Haemolytic Transfusion Reactions Due to Hla Antibodies

Panzer, Simon; Mayr, W. R.; Graninger, Wolfgang; Püchler, Kurt; Höcker, P; Lechner, Klaus

doi:10.1016/s0140-6736(87)92089-7

Cited by 26 publications

(8 citation statements)

References 18 publications

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“…Such antibodies were originally called anti‐Bg a , ‐Bg b and ‐Bg c , which are anti‐HLA‐B7, ‐B17 and ‐A28, respectively. Such antibody reactivities are usually weak and clinically insignificant, but there are several reports suggesting they may be clinically relevant (Van der Hart et al , 1974; Nordhagen & Aas, 1978; Panzer et al , 1984, 1987; Weitkamp et al , 1993; Benson et al , 2003). One example of anti‐Bg a produced strongly positive results in a monocyte monolayer assay (Arndt & Garratty, 2004) suggesting clinical significance, and 51 Cr‐labelled RBCs that were incompatible with HLA antibodies were shown to have reduced survival (Panzer et al , 1984, 1987).…”

Section: Novel Mechanisms That May Explain Some Of the Discrepancies mentioning

confidence: 99%

“…Such antibody reactivities are usually weak and clinically insignificant, but there are several reports suggesting they may be clinically relevant (Van der Hart et al , 1974; Nordhagen & Aas, 1978; Panzer et al , 1984, 1987; Weitkamp et al , 1993; Benson et al , 2003). One example of anti‐Bg a produced strongly positive results in a monocyte monolayer assay (Arndt & Garratty, 2004) suggesting clinical significance, and 51 Cr‐labelled RBCs that were incompatible with HLA antibodies were shown to have reduced survival (Panzer et al , 1984, 1987). Strong evidence that HLA may sometimes cause haemolytic transfusion reactions comes from observation of a woman with gastrointestinal bleeding who received 13 uncomplicated RBC transfusions in a 2‐week period; with the 14th unit of RBCs, she developed shaking chills, nausea, vomiting and red urine (Weitkamp et al , 1993).…”

Section: Novel Mechanisms That May Explain Some Of the Discrepancies mentioning

confidence: 99%

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The James Blundell Award Lecture 2007: Do we really understand immune red cell destruction?

Garratty

2008

Transfusion Medicine

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SUMMARY. We have learned a great deal about immune red blood cell (RBC) destruction since the elaboration of biochemical/immunological interactions of antibodies, complement and macrophages during the past 50 years. We first learned about the direct lysis of RBCs involving complement. We then learned of the role of the macrophage (particularly in the spleen and the liver) in initiating phagocytosis and antibody-dependent cytotoxicity of antibody-coated RBCs. Later, as the complexities of the human complement system were unravelled, we learned that complement-coated RBCs that were not directly haemolysed could interact with macrophages and that specific complement molecules on the RBC membrane could lead to a phagocytic event or the RBC (although heavily coated with complement) could survive normally. The application of isotope-labelling procedures (e.g. 51Cr) for RBC survival (starting in the 1950s) advanced our knowledge considerably. Advances in knowledge in immunology helped us understand the complexity of the immunoglobulins (e.g. subclasses) and the specific receptors on macrophages and their role in immune haemolysis. Nevertheless, after more than 30 years researching this area, I am sometimes embarrassed to realize how much I cannot explain.

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Section: Novel Mechanisms That May Explain Some Of the Discrepancies mentioning

confidence: 99%

Section: Novel Mechanisms That May Explain Some Of the Discrepancies mentioning

confidence: 99%

The James Blundell Award Lecture 2007: Do we really understand immune red cell destruction?

Garratty

2008

Transfusion Medicine

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“…HLA alloimmunization may also impact RBC transfusion therapy, as it has been associated with decreased RBC survival and hemolysis of allogeneic transfused RBC [32,33]. Although HLA antibodies may be inconsequential in most RBC transfusions, there is evidence that in rare circumstances including transfusion of Bg + RBCs, HLA alloantibodies may be associated with immune-mediated, delayed hyperhemolytic transfusion reactions (DHTR) [32,34,35].…”

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confidence: 99%

HLA alloimmunization is associated with RBC antibodies in multiply transfused patients with sickle cell disease

McPherson

Anderson

Bsn

et al. 2009

Pediatric Blood & Cancer

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Background Alloimmunization to minor red blood cell (RBC) antigens occurs commonly in sickle cell disease (SCD). Patients with alloimmunization demonstrate increased risk for new alloantibody formation with subsequent transfusion. Alloimmunization to human leukocyte antigens (HLA) can occur with RBC transfusion and may result in graft rejection during stem cell or organ transplantation. The prevalence and risk factors for HLA alloimmunization in multiply transfused pediatric SCD patients are unknown. Procedure A cross-sectional study of HLA alloimmunization in SCD patients aged 3–21 years with a history of ≥3 RBC transfusions was performed to test the hypothesis that HLA alloimmunization is associated with RBC alloimmunization. Antibodies to class I and class II HLA were measured by Flow Panel Reactive Antibody (FlowPRA®). Results Seventy-three SCD patients (30 with RBC antibodies) were tested. HLA antibodies were detected in 25/73 (34%) patients; class I HLA antibodies occurred in 24/73 (33%) and class II HLA antibodies occurred in 3 (4%). Among patients with RBC antibodies, 16/30 (53%) had HLA antibodies, while 9/43 (21%) patients without RBC antibodies had HLA antibodies (OR 4.32 [1.6–12.1]). In a multivariate analysis, antibodies to RBC antigens were an independent predictor of HLA alloimmunization (P =0.041). The association of RBC and HLA immunization was strongest among patients with no history of chronic transfusion therapy. Conclusions This analysis is the first description of HLA alloimmunization in pediatric SCD patients who receive primarily leukoreduced RBC transfusions and demonstrates that HLA alloimmunization tendency is associated with antibodies to RBC antigens.

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“…14 The use of leucocyte depleted blood markedly reduces the incidence of sensitisation to leucocyte antigens.1 This is most easily achieved at the bedside by administering blood through a blood administration set to which a leucocyte removal filter has been attached.…”

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The development of anti-HLA antibodies in multiply transfused preterm infants.

Russell

Rivers²,

Davey³

1993

Archives of Disease in Childhood

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The development of antihuman leucocyte antigen antibodies (aHLAA) in response to multiple transfusions in preterm infants was studied prospectively. Fifty seven infants requiring a minimum of two blood transfusions were recruited after obtaining informed written parental consent. They were randomised to receive either whole blood or blood that had been passed through a leucocyte filter. Anti-HLAA were sought in maternal and cord blood so as to ensure that any aHLAA detected after transfusion had not been passively transferred antenatally, and in 1 ml samples drawn monthly from the baby, at least 10 days from a previous transfusion, until discharge from hospital. Anti-HLAA were detected by microlymphocytotoxicity assay. Results were obtained in 42 babies, 19 in the filter and 23 in the no filter group. Fifteen babies had to be excluded because of protocol violation or because they died. None of the babies receiving filtered blood developed aHLAA, but seven babies in the no filter group developed aHLAA.In conclusion, multiply transfused preterm infants have the ability to elaborate antibodies to HLA and leucocyte filters may prevent this.

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Haemolytic Transfusion Reactions Due to Hla Antibodies

Cited by 26 publications

References 18 publications

The James Blundell Award Lecture 2007: Do we really understand immune red cell destruction?

The James Blundell Award Lecture 2007: Do we really understand immune red cell destruction?

HLA alloimmunization is associated with RBC antibodies in multiply transfused patients with sickle cell disease

The development of anti-HLA antibodies in multiply transfused preterm infants.

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