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Jackman RP, Darst O, Gaillard B, Tran JQ, Tomayko MM, Muench MO. Enhanced alloresponse to platelet transfusion due to immune dysregulation following ablative chemotherapy in mice. Front Immunol 2023; 14:1281123. [PMID: 38090570 PMCID: PMC10711281 DOI: 10.3389/fimmu.2023.1281123] [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: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Alloimmunization is common following platelet transfusion and can result in negative outcomes for recipients such as refractoriness to subsequent transfusions and rejection of transplants. Healthy people do not receive blood transfusions, and the diseases and therapies that result in a need to transfuse have significant impacts on the immunological environment to which these alloantigens are introduced. Ablative chemotherapies are common among platelet recipients and have potent immunological effects. In this study, we modeled the impact of chemotherapy on the alloresponse to platelet transfusion. As chemotherapies are generally regarded as immunosuppressive, we hypothesized that that they would result in a diminished alloresponse. Methods Mice were given a combination chemotherapeutic treatment of cytarabine and doxorubicin followed by transfusion of allogeneic platelets, and compared to controls given no treatment, chemotherapy alone, or transfusion alone. Alloantibody responses were measured 2 weeks after transfusion, and cellular responses and growth factors were monitored over time. Results Contrary to our hypothesis, we found that chemotherapy led to increased alloantibody responses to allogeneic platelet transfusion. This enhanced response was antigen-specific and was associated with increased CD4+ and CD8+ T cell responses. Chemotherapy led to rapid lymphocyte depletion followed by reconstitution, non-specific activation of transitional B cells with the highest levels of activation in the least mature subsets, and increased serum levels of B cell activating factor (BAFF). Conclusion These data suggest that ablative chemotherapy can increase the risk of alloimmunization and, if confirmed clinically, that additional measures to protect these patient populations may be warranted.
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Affiliation(s)
- 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
| | - Orsolya Darst
- Vitalant Research Institute, San Francisco, CA, United States
| | - Betty Gaillard
- Vitalant Research Institute, San Francisco, CA, United States
| | - 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
| | - Mary M. Tomayko
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
- Department of Pathology, Yale School of Medicine, New Haven, CT, 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
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Yazer MH, Dunbar NM, Delaney M. Survey of the RhD selection and issuing practices for uncrossmatched blood products at pediatric trauma hospitals in the United States: The BEST collaborative study. Transfusion 2021; 61:3328-3334. [PMID: 34595764 DOI: 10.1111/trf.16692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND As evidence demonstrating the importance of early transfusions in trauma resuscitation accumulates, when RhD-negative products might not be available, it is important to understand the nature of the RhD-type of products provided to bleeding pediatric patients of potentially unknown RhD-type. METHODS A survey link was electronically sent to the transfusion service medical director and/or laboratory manager at American pediatric Level I and Level II hospitals inquiring about their practices for selecting RhD-type of uncrossmatched red blood cells (RBC) or low titer group O whole blood (LTOWB) for boys and girls. RESULTS There were 55/117 (47.0%) analyzable responses; 43/55 (78.2%) from Level I and 12/55 (21.8%) from Level II hospitals. For in hospital transfusions, 51/55 (92.7%) of centers use only RhD-negative blood products to resuscitate girls ≤18 years old while 30/55 (54.5%) of centers do the same for boys ≤18 years old. Most centers 41/55(74.5%) store RBCs and/or LTOWB in in-hospital remote refrigerators; 27 store only RhD-negative RBCs and 2 store only RhD-negative LTOWB units in these refrigerators. A total of 24/55 (43.6%) centers have RBCs and/or LTOWB available on road ambulances or helicopters for prehospital transfusion; 12 transport only RhD-negative RBCs and two transport only RhD-negative LTOWB. Most centers, 35/55 (63.6%), address the prophylaxis of an RhD-negative female recipient of RhD-positive transfusion on a case-by-case basis. CONCLUSION While there is some variability, most of the responding pediatric trauma centers routinely utilized RhD-negative RBCs for emergency transfusion for patients ≤18 years old of unknown RhD-type.
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Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology and Pediatrics, George Washington University Medical School, Washington, District of Columbia, USA
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Tamai Y, Ohto H, Takahashi H, Kitazawa J. Transfusion-Related Alloimmunization to Red Blood Cell Antigens in Japanese Pediatric Recipients. Transfus Med Rev 2020; 35:29-36. [PMID: 33012576 DOI: 10.1016/j.tmrv.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Red blood cell (RBC) transfusion to neonates is thought to rarely provoke an immune response. Neonatal testing guidelines suggest that antibody screening is not necessary when the mother has no antibodies. Alternatively, maternal blood samples can be used for antibody screening and cross-matching. However, the guidelines are based on small-scale studies of white-dominant populations. Furthermore, transfusion-related alloimmunization is less well established among children and adolescents as a whole among Japanese and East Asians. To elucidate the incidence of transfusion-related alloimmunization among neonates, children, and adolescents, and whether current guidelines are applicable to Japanese populations, a nationwide retrospective multicenter cohort survey was conducted in 50 tertiary-care hospitals in Japan. Between 2001 and 2015 inclusive, recipients of at least 1 allogeneic RBC transfusion were categorized into groups A-F according to their age at the time of transfusion: (A) neonates <1 month; (B) infants 1 to <12 months; (C) children 1 to <5 years; (D) prepubescents 5 to <10 years; (E) young pubescents 10 to <15 years; and (F) adolescents/young adults 15 to <20 years. Excluding maternally derived antibodies and naturally occurring, cold-reactive, and/or nonspecific antibodies, 69 (0.61%) of 11350 RBC recipients <20 years old formed at least 1 clinically significant alloantibody. The alloimmunization rate differed significantly (P < .0001) by age: none (0%) of 3407 in group A; 11 (0.46%) of 2410 in group B; 18 (0.76%) of 2361 in group C; 9 (0.80%) of 1119 in group D; 12 (1.15%) of 1043 in group E; and 19 (1.88%) of 1010 in group F. Clearly different incidences of alloimmunization emerged in group A compared to B, C, D, E, or F, as confirmed by logistic regression analysis adjusted by numbers of donor exposure. Alloimmunization did not occur from RBC transfusions within the first month of life and rarely occurred (0.46%-0.80%) after transfusion within the first decade of life. Alloimmunization occurred in 1.15%-1.88% of young pubescents and adolescents/young adults. These findings support the use of guidelines developed in Europe and the United States for East Asian pediatric recipients.
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Affiliation(s)
- Yoshiko Tamai
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Hirosaki University Post-Graduate School of Medicine, Hirosaki, Japan
| | - Hitoshi Ohto
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Fukushima Medical University, Fukushima, Japan.
| | | | - Junichi Kitazawa
- Japan Society of Blood Transfusion and Cell Therapy, Tokyo, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
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Yazer MH, Delaney M, Doughty H, Dunbar NM, Al‐Riyami AZ, Triulzi DJ, Watchko JF, Wood EM, Yahalom V, Emery SP. It is time to reconsider the risks of transfusing RhD negative females of childbearing potential with RhD positive red blood cells in bleeding emergencies. Transfusion 2019; 59:3794-3799. [DOI: 10.1111/trf.15569] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mark H. Yazer
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
- Vitalant Pittsburgh Pennsylvania
| | - Meghan Delaney
- Division of Pathology and Laboratory MedicineChildren's National Medical Center Washington District of Columbia
- Department of Pathology and PediatricsGeorge Washington University Medical School Washington District of Columbia
| | | | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Arwa Z. Al‐Riyami
- Department of HematologySultan Qaboos University Hospital Muscat Oman
| | - Darrell J. Triulzi
- Department of PathologyUniversity of Pittsburgh Pittsburgh Pennsylvania
- Vitalant Pittsburgh Pennsylvania
| | - Jon F. Watchko
- Department of PediatricsUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Erica M. Wood
- Transfusion Research UnitSchool of Public Health and Preventive Medicine, Monash University Melbourne Australia
- Department of Clinical HaematologyMonash Health Melbourne Australia
| | - Vered Yahalom
- Rabin Medical CenterBlood Services and Apheresis Institute Petah Tiqva Israel
| | - Stephen P. Emery
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania
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Thibault L, de Grandmont MJ, Cayer MP, Dussault N, Jacques A, Ducas E, Beauséjour A, Lebrun A. Rhesus D Antigenic Determinants on Residual Red Blood Cells in Apheresis and Buffy Coat Platelet Concentrates. Transfus Med Hemother 2019; 47:129-134. [PMID: 32355472 DOI: 10.1159/000501106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 05/22/2019] [Indexed: 12/26/2022] Open
Abstract
Background The level of residual red blood cells (RBCs) in platelet concentrates (PCs) is of interest because of clinical concerns related to alloimmunization to RBC antigens in transfused patients. This work aims at characterizing and quantifying the levels of intact and fragmented RBCs in apheresis (AP-PCs) and buffy coat PCs (BC-PCs) to assess their potential risk for RhD antigen alloimmunization. Methods After staining with anti-CD41 (platelets) and anti-CD235a (RBCs) antibodies, the size and density of RhD antigen on intact and fragmented RBCs were analyzed by flow cytometry. Results Residual RBC counts were 29 ± 22 × 10<sup>6</sup>/unit in AP-PCs and 121 ± 54 × 10<sup>6</sup>/unit in BC-PCs, which correspond to about 3 and 11 µL of RBCs by product, respectively. RhD expression was about 4 times higher on RBC particles in AP-PCs, and these particles contribute to 66 and 75% of the total antigenic load in BC-PCs and AP-PCs, respectively. Conclusions Processing methods influence the quantity and nature of contaminating residual RBCs and RBC-derived particles in PCs. The estimation of residual RBCs in these blood products is generally based on measurements of intact RBCs, which might underestimate the risk for alloim-munization in transfused patients. The question of whether these RBC-derived particles can produce an immune response and, thus, should then be taken into consideration for Rh immune prophylactic treatments, remains to be clarified.
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Affiliation(s)
- Louis Thibault
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | | | | | | | - Annie Jacques
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - Eric Ducas
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - Annie Beauséjour
- Héma-Québec, Medical Affairs and Innovation, Québec, Québec, Canada
| | - André Lebrun
- Héma-Québec, Medical Affairs and Innovation, Montréal, Québec, Canada
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Giraud C, Thibert JB, Desbrosses Y, Debiol B, Alsuliman T, Bardiaux L, Garban F, Huynh TNP, Samsonova O, Yakoub-Agha I, Bruno B. Transfusion dans l’autogreffe et l’allogreffe de cellules souches hématopoïétiques chez l’adulte et l’enfant : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bull Cancer 2019; 106:S52-S58. [DOI: 10.1016/j.bulcan.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/27/2018] [Indexed: 01/07/2023]
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Qadri SM, Donkor DA, Yan M, Ning S, Branch DR, Seghatchian J, Sheffield WP. Red blood cells, still vital after all these years: Commentary on Canadian Blood Services' International Symposium 2017. Transfus Apher Sci 2018; 57:298-303. [PMID: 29691151 DOI: 10.1016/j.transci.2018.04.011] [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] [Indexed: 12/18/2022]
Abstract
Canadian Blood Services (CBS), Canada's national blood transfusion service, has for many years sponsored an annual conference, for the education and awareness of interested participants, showcasing the latest evidence-based understanding of both basic science and clinical issues in transfusion medicine and science. The 15th iteration of this symposium took place September 9, 2017 and focused on some of the vital aspects of red blood cells (RBC), in line with the" 3Rs" concept, namely the provision of the Right red blood cell (RBC) product to the Right patient at the Right time. Presentations touched upon: the evolution of blood banking in North America; the monocyte monolayer assay as a predictor of post-transfusion hemolysis; hemoglobin-based oxygen carriers; RBC alloimmunization; serological approaches to complex RBC antibody problems; randomized clinical trials related to the age of stored RBC; RBC genotyping; pathophysiology, prevention and treatment of hemolytic disease of the fetus and newborn (HDFN); and testing and timing in perinatal serology. This commentary provides summaries of all speakers' presentations annotated with relevant references. Special thanks are due to all contributors for their praiseworthy approaches in sharing their experiences and knowledge on this interesting scientific/clinical and management theme.
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Affiliation(s)
- Syed M Qadri
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David A Donkor
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shuoyan Ning
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald R Branch
- Centre for Innovation of Canadian Blood Services, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, United Kingdom.
| | - William P Sheffield
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Arora K, Kelley J, Sui D, Ning J, Martinez F, Lichtiger B, Tholpady A. Cancer type predicts alloimmunization following RhD-incompatible RBC transfusions. Transfusion 2017; 57:952-958. [PMID: 28191636 DOI: 10.1111/trf.13999] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Immunosuppressed, RhD-negative oncology patients tend to have lower rates of sensitization to the D antigen when they receive transfusion with RhD-positive blood components. Clinical factors associated with alloimmunization to the D antigen in RhD-negative oncology patients when they receive transfusion with RhD-positive red blood cells (RBCs) have not been well defined. STUDY DESIGN AND METHODS This was a 4-year, retrospective analysis identifying RhD-negative oncology patients who received RhD-positive RBCs and were not previously alloimmunized to the D antigen. Age, sex, race, ABO group, primary oncology diagnosis, and numbers of RhD-incompatible RBC transfusions were recorded. The association between antibody formation and clinical factors was studied. The incidence of alloanti-D was calculated from a subsequent antibody-detection test performed at least 28 days after receipt of the first transfusion of RhD-positive RBCs. RESULTS In total, 545 RhD-negative oncology patients received 4295 RhD-positive RBC transfusions. Of these, 76 (14%) became alloimmunized to the D antigen. Diagnosis type was the only factor significantly associated with responder status. The logistic regression model indicated that patients who had myelodysplastic syndrome or solid malignancies were more likely to be responders than those who had acute leukemia. CONCLUSION We measured a 14% sensitization rate to the D antigen in our RhD-negative oncology population. The rate of alloimmunization was higher in patients who had solid cancers (22.6%) or myelodysplastic syndrome (23%) compared with those who had other hematologic malignancies (7%). Knowledge of diagnoses that predispose to RhD alloimmunization enables better utilization of RhD-negative RBCs during times of shortage.
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Affiliation(s)
- Komal Arora
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James Kelley
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dawen Sui
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fernando Martinez
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Lichtiger
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashok Tholpady
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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