Transient platelet and HLA antibody formation in multitransfused patients with malignancy

McGrath, K.M.; Wolf, M.; J, Bishop; Veale, Margaret F.; Ayberk, H.; Szer, Jeff; Cooper, I.; Whiteside, M. G.

doi:10.1111/j.1365-2141.1988.tb04212.x

Cited by 50 publications

(31 citation statements)

References 12 publications

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“…The positive rate of HLA antibodies in our study after multiple transfusions with red cells and platelets is similar to the reports of the Western world [13,14]. Although it is well documented that platelet transfusion can induce the formation of HLA antibodies, red cell transfusion can have a similar effect because contaminated leukocytes may generate a two-signal process requiring both class I and II antigens [15].…”

Section: Discussionsupporting

confidence: 71%

“…Many studies have discovered that HLA antibodies may disappear in certain groups of patients [13,16], We also noticed that HLA antibodies disappeared in 10% of the immunized patients in spite of continuous transfu sions. Tejada et al [20] have suspected the loss of HLA an tibodies as a result of continuous immunosuppression sec ondary to ongoing intensive chemotherapy.…”

Section: Discussionmentioning

confidence: 98%

“…However, it devel oped transiently in most cases that were secondary to sep ticemia and disappeared after the episode of infection [13,21], These are mainly autoantibodies and may not be re lated to blood transfusion. We also found that some pa tients developed platelet antibodies during infection and jaundice.…”

Section: Discussionmentioning

confidence: 99%

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Red Cells, HLA and Platelet Antibody Formation in Patients with Multiple Transfusions

Chow

Hu²,

Lyou³

et al. 1994

Acta Haematol

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Totally 436 Chinese patients having received multiple transfusions of red cells and platelets on more than three occasions were screened for red cell antibodies. Twenty-six (6%) of them were positive. Anti-E, -Mia, and -c were the common alloantibodies. Nine patients were immunized during the period of regular transfusions, with a newly immunized rate of 2% (9/436). Among 436 patients, 387 were screened for HLA antibodies by lymphocytotoxicity test (LCT). The overall positive rate was 35%. Most of the antibodies identified were against the high-frequency HLA antigens in the Chinese population. About 10% of the LCT-positive cases reverted to negative state during the follow-up period. After chloroquine stripping of the target platelets, mixed passive hemagglutination assay was used to detect platelet antibodies other than HLA antibody. Fifty-eight of 161 cases (36%) were positive for platelet antibodies, but half of them disappeared within 1 month. Nineteen of the 58 patients had sepsis and 2 had jaundice. These findings suggested that HLA and platelet antibodies are common among Chinese, though their clinical significance and the role in platelet damage are doubtful.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 98%

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Red Cells, HLA and Platelet Antibody Formation in Patients with Multiple Transfusions

Chow

Hu²,

Lyou³

et al. 1994

Acta Haematol

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“…Phelan et al 19 elegantly demonstrated that normal individuals contain anti-idiotypic antibodies to anti-HLA molecules exquisitely specific for the HLA antigens encoded from the noninherited maternal allele (NIMA), but not paternal HLA alleles. Additionally, anti-HLA reactivity may be transient in patients with malignancy, 20 and it has been shown that in these patients, as in pregnant women, anti-idiotypic antibodies may actively down-regulate anti-HLA antibodies. [21][22][23][24] We speculated that pooling sera from multiparous women might increase the content of anti-HLA-specific anti-idiotypes to produce a more effective IVIg product for alloimmunized patients.…”

Section: Introductionmentioning

confidence: 99%

γ-Globulins prepared from sera of multiparous women bind anti-HLA antibodies and inhibit an established in vivo human alloimmune response

Semple

Kim

Lazarus

et al. 2002

Blood

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It has previously been shown that sera from multiparous women have increased levels of anti-idiotypic antibodies specific for anti-HLA molecules. ␥-Globulins prepared from these sera may be superior to commercial preparations of intravenous ␥-globulin (IVIg) for inhibiting HLA alloimmunization. To test this, F(ab) 2 fragments prepared from either commercial IVIg or from the sera of men or multiparous women were coupled to CNBrSepharose and tested for their ability to bind F(ab) 2 fragments derived from polyspecific anti-HLA sera. As determined by flow cytometry, compared with columns coated with F(ab) 2 derived from commercial IVIg or sera from men, columns coated with F(ab) 2 prepared from the sera of multiparous women bound significantly more anti-HLA. In addition, intact IgG molecules prepared from the sera of multiparous women significantly neutralized the reactivity of the anti-HLA F(ab) 2 fragments. To determine whether the intact IgG molecules or their corresponding F(ab) 2 fragments could affect in vivo alloimmunity, they were tested for their ability to inhibit an established IgG human alloimmune response in humanized severe combined immunodeficient (SCID) mice. Compared with commercial IVIg, when intact IgG or F(ab) 2 fragments derived from multiparous women were administered to SCID mice making human anti-HLA antibodies, a significant reduction in anti-HLA reactivity was observed. The findings suggest that IgG molecules prepared from the sera of multiparous women have increased antiidiotypic reactivity against anti-HLA antibodies, which can significantly inhibit an established human IgG alloimmune response in an Fc-independent manner. IntroductionIntravenous ␥-globulin (IVIg) is widely used to treat patients with immunoregulatory disorders, particularly chronic autoimmune thrombocytopenic purpura (AITP). 1-4 Although IVIg therapy has been shown to have a benefit in raising platelet counts in autoimmune platelet disorders, it appears to be not efficacious in patients with platelet-induced HLA alloimmunization. [5][6][7][8] The reasons for this are unclear but may relate to the nature of the immune response and the mechanisms of action of IVIg, that is, Fc receptor blockade/inhibition 4,9 or anti-idiotypic regulation. [10][11][12] One of the mechanisms by which the peripheral antibody repertoire is regulated is via the production of antibodies reactive with the variable regions of other antibodies, that is, antiidiotypes. [13][14][15] It has also been shown that the production and reactivity of anti-HLA antibodies are under the regulation of anti-idiotypic antibodies. [16][17][18] Perhaps the most striking example of natural in vivo anti-idiotypic regulation of alloimmunization to HLA is that associated with pregnancy, both at the level of the fetus and of the mother. Phelan et al 19 elegantly demonstrated that normal individuals contain anti-idiotypic antibodies to anti-HLA molecules exquisitely specific for the HLA antigens encoded from the noninherited maternal allele (NIMA), but not paternal HLA al...

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“…By the MAIPA assay platelet reactive antibodies were uncovered even before their detection by the LCT. As previously demonstrated [3,11,12], panreactive platelet and HLA antibodies may wax and wane at the time of chemotherapy-induced severe aplasia. The induction of antibody production coincided with feverish episodes.…”

Section: Discussionmentioning

confidence: 86%

Platelet Antibodies and Fever: Their Association in Multitransfused Patients with Hemato-Oncological Diseases

Kurz¹,

Eichelberger²,

Greinix³

et al. 1999

Transfus Med Hemother

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The posttransfusion platelet increment depends significantly on the clinical condition of the patient and the presence of platelet-reactive antibodies. We prospectively determined the development of platelet-reactive antibodies in weekly intervals at the time of chemotherapy in 17 multitransfused patients with hemato-oncological diseases. Sera were tested by both the MAIPA technique and the lymphocytotoxicity test (LCT) for antiplatelets against HLA class I antigens. In addition, we applied the MAIPA technique to determine the presence of platelet-reactive antibodies against human platelet-specific alloantigens (HPA-1, -2, -3, -5) and the platelet membrane glycoproteins (GP) Ia/IIa, Ib/IX, IIb/IIIa (panreactive). Platelet-reactive HLA antibodies were the most common antibodies, found in the sera of 8 patients. They were transient in 5 patients and were constantly detectable throughout the observation period in the other 3. Ten sera from 7 patients were positive for HLA antibodies by MAIPA, but negative by LCT. Of note, in 5 patients the presence of antibodies was indicated by MAIPA, but the LCT became positive only in the consecutive sample.

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Transient platelet and HLA antibody formation in multitransfused patients with malignancy

Cited by 50 publications

References 12 publications

Red Cells, HLA and Platelet Antibody Formation in Patients with Multiple Transfusions

Red Cells, HLA and Platelet Antibody Formation in Patients with Multiple Transfusions

γ-Globulins prepared from sera of multiparous women bind anti-HLA antibodies and inhibit an established in vivo human alloimmune response

Platelet Antibodies and Fever: Their Association in Multitransfused Patients with Hemato-Oncological Diseases

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