血小板配合性输注的分析和展望  

Analysis and prospect of platelet compatible transfusion

作　　者：朱发明[1] 毛伟[2] 张志欣[3] ZHU Faming;MAO Wei;ZHANG Zhixin(Blood Center of Zhejiang Province,Hangzhou 310052,China;Blood Center of Chongqing;Red Cross Blood Center of Beiing)

机构地区：[1]浙江省血液中心,浙江杭州310052 [2]重庆市血液中心,重庆400015 [3]北京市红十字血液中心,北京100088

出　　处：《中国输血杂志》2022年第11期1097-1100,共4页Chinese Journal of Blood Transfusion

摘　　要：血小板配合性输注可有效解决免疫性血小板输注无效(PTR)并节约血小板资源、提升血液安全性。本文对血小板配合性输注中的HLA、HPA和CD36配合性方式,HLA抗体效价和抗原免疫原性以及血小板配合性输注发展作了述评和展望。HLA配合性方式涉及等位基因、抗原、表位水平的配合以及规避供者特异性抗体(DSA)对应抗原的策略,需要探索的是设定规避DSA强度(MFI)的阈值。PTR患者可检出HLA等位基因特异性抗体,因此患者和献血者HLA-A、-B位点宜做高分辨水平的基因分型,以规避相应特异性的抗-HLA。HLA-A、-B位点不同抗原或表位的免疫原性存在差异,选择抗原低表达或免疫原性低的献血者血小板或成为1种相容性配合方式。不同人群抗-HPA产生的概率和种类不同,HPA配合性方式有等位基因的配合和规避抗体对应抗原的配合。CD36配合性方式为规避抗体对应抗原的配合,原则上优先选择CD36抗原Ⅰ型缺失的献血者,次选CD36抗原Ⅱ型缺失的献血者。今后在血小板配合性输注中,应关注供者血小板基因库的库容量提升和信息化建设;在库存和待检血小板检索和配合,将会明显缩短血小板配合性输注所需时间。Platelet compatible transfusion can effectively solve the immune mediated platelet transfusion refractoriness(PTR), save platelet resources and improve blood safety. This paper comments and prospects the compatibility modes of HLA, HPA and CD36, HLA antibody titer, antigen immunogenicity and the development of platelet compatible transfusion. The pattern of HLA compatible platelets involves the matching in the alleles, antigens and epitopes levels, respectively, as well as avoidance donor specificity antibody(DSA) method. While setting the mean fluorescence intensity(MFI) threshold of avoidance DSA needs to be explored when using the DSA prediction method. Allele specific HLA antibodies can be found in the patients with PTR. Therefore, the patients and donors should be genotyped for HLA-A,-B loci at high-resolution level in order to avoid allele specific HLA antibodies. The immunogenicity of various antigens or epitopes at HLA-A and-B loci are different. Selecting donor platelets with low antigen expression or low immunogenicity may be a way of HLA compatible platelets. As the probability and type of HPA antibody production are different in the various populations, the approaching of compatibility HPA involves allele matching and avoidance DSA. As to CD36, the compatibility mode mainly refers to avoidance DSA, which means blood donors with CD36 antigen type Ⅰdeficiency are preferentially selected, and then those with CD36 antigen type Ⅱ deficiency. In the future, more attention should be paid to the scale up of database capacity and update of the information construction. The time waiting for compatible platelets transfusion in clinical could be significantly shortened if the requiring and matching are only conducted within the inventory and candidate platelets.

关 键 词：血小板配合性输注 人类白细胞抗原 血小板输注无效 等位基因特异性抗-HLA 规避DSA对应抗原 血小板同种抗原 

分 类 号：R457.11[医药卫生—治疗学] R331.143[医药卫生—临床医学]