BackgroundDespite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion.Study Design and MethodsEach participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted.ResultsBetween October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow‐up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti‐E was identified in 25 patients, anti‐Jka in 5, and anti‐c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti‐E in 7, anti‐Jka in 4, and anti‐Lea in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p = .012).DiscussionThe number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.

中文翻译：

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输血后红细胞抗体的产生和消失：日本的一项多机构前瞻性研究


背景尽管有一些关于红细胞（RBC）同种免疫的报道，但输血患者中红细胞同种免疫的实际患病率和影响因素仍知之甚少。我们研究了临床因素与输血后红细胞抗体的产生和消失之间的关联。研究设计和方法每个参与机构在红细胞输注前后均进行了抗体筛查。对患者特征、抗体筛查及鉴定结果、抗体筛查方法、红细胞输注总量、不良反应等进行调查。结果2018年10月至2023年3月，5家机构共登记1194例患者。总体而言，958 名患者在输血后至少接受了一次红细胞抗体后续筛查，结果显示 44 名患者 (4.6%) 出现了新抗体。 25 名患者中发现了抗 E，5 名患者中发现了抗 Jka，4 名患者中发现了抗 c。输注的 RBC 单位数量与输血后抗体的产生显着相关 (p < .001)。在 55 名输血后发现抗体（包括历史抗体）的患者中，18 名（33%）的抗体消失； 7 中为抗 E，4 中为抗 Jka，2 为抗 Lea。通过盐水和/或酶方法比持久性抗体更频繁地识别出消失抗体 (p = .012)。讨论输注的红细胞单位数量可能会影响抗体的产生，以及仅通过盐水和/或酶方法鉴定的抗体，被认为在临床上不显着，可能具有较高的消失率。应仔细进行抗体筛查，尤其是接受大量红细胞单位的患者。 无论临床相关性如何，都应确认先前的抗体筛选结果，以防止遗漏消失的抗体。