Élimination de certains chocs transfusionnels par l'utilisation de sang appauvri en leucocytes*

Abstract

Résumé Chez une malade dans le sérum de laquelle existait une puissante leuco‐agglutinine et qui présentait à chaque transfusion des chocs violents ont été entreprises des expériences de transfusion des diffé‐rents éléments du sang. Aucun choc n'a suivi I'injection du plasma, du plasma riche en plaquettes, du sang appauvri en leucocytes. Un choc a été observé chaque fois que les leucocytes en nombre suffisant ont été injectés. Ces résultats ont conduit à n'utiliser chez cette malade que du sang préalablement appauvri en leucocytes. Depuis lors aucun choc n'a plus été enregistré. Une technique de préparation du sang appauvri en leucocytes est présentée. Summary In a patient whose serum contained a potent leuko‐agglutinin and who suffered severe shock at every blood transfusion, experiments were undertaken with various elements of blood. The injection of plasma, of plasma rich in platelets, and of blood with a reduced leukocyte content did not cause any shock, but shock occurred whenever sufficient leukocytes were given. Following these results, the patient was treated only with blood from which most leukocytes had been removed, and from then on no shock was observed any more. The technique used for removing the leukocytes is described in detail. Zusammenfassung Bei einer Patientin, deren Serum ein hochtitriges Leukozytenagglutinin enthielt, und die Lei jeder Vollbluttransfusion mit einem schweren Schock reagierte, wurden versuchsweise die verschiedenen Zellelemente des Blutes getrennt transfundiert. Die Transfusion von Plasma, plättchenreichem Plasma und leukozytenarmem Blut wurde von der Patientin reaktionslos ertragen. Jedesmal, wenn eine genügende Anzahl Leukozyten transfundiert wurde, reagierte die Patientin mit einem mehr oder minder schweren Schock. Diese Beobachtung veranlaßte uns, dieser Patientin nurmehr leukozytenarme Erythrozytenaufschwemmungen zu transfundieren, welche von ihr bisher stets reaktionslos ertragen wurden. Eine Technik zur Herstellung von leukozytenarmen Erythrozytenaufschwemmungen wird beschrieben.

Immune Platelet Iso‐Antibodies

“…(c) Transfusion reactions. As with leucocyte antibodies [5, 11,261 it is probable that a great number of transfusion reactions are due t o a reaction between platelets transfused and platelets agglutinins present in the patient's plasma. We have investigated a typical case.…”

Leucocyte Antibodies in Sera of Pregnant Women

“…(4) Weakly positive results: these varied for different sera from 3 yo to 12 yo. (5) The optimum temperature was found to be 37" C. The reaction was weaker a t 22" C. and negative a t 4" C. (6) Variation in the p H from 6 to 8 had no definite influence on the agglutination reaction. (7) Freezing the sera to -20" C. during several months caused no decrease in titre.…”

Acquired Inhibitors of Coagulants

“…Inhibitors of Factor IX.-Some patients with haemophilia B develop inhibitors following repeated transfusion with plasma in the same way as do patients with classical haemophilia (18,24,25,(63)(64)(65). Dausset (18) was of the opinion that patients with haemophilia B were more likely to develop inhibitors than those with haemophilia A.…”

“…In one of these the plasma is totally deficient in protein bearing any immunological relationship to the missing factor and such patients might be expected to develop an inhibitor following treatment. In the other group, the defect, possibly caused by the substitution of a particular amino acid in the protein structure, in analogy with abnormal haemoglobins, gives rise to a deficiency of function in the coagulation mech anism, but the immunological specificity of the protein is unaffected, and the normal version of the coagulation factor would not then be antigenic (18,(20)(21)(22)(23). Patients belonging to the same family should have the same type of defect, and therefore a similar tendency to develop inhibitors.…”

“…Munro & Jones (4) had recognised the connection between the development of the anticoagulant in a haemophilic patient and frequent transfusions of whole blood and plasma (according to Quick, Munro was himself the patient), but did not appear to see the implication of an immunisation mechanism. About this time (1957) Rosenthal (8) discussed the "Mechanism of plasma refractoriness in hemophilia" and its linkage with intensive plasma therapy, while Speer and co-workers (9) thought that the anticoagulant might be similar to sphingosine, and Surgenor (10), in spite of earlier evidence to the contrary, still thought it might be heparin.l During this period much clinical material was collected (12)(13)(14)(15)(16)(17)(18) culminating, in 1961, in the monumental review by Margolius, Jackson & Ratnoff (11) to which the reader is specially referred for its study of 40 case histories cover ing all types of circulating anticoagulants.…”