RESUMEN
Alloimmunization is a common phenomenon after transfusion, with an estimated incidence of 0.5% increasing to 20-60% in chronically transfused patients. In recently transfused patients, serological typing can be hampered by mixed field agglutination. We established RT-PCR methods for RHD, RHC/c and RHE/e typing using mRNA from reticulocytes. Molecular typing was performed soon after 51 separate mismatched transfusion events involving 30 patients. Accurate identification of the transfused patients' phenotype was confirmed in all cases. Reticulocyte maturation studies revealed that temperature is a crucial parameter for transition into mature red blood cells.
Asunto(s)
Tipificación y Pruebas Cruzadas Sanguíneas/métodos , ARN Mensajero/sangre , Reticulocitos/química , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos , Isoinmunización Rh/diagnóstico , Sistema del Grupo Sanguíneo Rh-Hr/genética , Reacción a la Transfusión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Proteínas de Transporte de Catión/análisis , Proteínas de Transporte de Catión/genética , Supervivencia Celular , Frío , ADN Complementario/genética , Transfusión de Eritrocitos , Eritropoyesis , Femenino , Pruebas de Hemaglutinación , Humanos , Procedimientos de Reducción del Leucocitos , Masculino , Glicoproteínas de Membrana/análisis , Glicoproteínas de Membrana/genética , Persona de Mediana Edad , Fenotipo , ARN Mensajero/genética , Sistema del Grupo Sanguíneo Rh-Hr/análisis , Factores de TiempoRESUMEN
The study's objective was to identify HPA 1a-negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a-negative women were screened for anti-HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a-negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 x 10(9)/L. Of the women screened, 2.1% were HPA 1a negative, and anti-HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a-positive children. Of these, 55 had severe thrombocytopenia (< 50 x 10(9)/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.