Evidence that circulating immune complexes remove transfused platelets from the circulation

Kutti, Jack; Zaroulis, Charles G.; Safai‐Kutti, Soodabeh; Dinsmore, Robert E.; Day, Noorbibi K.; Good, Robert A.

doi:10.1002/ajh.2830110305

Cited by 18 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another explanation might be that circulating immune complexes are present (Kutti et al, 1981) which may be detected by PIFT but not MAIPA. The MAIPA crossmatches that were performed were not informative in most cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions

Sintnicolaas¹,

Löwenberg

1996

Br J Haematol

View full text Add to dashboard Cite

Platelet crossmatching may provide a useful way of selecting donors for effective platelet transfusions in patients refractory to random donor platelet concentrates due to alloimmunization. We assessed the predictive value of a flow cytometric platelet immunofluorescence crossmatch test for the outcome of HLA matched platelet transfusions in a group of alloimmunized patients. Platelet immunofluorescence (PIFT) crossmatches were performed for 104 HLA-matched platelet transfusions administered to 30 patients. A negative PIFT crossmatch correctly predicted a successful platelet transfusion (1 h post-transfusion platelet recovery >20%) in 56/75 (75%) cases. We also considered non-immunological factors that, in combination with alloimmunization, might have contributed to an unsuccessful transfusion result, i.e. fever, septicaemia, splenomegaly, disseminated intravascular coagulation and bleeding. The predictive value of a negative PIFT crossmatch was better when these non-immunological factors were absent [48/59 (81%) correct predictions] than when these factors were present [8/16 (50%) correct predictions] (P=0.01; chi-square test). The effect of ABO incompatibility between donor and recipient on the predictive value of the PIFT crossmatch was also analysed. Positive PIFT crossmatches occurred more frequently in ABO incompatible donor-recipient combinations [in 18/28 (64%) cases] than in ABO-compatible donor-recipient combinations [in 11/76 cases (14%)] (P<0.001, chi-square test). Successful platelet transfusions were observed on 53/76 (70%) occasions in ABO compatible transfusions as compared to 16/28 (57%) in ABO incompatible transfusions. This difference was not statistically significant (P=0.23; chi-square test). Consequently, a negative PIFT crossmatch appeared to be non-predictive for the transfusion outcome in cases of ABO incompatibility between donor and recipient. We conclude that the PIFT crossmatch for platelet donor selection in addition to matching for HLA antigens, is predictive for the outcome of ABO compatible transfusions in alloimmunized recipients and prediction levels are increased when non-immunological causes for platelet refractoriness are absent.

show abstract

Section: Discussionmentioning

confidence: 99%

“…One possible explanation is that the PIFT is more sensitive than the MAIPA. Another explanation might be that circulating immune complexes are present (Kutti et al, 1981) which may be detected by PIFT but not MAIPA.…”

Section: Discussionmentioning

confidence: 99%

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions

Sintnicolaas¹,

Löwenberg

1996

Br J Haematol

View full text Add to dashboard Cite

show abstract

“…Circulating immune complexes have been demonstrated frequently in patients with cancer (Carpentier & Miescher. 1983;Rossen et al 1977;Dass et al 1991) and leukaemia (Carpentier et al, 1979;Larson et al, 1991) and are present in the plasma of patients refractory to platelet transfusion (Kutti et al, 1981). In this study, immune complexes consisting of IgG and C l q were detected in 30% of haematological patients receiving platelets.…”

Section: Discussionmentioning

confidence: 47%

Circulating immune complexes involving the ABO system after platelet transfusion

et al. 1993

View full text Add to dashboard Cite

Summary. It has been proposed that when ABO unmatched platelets are transfused circulating immune complexes (CIC) may be formed between the patient's soluble ABH antigens and the transfused antibodies. Platelets might then be destroyed by bystander mechanisms or by the binding of CIC to the Fc receptor or to C3 binding membrane proteins on the platelet. An ELISA Clq assay was used to detect CIC in 40 patients with haematological diseases who had received multiple platelet transfusions. A significantly larger number of refractory patients were positive (41%) in the assay than non‐refractory patients (13%) or normal blood donors (0%). The presence of circulating IgG anti‐A was sought in six group A refractory patients who had been transfused with ABO unmatched platelets. To determine whether the IgG anti‐A was monomeric or in high molecular weight complexes, the serum was fractionated by gel exclusion chromatography and fractions were tested for the presence of IgG anti‐A. In all six patients the peak of IgG anti‐A binding occurred in fractions of high molecular weight (200–900 kD). Five out of six patients also demonstrated anti‐A activity in fractions corresponding to monomeric IgG (about 150–180 kD). Fractions containing high molecular weight anti‐A were purified using a protein G column and the eluates were tested for the presence of group A antigen using dot immunoblotting. Group A antigen was associated with the purified IgG anti‐A in 4/5 patients tested. Appropriate transfused and non‐transfused controls had no anti‐A in any fractions. Although not unexpected, these studies demonstrate for the first time that refractory patients receiving ABO unmatched platelets have CIC composed of ABO antigens and their corresponding antibodies present in their serum that circulate for at least several days. It also confirms the hypothesis that some CIC in haematological patients are induced by transfusion.

show abstract

Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Brubaker

Romine

1987

American J Hematol

View full text Add to dashboard Cite

Platelet crossmatching assays have been used to predict the outcome of platelet transfusions in alloimmunized patients by detecting antibodies against platelets. The transfusion failure of HLA-matched platelets predicted by platelet crossmatching may be related to HLA antibodies undetected by lymphocytotoxicity but detected by platelet immunoglobulin-binding assays or platelet-specific antibodies (both antibodies defined here as platelet-reactive antibodies). To differentiate platelet-reactive antibodies from lymphocytotoxic HLA antibodies, we used HLA characterized lymphocytes in parallel with platelets from individuals to form separate frozen panels. Sera from 10 allosensitized patients were studied in the lymphocyte panel by lymphocytotoxicity and in the platelet panel by enzyme-linked immunoassay (ELISA). By comparing pattern and percent wells reacting in each panel, lymphocytotoxic HLA antibodies and antibodies reactive with platelets in ELISA were detected separately. In all 10 allosensitized patients, platelet-associated antibodies were present and 7 had additional lymphocytotoxic HLA antibodies. Using this double parallel panel technique, we found platelet-reactive antibodies important in platelet alloimmunization, unrecognized by lymphocytotoxicity. These data indicate platelet-crossmatching be solely used in the selection of platelets for allosensitized patients.

show abstract

Evidence that circulating immune complexes remove transfused platelets from the circulation

Cited by 18 publications

References 11 publications

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions

Circulating immune complexes involving the ABO system after platelet transfusion

Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Contact Info

Product

Resources

About