혈소판불응증 환자의 HLA적합혈소판 수혈효과
An Evaluation of HLA-matched Platelet Transfusion Effect in Patients with Platelet Refractoriness
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배경 : HLA 동종면역반응에 의한 혈소판불응증 환자에게는HLA적합혈소판을 수혈하면 혈소판 증가효과를 얻을 수 있다. 본연구에서는 서울대병원에서 직원 450명을 대상으로 수립한 소규모의 HLA적합혈소판 헌혈자 풀을 이용하여 혈소판불응증 환자에게 HLA적합혈소판을 수혈한 후 그 효과를 후향적으로 분석하였다.방법 : 임의헌혈 혈소판에 대해 혈소판불응증(1시간 CI<7,500/ L/m2; 평균 1,887/ L/m2)과 HLA 동종면역반응(PRA≥50%)을 보인 17명의 환자들에 대하여 62명의 헌혈자로부터 총78회의 혈소판 성분채집을 시행하였다. HLA적합혈소판 헌혈자들은 HLA 적합 정도와 환자들의 HLA 항체 특이성에 근거하여선정되었다.결과 : 한 환자당 평균 4.6회의 HLA적합혈소판 수혈을 받았고수혈 후 환자의 혈소판은 1시간 CI가 17,813/ L/m2로 증가하였다. 총 수혈건수의 76% (59/78회)에서 혈소판 수혈효과가 있었다(1시간 CCI ≥7,500/ L/m2). HLA 교차시험(NIH법)에서음성인 경우 양성에 비해 1시간 CI가 유의하게 높았다 (23,877±16,583 vs 10,823± 9,264; P=0.000). HLA 적합도가 더 적합한A-B2U군에서 덜 적합한 군에 비해 더 좋은 수혈효과(1시간 CI=23,853/ L/m2)를 보였으나, 환자의 HLA 항체 특이성에 따라적합한 헌혈자를 잘 선정함으로써 적합도가 가장 낮은 군에서도상당한 수혈효과(C, D군 1시간 CCI=17,062/ L/m2)가 있었다.한편, 혈소판 채집 후 24시간 이내에 수혈하는 것이 24시간 지나서 수혈하는 경우에 비해 CCI 증가 유의하게 높았다(20,325±16,590 vs 11,417± 10,726; P=0.029). 결론 : 상대적으로 적은 수의 헌혈자 등록 규모에도 불구하고, HLA 항체 특이성에 따라 적합한 헌혈자를 선정하여 수혈을 실시함으로써 대부분의 환자에서 좋은 수혈효과를 얻을 수 있었다.
Abstract
Background : Patients with platelet refractoriness as a result of human leukocyte antigen (HLA) alloimmunization can be effectively managed by transfusion of HLA-matched platelets. In this study, we have retrospectively evaluated the effect of HLA-matched platelet transfusion using a hospitalbased donor pool of 450 HLA typed donors. Methods : For 17 patients showing platelet refractoriness to random donor platelets [1 hr corrected count increment (CCI) <7,500/ L/m2; mean 1,887/ L/m2] and HLA alloimmunization, 78 single-donor apheresis platelets from 62 donors were transfused. HLA compatible donors were selected based on HLA match and patients’ HLA antibody specificities. Results : An average of 4.6 transfusions per patient were done and effective post-transfusion platelet increments were obtained with a mean 1 hr CCI of 17,813/ L/m2. In 76% (59/78) of the total transfusions, an effective platelet increment (1 hr CCI ≥7,500/ L/m2) was obtained. HLA crossmatch (NIH method) negative patients showed a significantly higher platelet increment compared with crossmatch positive patients (23,877 vs 10,823; P=0.000). Although better transfusion effect was obtained in higher grade HLA match of A-B2U by selection of HLA compatible donors according to patients’ HLA antibody specificities, an effective platelet increment was obtained in lower grade matches as well. Platelets transfused ≤24 hours after collection showed a significantly higher platelet increment compared with those stored >24 hours (20,325 vs 11,417; P=0.029). Conclusions : Although many low grade matched donors were selected due to a relatively small size of HLA typed donor pool, effective platelet increments were obtained by selecting platelet donors on the basis of HLA antibody specificity. (Korean J Lab Med 2004; 24: 426-31)
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