【正文】 u r e s . It is suggested that as for nongeneric pharmaceuticals, the c l i n i c a l benefits of these various PCs should be individually proved. TRANSFUSION Volume 38, July1998 White cell subsets in apheresis and filtered platelet concentrates . SowemimoCoker, A. Kim, E. Tribble, . Brandwein, and B. Wenz TRANSFUSION Volume 38, July1998 White cell subsets in apheresis and filtered platelet concentrates (Continuous) TRANSFUSION Volume 38, July1998 White cell subsets in apheresis and filtered platelet concentrates (Continuous) Functions of Leukocyte Subsets Monocytes: Major Antigen Presenting Cells (which are able to initiate immune reactions leading to alloimmunization). Granulocytes: Phagocytic cells which engulf and destroy foreign matter. Mainly responsible for febrile transfusion reactions. Evidence suggests that cytomegalovirus (CMV) may be specific to granulocytes, although monocytes may also harbor CMV. Lymphocytes: Carry out a variety of immune functions. Main reservoir for cell associated retroviruses. B Lymphocytes: Committed B lymphocytes produce and secrete antibodies (IgG, IgM). Major antigen presenting cells responsible for alloimmunization. Functions of Leukocyte Subsets (Continuous) T4Lymphocytes: T cells having CD4 phenotype play key “helper ＂ role in regulating the immune response by virtue of their ability to direct “B ＂ cells to differentiate and produce antibodies, direct activation of CD8 positive cytotoxic effector cells, activate macrophages and Natural Killer Cells (NK), and also direct the generation of CD8positive suppressor cells. T8Lymphocytes: T cells having CD8 phenotypes can develop into Tsuppressor cells (that also play an important role in modulating the production of antibodies by B lymphocytes) and also TCytotoxic cells which are important in the defense against viruses. Natural Killer Cells: Lymphoid cells that are distinct from T and B lymphocytes and are important in transplantation rejection and elimination of malignant tumors. 主旨 NH(F)TR發(fā)生的概率并無(wú)法因 Prestorage之白血球過(guò)濾處理而具有任何統(tǒng)計(jì)上意義之降低，目前一系列新的證據(jù)顯示，使用乏白血球處理后之血小板，能使 NH(F)TR發(fā)生比率再降低之關(guān)鍵并非以 Prestorage方式去白血球可以降低之 Cytokine，而在血小板本身產(chǎn)生之 Chemokine RANTES系列。 Pall Program/AABB. ROLE OF BLOOD TRANSFUSION IN CMV TRANSMISSION AND REACTIVATION: CMV PRIMARY INFECTION eg Blood Transfusion REINFECTION 2nd Strain Introduced in Blood Transfusion REACTIVATION eg Immunosuppression Leukocyte Reduction Comparable to CMV Seronegative Blood Bowden RA et al. Transfusion (1995) 35:719722 ? A prospective, randomized trial ? ? 520 CMV seronegative marrow recipients: ? Screened Blood : N = 252 ? Filtered Blood : N = 250 ? Between days 21 and 100 after transplant , patients were ? monitored for the development of CMV infection and ? tissuedocumented CMV disease. Leukocyte Reduction Comparable to CMV Seronegative Blood 7982020406080100Seronegative UnscreenedFilteredCMV Infection/Disease SurvivalTransfusion Treatment % P Seronegative vs Unscreened Filtered Bowden RA et al. Transfusion (1995) 35:719722 Transfusion induced immunosuppression (infection) Adapted from Jensen et al. Lancet 1996。紅血球抗原的致免疫性以 Rh(D)抗原最強(qiáng)， K抗原其次。 臨床上紅血球抗體的發(fā)生，與紅血球抗原的致免疫性 (immunogenecity，或稱抗原性 )有關(guān)。 脾切除：脾切除對(duì)自體免疫性血小板減少癥及脾功能過(guò)盛之病人亦為一很好之治療方法。 減少捐贈(zèng)者的人數(shù)并沒(méi)有減少異體免疫抗體產(chǎn)生的機(jī)會(huì)。一但白血球引發(fā)原發(fā)性異體免疫反應(yīng) (primary alloimmunization)，血小板亦引發(fā)次發(fā)性異體免疫反應(yīng) (secondary alloimmunization)。 ? 血小板只有攜帶第一型 (classI)HLA抗原，血小板本身并不足以對(duì)這些抗原引發(fā)原發(fā)性免疫性免疫反應(yīng)。有少數(shù)的病人于輸血小板前即有異體抗體 (alloantibody)，多半是因?yàn)閺那霸斞“寤驊言械木壒省? ? 頑固性 (refractory)的血小板減少癥： ? 頑固性 (refractory)的血小板減少癥包含了： ? (nonimmune)的頑固性的血小板減少癥 ? (alloimmunization)的頑固性的血小板減少癥 ? 非免疫性的頑固性血小板減少癥的原因包含：敗血癥 (sepsis)，彌漫性血管內(nèi)凝血癥 (DIC)，以及脾臟腫大 (splenomegaly)等。相對(duì)的，有一些疾病所導(dǎo)致的血小板減少癥，輸血小板則為其禁忌癥。如化學(xué)治療后，放射線治療后，維持生活素缺乏，或是再生性不良性貧血等。通常此時(shí)醫(yī)師必須積極去追查造成頑固性血小板減少的原因。這時(shí)在輸血小板之前及之后，對(duì)血中血小板數(shù)量的監(jiān)測(cè)與比較是很重要的，因?yàn)檫@樣可以評(píng)估血小板的存活數(shù)量，以及預(yù)測(cè)未來(lái)對(duì)輸血小板的需求。因此，除了血小板的數(shù)目外，引起血小板減少之原因及疾病亦應(yīng)注意，才能掌握血小板輸注的正確時(shí)效。 C OS T S :A C OM P A R IS O N B E T W E E N R E F R A C T OR YA N D N ON R E F R A C T OR Y P A T IE N T SG or d on e t al . , A S H 19 960102030405060708090P at i e n tN u m b e rP l at e l e tU n i t sT r an s f u s e dL e n gt h ofS t ayP l at e l e tC o s t sT o t al C o s t sR ef r a ct o ryN o n R ef r a ct o ry%N = 24 5N = 48 0$2 3, 51 0$3,126$5 9, 42 6$1 5, 89 7Author Patient Group Alloimmunisation Refractoriness Blood Product Reduction Standard Leucodepleted Standard Leucodepleted Red Cells Platelets HLA Matched . Study, 1997 AML 45% 17% 13% 3% 0% 0% Killick et al ., 1997 Aplastic 50% 12% 0% Anaemics Novotney et al ., 1995 Aplastic 12% 5% Thrombocytopenics Adamzik et al ., 1995 Cancer 27% 0% 27% 0% % AML % Blumberg et al ., 1995 AML 0% % * Lymphoma % % * Williamson et al ., 1994 Cancer % % 31