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首页> 外文期刊>Transfusion: The Journal of the American Association of Blood Banks >Investigation of whether the acute hemolysis associated with Rh(o)(D) immune globulin intravenous (human) administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model.
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Investigation of whether the acute hemolysis associated with Rh(o)(D) immune globulin intravenous (human) administration for treatment of immune thrombocytopenic purpura is consistent with the acute hemolytic transfusion reaction model.

机译：与Rh（o）（D）免疫球蛋白静脉（人）给药相关的急性溶血以治疗免疫性血小板减少性紫癜的研究与急性溶血性输血反应模型一致。

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BACKGROUND: Immune thrombocytopenic purpura and secondary thrombocytopenia patients treated with Rh(o)(D) immune globulin intravenous (human; anti-D IGIV) have experienced acute hemolysis, which is inconsistent with the typical presentation of extravascular hemolysis -- the presumed mechanism of action of anti-D IGIV. Although the mechanism of anti-D-IGIV-associated acute hemolysis has not been established, the onset, signs/symptoms, and complications appear consistent with the intravascular hemolysis of acute hemolytic transfusion reactions (AHTRs). In transfusion medicine, the red blood cell (RBC) antigen-antibody incompatibility(-ies) that precipitate AHTRs can be detected in vitro with compatibility testing. Under the premise that anti-D-IGIV-associated acute hemolysis results from RBC antigen-antibody-mediated complement activation, this study evaluated whether the incompatibility(-ies) could be detected in vitro with a hemolysin assay, which would support the AHTR model as the hemolytic mechanism. STUDY DESIGN AND METHODS: Seven anti-D IGIV lots were tested to determine the RBC antibody identities in those lots, including four lots that had been implicated in acute hemolytic episodes. Hemolysin assays were performed that tested each of 73 RBC specimens against each lot, including the RBCs of one patient who had experienced acute hemolysis after anti-D IGIV administration. RESULTS: Only two anti-D IGIV lots contained RBC antibodies beyond those expected. No hemolysis endpoint was observed in any of the hemolysin assays. CONCLUSION: Although the findings did not support the AHTR model, the results are reported to contribute knowledge about the mechanism of anti-D-IGIV-associated acute hemolysis and to prompt continued investigation into cause(s), prediction, and prevention of this potentially serious adverse event.
机译：背景：接受静脉内Rh（o）（D）免疫球蛋白（人;抗D IGIV）治疗的免疫性血小板减少性紫癜和继发性血小板减少症患者经历了急性溶血，这与典型的血管外溶血表现不一致-推测的机制抗D IGIV的作用。尽管尚未建立抗D-IGIV相关的急性溶血的机制，但其发作，体征/症状和并发症似乎与急性溶血性输血反应（AHTR）的血管内溶血一致。在输血医学中，可以通过相容性测试在体外检测出沉淀AHTR的红细胞（RBC）抗原-抗体不相容性。在RBC抗原抗体介导的补体激活导致抗D-IGIV相关急性溶血的前提下，本研究评估了是否可以通过溶血素测定法在体外检测到不相容性，这将支持AHTR模型作为溶血机制。研究设计和方法：测试了7个抗D IGIV批次以确定这些批次中的RBC抗体身份，其中包括4个涉及急性溶血事件的批次。进行了溶血素测定法，针对每批样品对73个RBC标本进行了测试，包括一名在施用抗D IGIV后经历了急性溶血的患者的RBC。结果：只有两个抗D IGIV批次含有超出预期的RBC抗体。在任何溶血素测定中均未观察到溶血终点。结论：尽管研究结果不支持AHTR模型，但据报道该结果有助于了解抗D-IGIV相关的急性溶血的机制，并有助于继续调查原因，预测和预防这种可能严重不良事件。

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