Haemolytic transfusion reactions due to HLA antibodies. A prospective study combining red-cell serology with investigations of chromium-51-labelled red-cell kinetics.
In a prospective study to see whether HLA sensitisation is associated with increased red-blood-cell (RBC) destruction after HLA-incompatible transfusion, chromium-51-labelled RBC survival and site of sequestration were monitored in nine patients in whom HLA antibodies had developed after RBC transfusions. The donors selected were compatible in ABO and RBC-specific antigen systems but mismatched for the HLA antigen in question. Haemolytic transfusion reactions occurred in all four patients who received HLA-B7-incompatible RBC. A direct radioimmune anti-IgG test became positive, Cr51-RBC survival was very short (22.3, 36.9, 41.4, and 44.0 days), and excess sequestration in the spleen was measured. There was a rise in serum lactic dehydrogenase and a fall in haptoglobin. HLA-B7 antibody was detected in the eluate prepared from RBC collected after transfusion. A similar reaction was found in only one further patient, caused by an HLA-A2 incompatibility. No indications of immune-mediated RBC sequestration were discernible after transfusion of HLA-B7-compatible RBC in one of the patients who had shown a reaction with HLA-B7-incompatible blood, nor in any of the other patients who received HLA-B7-compatible RBC. The haemolytic transfusion reactions could not be anticipated by conventional crossmatch procedures, nor by the measurement of the Cr51-RBC survival 1 h after transfusion.
D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology*; D000906:Antibodies / Q000276:immunology*; D002860:Chromium Radioisotopes; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D015793:HLA-B7 Antigen; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065227:Transfusion Reaction
D000906:Antibodies; D002860:Chromium Radioisotopes; D006680:HLA Antigens; D015793:HLA-B7 Antigen; D007074:Immunoglobulin G