Suppression of transfusion-related alloimmunization in intensively treated cancer patients

Abstract

A retrospective review of HLA antibody testing and transfusion records of 100 cancer patients who required extensive platelet support revealed that 27 of 100 patients exhibited positive HLA antibody tests; only 13 remained positive on repetitive examination, while 88% of aplastic anemia patients so tested were positive. Sixty-five patients with leukemia, 16 with Ewing's sarcoma, and 19 with recurrent undifferentiated lymphoma were studied. Each patient received at least 10 U of platelets (mean of 72). HLA antibodies were detected in 31% (20/65) of the leukemias, 12% (2/16) of the Ewing's, and 26% (5/19) of the lymphoma patients. Fourteen of the 27 patients who developed antibodies became antibody negative again within 2 mo and remained so. There were no significant differences in quantity of platelet transfusions between antibody-negative patients and alloimmunized patients. A smaller group (n = 8) of aplastic anemia patients followed at the NCl exhibited a frequency of alloimmunization of 88% (7/8) after a mean of 44 U of platelets were transfused. Granulocyte transfusions given therapeutically for granulocytopenia and documented infection did not appear to influence HLA antibody formation. These data indicate that significant immunosuppression occurs in intensively treated cancer patients, as measured by their ability to from antibodies to HLA antigens expressed on the surface of transfused platelets.

Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

“…These data suggest that there seems to be no enhanced RBC alloimmunization in patients with malaria. Absence of alloimmunization as a result of immunosuppressive effects of AIDS or anti-cancer chemotherapy has been reported in previous studies [20,26]. However, in this study 5 (55AE6%) of the 9 alloimmunized patients with cancer had been receiving anti-cancer chemotherapy.…”

Selecting donors of platelets for refractory patientson the basis of HLA antibody specificity

“…HLA antibodies may disappear over time, even in the presence of continued transfusions. 21,[46][47][48][49][50][62][63][64] Our data indicated that a decrease in PRA level occurred in 11 (31.4%) of 35 patients tested at least 28 days after initial testing. If one were not aware of the change in PRA level and continued to select platelets on the basis of initial testing, that would not adversely affect patient care, although it might result in an unnecessary selection of a matched or selected platelet component.…”

A case for stocking O D+ red blood cells in emergency room trauma bays

“…5 Yet in bone marrow transplant patients, patients with solid tumors, and patients with AIDS, the rate of D alloimmunization in D− patients after transfusion with D+ blood was less than 10%. [6][7][8][9] These rates certainly suggest that increasing immunologic compromise affects the incidence of D alloimmunization. 4,5 Anti-D, however, remains significant for females of child-bearing potential: 20% of pregnancies where maternal anti-D is detectable will have severe hemolytic disease of the newborn.…”