혈소판불응증 환자에서 HLA 교차시험 적합 혈소판 수혈효과의 평가 = An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness

다국어 초록 (Multilingual Abstract)

Background : Majority of immune-mediated platelet refractoriness is caused by HLA alloimmunization and can be effectively managed by HLA-matched platelet transfusions. However, HLA class Ityped large-sized donor registry has not been well established in Korea. We evaluated the effectiveness of platelet transfusion using HLA crossmatch-compatible donors without HLA typing.
Methods : Sixteen patients showing platelet refractoriness to random donor platelets (1 hr corrected count increment [CCI] <7,500/μL/㎡) and HLA alloimmunization (class I panel reactive antibody >60%) were crossmatched with 78 platelet apheresis-eligible donors using National Institute of Health (NIH) and anti-human globulin (AHG) lymphocytotoxicity methods. NIH negative/AHG negative and NIH negative/AHG positive donors were selected as best and second choice donors, respectively.
Results : Eleven patients (11/16, 69%) could find NIH-crossmatch negative donors and 27 donors (27/78, 35%) belonged to the best donors. To 8 patients, 32 apheresis platelet products from 19 donors were transfused. The mean 1 hr and 24 hr CCI values from the best donors were significantly higher than those from random donors (17,893 vs 2,358, P=0.003; 8,292 vs -614, P<0.001), whereas such differences were not observed for those from the second choice donors. Platelet storage time was inversely correlated with CCI values and platelets stored ≤10 hr after collection gave significantly higher CCI values. Neither ABO match nor donor status (related vs unrelated) affected the transfusion effectiveness.
Conclusions : Effective post-transfusion platelet increment using HLA crossmatch-compatible donors was attained in patients with platelet refractoriness due to HLA antibodies, and this method can be used effectively where HLA-typed platelet donor registry is not available.

국문 초록 (Abstract)

배경 : 면역학적 원인의 혈소판불응증의 대부분은 HLA 동종
면역반응에 의해 야기되며, HLA 적합 혈소판 수혈로 효과적인
혈소판 증가를 기대할 수 있다. HLA 적합 혈소판 공급을 위해
서는 HLA class I 항원형별검사가 되어 있는 대규모의 헌혈자
등록제도가 필요하지만 국내에서는 이런 제도가 잘 확립되어 있
지 않다. 본 연구에서는 HLA 항원형별검사를 하지 않고 HLA
교차시험 적합한 헌혈자로부터의 혈소판 수혈효과를 평가하고
자 하였다.
방법 : 임의헌혈 혈소판에 대해 혈소판불응증(1시간 corrected
count increment [CCI] <7,500/μL/㎡)과 HLA 동종면역반응
(class I PRA >60%)을 보인 16명의 환자에 대해 혈소판 성분채
집이 가능한 78명의 헌혈자와 세포독성검사법을 이용한 T세포
교차시험(National Institute of Health법 및 anti-human
globulin법, NIH법 및 AHG법)을 시행하였다. NIH법 음성/AHG
법 음성인 경우 최선의 헌혈자로, NIH법 음성/AHG법 양성인
경우 차선의 헌혈자로 선정하였다.
결과 : 11명의 환자(11/16, 69%)가 NIH 교차시험 음성인 헌
혈자를 찾을 수 있었고, 27명의 헌혈자(27/78, 35%)가 최선의
헌혈자에 해당하였다. HLA 적합헌혈자를 찾을 수 있었던 환자
중 8명에게 19명의 헌혈자로부터 총 32회의 혈소판 성분채집을
시행하여 수혈하였다. 최선의 헌혈자군에서는 임의헌혈 혈소판
수혈에 비해 수혈 후 1시간 및 24시간 CCI 가 유의하게 증가하
였으나(17,893 vs 2,358, P =0.003; 8,292 vs -614, P<0.001),
차선의 헌혈자군에서는 이러한 차이가 관찰되지 않았다. 혈소
판 보관시간과 CCI 값은 역상관관계를 보여 채집 후 10시간 이
내의 혈소판을 수혈 시 1시간 및 24시간 CCI가 유의하게 높은
값을 보였다. ABO 일치 여부와 환자와 헌혈자의 혈연/비혈연
관계 여부는 혈소판 수혈효과에 별다른 영향을 보이지 않았다.
결론 : HLA 동종면역에 의한 혈소판불응증 환자에서 HLA
교차시험 적합 헌혈자로부터 수혈 시 효과적인 혈소판 수의 증
가를 보였다. 이 방법은 HLA 적합 혈소판 헌혈자 등록제도가
수립되어 있지 않은 경우에 효과적으로 이용될 수 있다.

참고문헌 (Reference)

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