Screening for HLA antibodies in plateletpheresis donors with a history of transfusion or pregnancy (original) (raw)
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Screening for HLA antibodies in apheresis donors with a history of transfusion or pregnancy
BACKGROUND: Transfusion-related acute lung injury (TRALI) is known as a life-threatening complication of transfusion. HLA and HNA antibodies have been associated with the immune pathway of TRALI. Since donors with a history of transfusion and/or pregnancy are presumed to have an increased risk of carrying such antibodies, we investigated the association of a history of transfusion or pregnancy with the occurrence of HLA alloimmunization in our donor population. STUDY DESIGN AND METHODS: A total of 1018 female plateletpheresis donors and male plateletpheresis donors with a history of transfusion were enrolled in the study. Included donors were systematically screened, using Luminex technology, for anti-HLA Class I and II. The association of donor history with HLA alloimmunization status was analyzed. RESULTS: The overall alloimmunization rate was 20.2%. In 0.0% of the nulliparous transfused female donors and in 1.3% of the transfused male donors, anti-HLA were detected. Thirty-one percent of the parous women versus 4.2% of the nulliparous women screened positive for anti-HLA. The rate of HLA alloimmunization increased with parity. CONCLUSION: Our data indicate that a history of transfusion is a minor risk factor for immunization against HLA antigens. In contrast, former pregnancies constitute a major risk factor for the development of HLA antibodies. Since HLA alloimmunization rate increases with parity, TRALI risk reduction measures should focus on this particular donor population. Repeated testing of female plateletpheresis donors after each pregnancy is implemented in our blood service.
Transfusion, 2009
BACKGROUND: Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion-related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening plateletpheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined.STUDY DESIGN AND METHODS: A total of 8171 volunteer blood donors were prospectively recruited by six US blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion and a sample for HLA Class I and II antibody testing by multiantigen bead flow analysis.RESULTS: A total of 8171 donors were enrolled; 7920 (96.9%) had valid HLA antibody test results and 7841 (99%) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in nontransfused (n = 1138) and transfused (n = 895) men, 1.0% versus 1.7% (p = 0.16). HLA antibodies were detected in 17.3% of all female donors (n = 5834) and in 24.4% of those with a history of previous pregnancy (n = 3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7% (zero), 11.2% (one), 22.5% (two), 27.5% (three), and 32.2% (four or more pregnancies; p < 0.0001).CONCLUSION: HLA Class I and Class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk reduction measure.
Transfusion, 2010
BACKGROUND: HLA antibody testing of previously transfused or pregnant donors may help reduce the risk of transfusion-related acute lung injury (TRALI). However, the prevalence of HLA antibodies in transfused donors has not been well characterized.STUDY DESIGN AND METHODS: Transfusion and pregnancy history was obtained from consenting donors. HLA Class I and II antibody testing was performed by multiantigen bead Luminex platform. Cutoff values for Class I and II antibodies used normalized background ratios of 10.8 and 6.9, respectively. Linear probability models were used to evaluate potential associations between HLA alloimmunization and donor characteristics.RESULTS: A total of 7920 donors (2086 males and 5834 females) were tested. HLA antibody prevalence did not significantly differ between 895 transfused (1.7%) and 1138 nontransfused males (1.0%; odds ratio [OR], 1.75; 95% confidence interval [CI], 0.80-3.82]. Prevalence in 45 transfused nulliparous females (4.4%; 95% CI, 0.1%-11.8%) was not different from the 1.6% prevalence in 1732 nontransfused nulliparous females (OR, 2.94; 95% CI, 0.68-12.74). Transfused parous females had higher prevalence than nontransfused counterparts (p = 0.004; OR, 1.39; 95% CI, 1.07-1.80). In a linear probability model, the estimated additive risk of transfusion-induced alloimmunization was only 0.8% (95% CI, −0.2% to 1.8%; p = 0.10). Donor transfusion history showed that 58% of transfusions occurred more than 10 years previously.CONCLUSION: Transfused volunteer blood donors do not appear to have a significantly higher prevalence of HLA antibodies than their nontransfused counterparts. Thus, in an effort to reduce TRALI risk, ascertaining past history of transfusion and testing these donors for HLA antibodies is not necessary.
Establishing assay cutoffs for HLA antibody screening of apheresis donors
Transfusion, 2011
BACKGROUND-TRALI is the leading cause of transfusion-related deaths. Donor HLA antibodies have been implicated in TRALI cases. Blood centers are implementing TRALI risk reduction strategies based on HLA antibody screening of some subpopulations of ever-pregnant apheresis platelet donors. However, if screening assay cutoffs are too sensitive, donation loss may adversely impact blood availability.
…, 1995
The incidence and consequences of HLA and non-HLA immunization were evaluated in 229 patients with aplastic thrombocytopenia. All patients were transfused with prestorage filtered red blood cells and platelets. On admission, 29 patients presented with HLA antibodies due to prior immunization by pregnancy andlor blood transfusions. Of the 200 patients showing no detectable HLA antibodies on admission, 164 could be evaluated. HLA antibodies developed in 2.7% (3 of 112) of the patients with a negative risk history of prior immunization. The occurrence of HLA antibodies in patients with a history of previous pregnancies or prior nonleukocyte-depleted blood transfusions (risk history positive) was 3196 (16 of 52). Of the total of 48 patients who were or became alloimmunized, 92% (44 of 4 8 1 had a positive risk PROBLEM ASSOCIATED with long-term platelet supportive care in patients with aplastic thrombocytopenia is the development of a state of refractoriness resulting in poor platelet transfusion increments. Nonimmunologic factors are frequently associated with reduced platelet survival after transfusion. Platelet survival may also be impaired by the presence of circulating antibodies directed against antigens expressed on the platelet membrane. HLA antibodies are the most common cause of immunologic platelet transfusion refractoriness.
American Journal of Hematology, 1977
A critical factor limiting the availability of histocompatible platelet transfusions for alloimmunized, thrombocytopenic patients is the large pool of HLA-typed donors needed t o procure platelets perfectly matched for HLA antigens. We have, therefore, investigated the effectiveness of platelets obtained from donors having lesser degrees of histocompatibility. In 421 transfusions administered t o 59 alloimmunized patients who were refractory t o "random donor" platelets, it was found that platelets mismatched for 1 or 2 "cross-reactive" HLA antigens were in most instances as effective in increasing circulating platelet levels as perfectly matched platelets. A significant number of patients also responded t o platelets from donors selectively mismatched for non-cross-reactive HLA antigens. The latter group had a significantly reduced frequency of the antigen HLA-A2 (1 3%) in comparison t o the total patient population (49%). Use of donors whose HLA antigens are serologically cross-reactive with those of alloimmunized patients provides approximately 1 0 times as many prospective donors as does selection based on matching for HLA and simplifies the procurement of hemostatically effective platelets for such patients.
Unappreciated risk factors for transplant patients: HLA antibodies in blood components
Human Immunology, 2004
One of the more aggressive approaches in renal transplantation is the use of plasmapheresis (PP) and intravenous immunoglobulin to eliminate donor-directed human leukocyte antigen (HLA) alloantibodies. A potential complication of a PP protocol is iatrogenic hypocoagulability resulting from the removal of coagulation factors. To prevent bleeding, hypocoagulable patients may require transfusions with fresh frozen plasma (FFP) and/or cryoprecipitate (Cryo). Although HLA alloantibodies in these components have been linked to complications, such as transfusion-related acute lung injury (TRALI), whether they cause complications following transfusion into allograft recipients is unknown. The incidence of complications would be dependent, in part, upon the frequency of HLA alloantibodies in the various blood components. In this study, segments from 77 units of FFP, 66 units of Cryo, 106 units of packed red blood cells (RBCs), and 59 units of apheresis platelets (Plts) were tested for antibodies to HLA class I and class II antigens using FlowPRA, an HLA antigen-specific flow cytometric assay. On average, 22% of blood components tested contained HLA alloantibodies, tenfold greater than previously reported. This unappreciated frequency of HLA alloantibodies in blood components may pose a risk to transplant patients requiring transfusions by promoting allograft dysfunction or loss. Human Immunology 65, 240Ϫ244 (2004).
Annals of blood, 2022
Background: Human leukocyte antigen (HLA) selected platelets are frequently requested in patients with platelet transfusion refractoriness (PTR) due to HLA alloimmunization. A retrospective study was conducted to evaluate the provision of HLA-selected platelets by a regional blood centre from May 2010 to April 2020. Methods: In the study period, 1,080 units of HLA-selected platelets were collected from 393 donors recruited from the unrelated bone marrow donor registry. They were transfused to 147 patients (male 54%, mean age 48±21 years). Analysis was performed in each donor-recipient pair to identify the predictors of haematological response. Results: HLA-A and-B antigens in all except one donor-recipient pairs were 4 out of 4 matched. In 84% of instances, mean 1-hour corrected platelet count increment (CCI) were greater than 7,500 m 2 /µL, the threshold of satisfactory increment. Improvement in 1-hour CCI (CCI HLA selected platelets-CCI random donor platelets) of patients who were not refractory to random donor platelet transfusions was 11,134 m 2 /µL (95% CI: 12,326-14,306 m 2 /µL) less than those who had PTR. Following HLA-selected platelet transfusions, male patients' mean 1-hour CCI was 3,592 m 2 /µL (95% CI: 1270-7,145 m 2 /µL) less than that of female patients. Mean 1-hour CCI was 8,727 m 2 /µL (95% CI: 595-12,970 m 2 /µL) higher in patients who demonstrated anti-HLA antibodies. ABO compatibility did not significantly influence 1-hour CCI. Conclusions: HLA-selected platelets provided locally were almost exclusively 4 out of 4 matched and resulted in satisfactory 1-hour CCIs. In addition to expanding the donor pool, advocating judicious request for the product and thorough investigations of PTR could enhance service provision.