睡眠性血红蛋白尿患者由于粒细胞-凝集抗体致输血相关的急性肺损伤

背景 输血相关急性肺损伤(TRALI)常因为输入含有供者白细胞(WBC)抗体的血液成分,如果患者本身有这些抗体则非常罕见。TRALI的致病机理尚未为人们所充分理解,而且并非所有的输血受者都会出现TRALI,即使是供者及受者有WBC抗体。病例报导 1例睡眠性血红蛋白尿(PNH)患者输入未去除白细胞的红细胞后出现TRALI。在他的血清中检测出粒细胞-     

急性淋巴细胞性白血病患者输入骨髓细胞后发生的TRALI

背景 TRALI 是输血后发生的最严重、具有生命危险的并发症之一。供者针对受者噬中型粒细胞或HLA分子的抗体被认为是发生疾病的第一大原因。罕见地,受者抗体可能与输入的噬中型粒细胞发生反应激发同样的事件,这提高了在同种外用血干细胞(PBPC)移植中也会发生TRALI的可能性。病例报道1例患有急性淋巴细胞性白血病的30岁日本男性患者,在输入     

在供者血浆中附着于粒细胞上中性粒细胞抗原3a(5b)的同种抗体导致TRALI:两例死亡报导

背景 TRALI通常是在输注血浆时抗WBC抗体引起的免疫反应,其次只发生在ABO配型错误引起输血相关的死亡,相关供者通常是多产妇女(3次妊娠)。研究设计和方案 通过临床和实验检测供者血浆同种抗体,研究两例TRALI死亡病例。采用淋巴细胞毒试验(LCT)、FlowPRA和粒细胞免疫荧光凝聚试验检查WBC抗体。第1例患者62岁,男性,患有慢性T淋巴细胞白血病;第2例患者54岁,女性,接受了尸肾移植。两例患     

输血相关性急性肺损伤误诊文献荟萃与分析

目的荟萃分析输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)病例报道文献,探讨误诊及治疗失误原因,降低TRALI发生率及误诊率。方法以"输血相关性肺损伤、病例报道"为检索式,计算机检索万方数据库、中国学术期刊全文数据库、中国生物医学文献数据库、维普数据库2010年1月—2017年10月纳入文献,按照纳入/排除标准筛选文献,提取数据、统计结果,分析TRALI发生原因与诊治情况。结果符合纳入标准文献19篇,共计29例患者。12例发生于输血期间,17例发生于输血后,其中16例发生于输血后6 h内,1例发生于输血后24 h。26例(89.66%)表现为呼吸困难,25例(86.21%)血氧饱和度0.80,17例(58.62%)出现肺部阳性体征及影像学改变。12例(41.38%)发病时即确诊为TRALI,8例(27.59%)误诊为急性左心衰竭,4例(13.79%)误诊为肺部感染合并呼吸衰竭,5例(17.24%)诊断不明确。本组9例死亡,病死率31.03%。结论我国TRALI病死率较高,与临床医师缺乏警惕性、发生误诊误治有关。减少高危供血者血液使用,建立血液预警机制,可降低TRALI的发生率。     

输血相关急性肺损伤中的HLA-Ⅱ抗体

背景 输血相关急性肺损伤(TRALI)是一个有时致命的严重输血并发症。已证实献血员的粒细胞抗体和HLA-Ⅰ抗体与TRALI相关,但在一些TRALI的病案中涉及了HLA-Ⅱ抗体。方法 作者检测18个月中有TRALI反应报告到血液中心的供血者,如果HLA抗体未确定,检测其HLA-Ⅰ和Ⅱ类抗体及粒细胞抗体。结果 在11例TRALI患者中的7例(64％),和至少一名供血者检测到HLA-Ⅱ抗体;这7例中有5例同时检测到     

输血相关急性肺损伤及其预防与控制策略的研究进展

输血相关急性肺损伤(TRALI)是指输血后6h内发生的急性肺损伤(ALI),是输血导致患者死亡的主要原因之一.目前对TRALI发病机制的假说包括“二次打击”学说与“阈值模型”学说等.超过80％ TRALI是由输注的血液制品中含特异性抗人类白细胞抗原(HLA)或人类中性粒细胞抗原(HNA)抗体介导的,并且导致TRALI发生的血液制品,主要来源于有多次妊娠史的女性献血者.目前,多个国家实行以男性献血者为主体,供应高血浆含量血液制品的临床预防、控制TRALI策略,以效降低TRALI发生率.笔者拟就TRALI的定义、发病机制、诊断、预防控制策略进行综述.     

连续3次输血引发输血相关急性肺损伤——附1例报告

目的探讨该例输血相关急性肺损伤(TRALI)的发生机制,为该疾病的及时诊断和有效治疗提供参考。方法回顾性查阅该病例相关的病程记录、输血资料、实验室检查及影像学数据,诊断标准参照欧洲血液预警网络基于临床特征的TRALI诊断标准[1]。结果该患者在3次输注血小板治疗后出现的呼吸困难、低血氧浓度、双肺纹理增多等临床表现,符合TRALI诊断,同时表现血小板输注无效。结合实验室检查结果,该TRALI疑为患者淋巴细胞抗体与供者相应抗原结合引起。结论 TRALI为严重少见的输血不良反应,临床和输血科应加强认识,及时诊断治疗;加强输血治疗合理性论证,避免不必要的输血不良反应及血液资源的浪费。     

由于供者带有抗人类白细胞Ⅱ类抗原抗体导致输血相关急性肺损伤的回顾性调查

输血相关急性肺损伤(TRALI)仍然被认为是输血最重要的并发症之一。早先的回顾性调查显示存在部分尚未得到确认的病例。作者调查了引起2例TRALI血液成份的供血者。此回顾性调查乃回顾性的病例记录研究评估,了解是否发生了与输血有关的事件。18例患者被确认为接受了2名供者带有在当地人群中高频的人类白细胞抗原(HLA)抗体的血液成分。接受了     

研究与预防抗体介导的输血相关急性肺损伤中的白细胞抗体筛查——国际输血协会粒细胞免疫生物学专题小组的推荐

输血相关急性肺损伤(TRALI)是由输血引起的非心源性肺水肿的症状表现而做出的一种临床诊断,并排除输血过量的可能性.在首次描述后不久发现,TRALI与供者体内的白细胞抗体以及较少情况下受血者血液中的白细胞抗体相关.     

研究与预防抗体介导的输血相关急性肺损伤中的白细胞抗体筛查——国际输血协会粒细胞免疫生物学专题小组的推荐

输血相关急性肺损伤(TRALI)是由输血引起的非心源性肺水肿的症状表现而做出的一种临床诊断,并排除输血过量的可能性.在首次描述后不久发现,TRALI与供者体内的白细胞抗体以及较少情况下受血者血液中的白细胞抗体相关.     

Transfusion-related acute lung injury reports in the Netherlands: an observational study

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a serious, sometimes fatal complication of transfusion, attributed to white blood cell (WBC)-reactive antibodies present in the blood product. This study investigated incidence and etiology in the Netherlands.
STUDY DESIGN AND METHODS: From January 2005 through July 2007, all TRALI cases reported to the Sanquin Blood Banks were evaluated. Only cases meeting the Canadian Consensus Conference criteria for TRALI were included and investigated for patient, donor, and product characteristics. Patients and donors were screened for HLA Class I, HLA Class II, and granulocyte antibodies.
RESULTS: A total of 56 TRALI cases were reported of which 49 were completely evaluated. Seventy-eight percent of the patients needed monitoring or mechanical ventilation on the intensive care unit, 10 patients died. In 61% of cases large-volume plasma products were involved. WBC-reactive antibodies in donors were found in 73% of cases, with proven incompatibility in 21 of 44 (48%) investigated cases. Possible TRALI cases, as defined by the Canadian Consensus Conference, had significantly lower incompatibility rates compared to TRALI cases, 18% versus 58% (p = 0.036). In the 21 alloimmune cases, a total of 31 implicated donors were found, of which 26 were female, including 12 fresh-frozen plasma (FFP) products.
CONCLUSION: TRALI is the most serious transfusion complication in the Netherlands, causing severe morbidity and mortality. Antibodies were found in the majority of the cases, but causality with proven incompatibility could be established in 21 cases (48%). Female FFP products were involved in 57% of proven alloimmune cases and would theoretically be prevented using male FFP only.     

Female donors and transfusion‐related acute lung injury

BACKGROUND: Although quantitative evidence is lacking, it is generally believed that the majority of cases of transfusion‐related acute lung injury (TRALI) are caused by female blood donors. We aimed to examine the relation between female donors and the occurrence of TRALI. STUDY DESIGN AND METHODS: We performed an international, multicenter case‐referent study. TRALI patients who were diagnosed clinically, independent of serology or donor sex, and had received transfusions either only from male donors or only from female donors (unisex cases) were selected. The observed sex distribution among the donors of these TRALI patients was compared to the expected sex distribution, based on the relevant donor populations. RESULTS: Eighty‐three clinical TRALI cases were included; 67 cases received only red blood cells (RBCs), 13 only plasma‐rich products, and three both. Among RBC recipients the relative risk (RR) of TRALI after a transfusion from a female donor was 1.2 (95% confidence interval [CI], 0.69‐2.1) and among plasma‐rich product recipients the RR was 19 (95% CI, 1.9‐191). The p value for the difference between RBCs and plasma was 0.023. CONCLUSION: Our data support the notion that plasma from female donors is associated with an increased risk of TRALI, while RBCs from female donors are not.     

Transfusion-related acute lung injury: reports to the French Hemovigilance Network 2007 through 2008

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is a major cause of transfusion‐related mortality and morbidity. Epidemiologic studies using data from national transfusion schemes can help achieve a better understanding of TRALI incidence. STUDY DESIGN AND METHODS: A multidisciplinary working group analyzed TRALI cases extracted from the French Hemovigilance Network Database (2007‐2008). All notified cases were reviewed for diagnosis. Those meeting the Canadian Consensus Conference criteria for TRALI were classified according to imputability to transfusion and clinical severity. Patient data (clinical characteristics, number and types of products transfused, and serology results) were obtained. RESULTS: There were 62 TRALI cases and 23 possible TRALI cases during the 2‐year period. An immune‐mediated mechanism was identified in 30 of 50 TRALI cases with complete serology. TRALI was considered to be the cause of death in 7.1% of patients and might have contributed to death in an additional 9.4% of TRALI or possible TRALI patients. Occurrence ranked high in obstetrics (15%), after surgery (34%), and in hematologic malignancies (21%). Single‐donor high‐plasma‐volume components were involved in half of the cases where the implicated blood product could be determined and carried the highest risk per component (1:31,000 for single‐donor fresh‐frozen plasma units and apheresis platelet [PLT] concentrates, and 1:173,000 for red blood cells). No incident could be definitively related to the transfusion of solvent/detergent‐treated pooled plasma (>200,000 units transfused), nor to pooled PLT concentrates. CONCLUSION: The proportion of TRALI cases related to plasma‐rich components was lower than previously described.     

Alloexposed blood donors and transfusion-related acute lung injury: a case-referent study

BACKGROUND: Donor white blood cell (WBC) antibodies are thought to increase the risk of transfusion‐related acute lung injury (TRALI). WBC antibodies can be present in blood products from donors who have been alloexposed. Alloexposed donors are increasingly excluded from donating plasma, but can still donate plasma‐poor products. We aimed to quantify the contribution of alloexposed donors to the occurrence of TRALI for different blood product types. STUDY DESIGN AND METHODS: We performed a case‐referent study including all reported TRALI patients and all Dutch blood donors. Data on alloexposure status of donors of all TRALI cases reported between January 2004 and October 2008, in the Netherlands, were compared to information on the total donor population. RESULTS: Alloexposure status of all 223 involved donors was compared to the expected status. The overall percentage of TRALI cases that could have been prevented by the deferral of all alloexposed donors (i.e., population‐attributable risk [PAR]) was 51% (95% confidence interval [CI], 14%‐88%). In 19 recipients of exclusively plasma‐poor products (mostly red blood cells [RBCs]), alloexposure of the donors was not associated with TRALI, while in 28 recipients of both plasma‐poor and plasma‐rich products (>200 mL plasma), the PAR was 94% (95% CI, 34%‐100%). CONCLUSIONS: Alloexposed donors conferred an increased risk of TRALI in recipients of plasma‐rich products, but not in recipients of plasma‐poor products. Although WBC antibodies are an important risk factor for TRALI, among RBC recipients another risk factor must be more important.     

The role of donor antibodies in the pathogenesis of transfusion-related acute lung injury: a systematic review

BACKGROUND: The majority of cases of transfusion‐related acute lung injury (TRALI) are thought to be caused by the presence of leukocyte antibodies in the blood of the donor. We performed a systematic search of the literature to quantify the contribution of donor antibodies to the occurrence of TRALI. STUDY DESIGN AND METHODS: We conducted a systematic search of the PubMed and EMBASE databases. Retrieved articles were judged by three authors independently. Reference lists of all articles were subsequently screened for relevant references. All articles in English, German, French, and Dutch, published at any time before December 2007, were eligible for inclusion. RESULTS: Of 77 articles on leukocyte antibodies in donors involved in a case of TRALI, 14 articles contained sufficient data. These 14 articles reported leukocyte antibodies in 24 of 51 donors (47%) associated with 24 of 28 TRALI cases (86%). Of 15 articles that reported the prevalence of leukocyte antibodies in the general donor population, 2 articles reported a prevalence of 17 percent in (452) randomly selected donors. The odds ratio for developing TRALI was 15 (95% confidence interval [CI], 5.1‐45) for patients who received a transfusion from a donor who tested positive for the presence of leukocyte antibodies, compared to donors who tested negative. Leukocyte antibodies contributed to 80 percent (95% CI, 51%‐92%) of all TRALI cases. CONCLUSION: Leukocyte antibodies were more prevalent in donors involved in TRALI cases than among randomly selected donors. These findings suggest that donor antibodies contribute to four‐fifths of all TRALI cases.     

成人嗜血细胞综合征的临床观察

目的探讨成人嗜血细胞综合征的病因、发病机制、临床表现、诊断、治疗及预后。方法2011年2月-2013年10月,对12例嗜血细胞综合征（HPS）患者的病因、临床表现、治疗及预后结合文献进行分析。结果临床表现：发热12例（100．0％）,肺部感染10例（83．3％）,淋巴结肿大6例（50．0％）,出血表现3例（25．0％）,脾肿大2例（16．7％）,肝肿大1例（8．3％）。实验室检查：骨髓嗜血现象12例（100．0％）,铁蛋白升高11例（91．7％）,血小板降低12例（100．0％）,白细胞降低10例（83．3％）,纤维蛋白原降低8例（66．7％）,高甘油三酯血症7例（58．3％）。10例感染相关性HPS,2例弥漫大B细胞淋巴瘤相关性HPS。2例治愈,9例死亡,1例自动出院。结论HPS临床罕见,感染相关性HPS最常见,临床表现多样,可累及多个系统,病情发展迅速,治疗难度大,病死率高。     

TRALI risk reduction: Donor and component management strategies

Transfusion‐related lung injury (TRALI) occurs in ～1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI. Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The complex interplay among various donor‐, component‐, and patient‐related factors underlying TRALI guarantees that effective prevention will not be a single or simple intervention but rather will require a multifaceted approach. Perhaps, the most important risk reduction strategy is the effort to ensure appropriate use of blood products and eliminate unnecessary transfusions. Blood collection agencies, however, have more proximate control over donor selection and component management than transfusion practice. AABB has provided some guidance on deferring donors implicated in TRALI and minimizing the preparation of high plasma volume components from donors who have anti‐leukocyte antibodies or are at increased risk of leukocyte alloimmunization. Blood centers have taken various approaches to mitigate the risk of TRALI, and the possible benefit and the inherent limitations of the current strategies will be reviewed. J. Clin. Apheresis 2009. © 2009 Wiley‐Liss, Inc.     

单倍体相合异基因造血干细胞移植治疗白血病

背景：对于无HLA全相合同胞供者的患者,采用单倍体相合造血干细胞移植面临移植物抗宿主病重、移植相关死亡率高的风险,但通过不同的移植模式,将有可能获取相近的疗效。目的：观察亲缘HLA单倍体相合异基因造血干细胞移植治疗白血病的疗效,并与亲缘HLA全相合异基因造血干细胞移植相比较。方法：45例白血病患者分为2组。单倍体组移植方式为外周血或联合骨髓干细胞移植,预处理方案为改良白消安与环磷酰胺或加抗胸腺细胞球蛋白,移植物抗宿主病的预防采用环孢素A＋甲氨蝶呤＋霉酚酸脂;全相合组移植方式为外周血干细胞移植,预处理方案为BuCY,移植物抗宿主病的预防采用环孢素A＋甲氨蝶呤。结果与结论：两组均获得造血重建时间差异无显著性意义。单倍体及全相合组急性移植物抗宿主病的累积发病率分别为73%对52%（P〉0.05）;慢性移植物抗宿主病的累积发病率分别为56%对45%（P〉0.05）;移植相关死亡率分别为36%对17%（P〉0.05）;单倍体组无复发,全相合组复发2例;两组的预计3年累积无病生存率分别为61%对60%（P〉0.05）。结果提示,亲缘单倍体异基因造血干细胞移植的总体疗效与亲缘全相合异基因造血干细胞移植相似,但中重度急性移植物抗宿主病的发生率较后者为高。     

AABB survey of transfusion-related acute lung injury policies and practices in the United States

BACKGROUND: Policies and practices with regard to transfusion-related acute lung injury (TRALI) diagnosis, laboratory investigation of TRALI cases, and donor deferral and donor management are not standardized. STUDY DESIGN AND METHODS: A Web-based survey was designed and administered to participating AABB member institutions in July 2006. RESULTS: The survey response rate was highest for donor centers, followed by larger hospital blood banks and transfusion services. Laboratory case workups regularly included HLA Class I and II antibody testing of donors followed less frequently by HNA antibody testing; recipient specimens for leukocyte antigen typing were usually not obtained, even if indicated as part of the planned workup. Several different criteria (i.e., all donors, female donors only, case by case determination) were used to select which donors should be tested. There was agreement that donors should be deferred if implicated in a TRALI case (i.e., antibody-cognate antigen match); however, donor management policies varied in other scenarios. The final diagnosis of TRALI was often (45%-66% depending on institutional type) based on a combination of clinical and serologic findings rather than on adherence to the clinical definition recommended by the Canadian Consensus Conference. Many TRALI policies appeared to be decided on a case-by-case basis at the discretion of the institution's medical director. CONCLUSIONS: There is wide variability in procedures and policies related to the diagnosis of and donor investigation and/or management of TRALI cases. Lack of a consensus approach may partly reflect limitations in understanding of TRALI pathogenesis. The survey suggests that increased education of transfusion medicine practitioners is needed.