【正文】 36: 707 7 1 3 . C3a Accumulates in Stored Platelet Products C3a and C3a des Arg77 Inhibit NK Cells Effect of Pall PL100TM Leukodepletion Filters on C3a Removal From Platelet Concentrates Effect of Storage on C3a in Pooled Random Donor Platelets and Filtration with PXL8TM Not all Filters are the Same P Two cases of adverse reaction due to leukocytereduction filter A Kokubunji*1, S Kai1, R Imaizumi1, J Ikemoto1, M Misawa2, M Natsuaki3 and H Hara1,2 Departments of 1Transfusion Medicine, 2Internal Medicine (Division of Hematology and Oncology). 3Dermatology, Hyogo College of Medicine, Hyogo, Japan Aims: Most adverse reactions associated with transfusion are nonhemolytic transfusion reactions (NHTR) with allergic symptoms such as rash, itching and urticaria. The causes of the reaction are difficult to be determined in most cases. We examined the cause of NHTR in association with leukocytereduction filters (LR filters) that are widely used to prevent alloimmunization. Materials and methods: NHTR occurred in two patients。 and the proDERM Institute for Applied Dermatological Research, Hamburg, Germany. Address reprint requests to: Harald Kluter, MD, Institute of Transfusion Medicine and Clinical Immunology, German Red Cross Blood Transfusion Service of BadenWurttemberg, Friedrich EbertStrasse 167, D68167 Mannheim, Germany。 PC(s)= platelet concentrate(s)。在該篇論文中詳細(xì)記錄、統(tǒng)計(jì)、分析了 1992~1996年間，德國血液及腫瘤科因化療或脊髓功能不健全而造成血小板缺乏癥而需輸血小板患者之所有輸血反應(yīng)之記錄，其二組對照比較之情況（均用 PALL Filter），如表一： Febrile and allergic transfusion reactions after the transfusion of white cellpoor platelet preparations H. Kluter, , H. Kirchner, and D. Wilhelm CONCLUSION: Prestorage WBC filtration did not reduce the incidence of these reactions, and inflammatory cytokines were of minor relevance. The proinflammatory plateletderived chemokine RANTES, which accumulates even in WBCreduced platelet concentrates, was associated with allergic transfusion reactions. Plateletderived mediators may be a key to understanding NHTRs. TRANSFUSION V o l u m e 39, N o v e m b e r / D e c e m b e r 1999 Febrile and allergic transfusion reactions after the transfusion of white cellpoor platelet preparations (Continuous) Nonhemolytic transfusion reactions (NHTRs) are mon side effects after the transfusion of blood ponents. Most of the reactions are mild, but some are lifethreatening, because of severe anaphylactic shock. Whereas in the past white cell (WBC) antibodies were of foremost relevance, their impact faded with the introduction of WBCreduction devices. Recently, contaminating inflammatory cytokines in platelet concentrates (PCs), such as interleukin (IL)1, IL 6, IL8, or tumor necrosis factor α (TNFα ), have been considered instrumental in the origin of these reactions. These mediators can accumulate in high concentrations in stored PCs, but their levels are very dependent on the WBC contamination. WBCreduced PCs contain few if any inflammatory cytokines, and prestorage filtration of PCs can circumvent the accumulation of these mediators during storage. There is also a remarkable difference in the reported incidence of NHTRs, according to the kind of PC transfused. Transfusion reactions still occur after the transfusion of WBCreduced PCs. Thus, underlying pathomechanisms besides the presence of WBC d e r i v e d i n f l a m m a t o r y c y t o k i n e s m i g h t a l s o be i n v o l v e d in N H T R s . ABBREVIATIONS: BC= buffy coat。348:841845. 0510152025N o n e L e u k o r e d u c e d A l l o g e n e i cW o u n d I n fe c ti o nPn e u m o n i aR e o p e r a ti o nInfection Rate (%) or Reoperation Reduces Wound Infection, Pneumonia and Reoperation Transfusion Regimen Pa ti e n t C h a r g e s024681012141618L e n g th o f S ta yN o n eL e u k o r e d u c e dA l l o g e n e i c14 11 8 5 Days in Hospital Dollars (thousands) CostEffectiveness of Leukoreduction Transfusion Regimen Adapted from Jensen et al. Transfusion 1995。當(dāng)然，致免疫性之高低，雖然主要是因抗原不同而異，但免疫途徑、免疫方法及頻率也有所影響，宿主本身的免疫力和身體狀況更是影響抗體發(fā)生的重大因素。即便是僅使用單一捐贈者輸血小板，亦只有少數(shù)研究報(bào)告顯示有統(tǒng)計(jì)上的差異。但是白血球同時攜帶第一型 (classI)及第二型 (class II)HLA抗原，足以引發(fā)異體免疫 (alloimmunization)反應(yīng)。 對于非免疫性的頑固性的血小板減少癥的處理方法有： ABO血型相符之血品 (splenectomy)的病人則應(yīng)增加血小板的劑量 (sepsis)及彌漫性血管內(nèi)凝血癥 (DIC)的原因 HLA相符之血小板等 ? 異體免疫性的頑固性血小板減少癥 ? 根據(jù)統(tǒng)計(jì)，約有 20%至 70%反覆輸血小板患者會產(chǎn)生異體抗體 (alloantibody)，一般發(fā)生在輸血小板兩個月內(nèi)。 ? 另外有一些疾病所導(dǎo)致的血小板減少癥則對輸血小板反應(yīng)不好，如：敗血癥 (sepsis)，脾臟腫大(splenectomy)，以及免疫性血小板減少癥，包括自體免疫性血小板減少癥 (immuhrombocytopenia)，藥物引起之血小板減少癥，或是淋巴增生性疾病等。如果血小板的數(shù)量沒有爬升，即使是反覆的輸血，可能對病人并沒有什么好處。不之疾病造成血小板之減少癥，對輸血小板之反應(yīng)不盡相同，如敗血癥，脾腫大，免疫性血小板減少癥，則對輸血小板之反應(yīng)不佳。 filter media is developed as a cleanup solution for Three Mile Island site. 1988 Pall introduces its leukoreduction filters to bat posttransfusion fever and allergic reactions. 1989 Pall’s Scientific and Laboratory Services develops filtration and maintenance standards for hydraulics systems on the Eurotunnel boring machines, ensuring reliable operation under challenging environmental conditions. 1990 Dr. Pall is awarded the National Medal of Technology by President Gee Bush Sr. A Culture of Innovation 1991 The Pall CentriSep174。 輸血過濾器的臨床應(yīng)用 陳育新 Military Aircraft Engine Intake Air Royal Navy Sea King Helicopter filtered by PALL Filtration 1230 Leo Yang Pall TWN Sciences Wele to Pall Corporation Pall is All Around You Ensuring the purity and clarity of the wine, beer and water you drink Pall is All Around You Helping to make vaccines pure and safe A Culture of Innovation 19