in graft failure (GF) in patients who underwent umbilical cord blood transplantation (UBT), matched unrelated donor transplantation (MUDT), or haploidentical stem cell transplantation (haplo-SCT). Presently, we know little about the prevalence of and risk factors for having anti-HLA antibodies among older transplant candidates. Therefore, we analyzed 273 older patients with hematologic disease who were waiting for haplo-SCT. Among all patients, 73 (26.7%) patients had a positive panel-reactive antibody (PRA) result for class I, 38 (13.9%) for class II, and 32 (11.7%) for both. Multivariate analysis showed that females were at a higher risk for having a PRA result for class II (P = 0.001) and for having antibodies against HLA-C and HLA-DQ. Prior pregnancy was a risk factor for having a PRA result for class I (P < 0.001) and for having antibodies against HLA-A, HLA-B and HLA-DQ. Platelet transfusions were risk factors for the following: having a positive PRA result for class I (P = 0.014) and class II (P < 0.001); having antibodies against HLA-A, HLA-B, HLA-C, HLA-DP, HLA-DQ, and HLA-DR; and having higher mean fluorescence intensity (MFI) of PRA for class I (P = 0.042). In addition, previous total transfusions were at high risk for having higher numbers of antibodies to specific HLA loci (P = 0.005), and disease course (7.5 months or more) (P = 0.020) were related to higher MFI of PRAs for class I. Our findings indicated that female sex, prior pregnancy, platelet transfusions and disease courses are independent risk factors for older patients with hematologic disease for having anti-HLA antibodies, which could guide anti-HLA antibody monitoring and be helpful for donor selection.
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Abstract
Allogeneic platelets collected for transfusion treated with pathogen reduction technology (PRT), which has been available in some countries for more than a decade, are now increasingly available in the United States (US). The implementation of PRT-treated platelets, also known as pathogen-reduced platelets (PRPs), has been spurred by the need to further decrease the risk of sepsis associated with bacterial contamination coupled with the potential of this technology to reduce the risk of infections due to already recognized, new, and emerging infectious agents. This article will review available PRP products, examine their benefits, highlight unresolved questions surrounding this technology, and summarize pivotal research studies that have compared transfusion outcomes (largely in adult patients) for PRPs with non-PRT-treated conventional platelets (CPs). In addition, studies describing the use of PRPs in pediatric patients and work done on the association between PRPs and HLA alloimmunization are discussed. As new data emerge, it is critical to re-evaluate the risks and benefits of existing PRPs and newer technologies and reassess the financial implications of adopting PRPs to guide our decision-making process for the implementation of transfusing PRPs.
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Affiliation(s)
- Wen Lu
- Section of Transfusion Medicine, Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
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Tran JQ, Muench MO, Heitman JW, Jackman RP. Pathogen reduction with riboflavin and ultraviolet light induces a quasi-apoptotic state in blood leukocytes. Transfusion 2019; 59:3501-3510. [PMID: 31599981 DOI: 10.1111/trf.15516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alloimmunization to platelet-rich plasma (PRP) transfusions can cause adverse reactions such as platelet refractoriness or transplant rejection. Pathogen reduction treatment with ultraviolet light and riboflavin (UV + R) of allogeneic PRP was shown to reduce allogeneic antibody responses and confer partial antigen-specific immune tolerance to subsequent transfusions in mice. Studies have shown that UV + R was effective at both rapidly killing donor white blood cells (WBCs) and reducing their ability to stimulate an allogeneic response in vitro. However, the manner in which UV + R induces WBC death and its associated role in the immune response to treated PRP is unknown. METHODS AND MATERIALS This study evaluates whether UV + R causes WBC apoptosis by examining phosphatidylserine exposure on the plasma membrane, membrane asymmetry, caspase activity, and chromatin condensation by flow cytometry. The immunogenicity of WBCs killed with UV + R versus apoptotic or necrotic pathways was also examined in vivo. RESULTS WBCs after UV + R exhibited early apoptotic-like characteristics including phosphatidylserine exposure on the outer leaflet of the plasma membrane and loss of membrane asymmetry, but unlike canonical apoptotic cells, caspase activity and chromatin condensation were not apparent. However, in vivo studies demonstrated, unlike untreated or necrotic WBCs, both apoptotic WBCs and UV + R-treated WBCs failed to prime alloantibody responses to subsequent untreated transfusions. CONCLUSION Overall, the mechanism of WBC death following UV + R treatment shares some membrane characteristics of early apoptosis but is distinct from classic apoptosis. Despite these differences, UV + R-treated and apoptotic WBCs both offer some protection from alloimmunization.
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Affiliation(s)
| | - Marcus O Muench
- Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | | | - Rachael P Jackman
- Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
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Rebulla P. The long and winding road to pathogen reduction of platelets, red blood cells and whole blood. Br J Haematol 2019; 186:655-667. [PMID: 31304588 DOI: 10.1111/bjh.16093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion-transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens' nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre-clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion-transmissible infections.
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Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and Haematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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Stolla M. Pathogen reduction and HLA alloimmunization: more questions than answers. Transfusion 2019; 59:1152-1155. [DOI: 10.1111/trf.15211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Moritz Stolla
- From the Bloodworks Northwest Research Institute, Platelet Transfusion Research Laboratory, Seattle, Washington; and the Department of Medicine, Division of Hematology, University of Washington School of Medicine; Seattle Washington
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