New developments in response to boundary violations: proceedings of the Harvard Residency Teaching Day.
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Biomedical subjects
Publications and source records attributed to D Rosen.
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The incidence and characteristics of HLA alloimmunization following transfusions of leukocyte concentrates as a source of enzyme replacement were determined in male patients with Hunter's syndrome. Five patients were given leukocyte concentrates from HLA matched donors (Group I) and another five patients received leukocyte concentrates from non-HLA matched donors (Group II). No other blood products were transfused in either group. Immune response pattern of HLA alloimmunization measured as the proportion of screening cells manifesting cytotoxicity with patient's sera obtained during the follow-up period was similar in both groups. HLA alloimmunization is seen with transfused leukocyte concentrates from either HLA-matched or non-HLA-matched donors in patients with Hunter's syndrome. There appears to be a trend for an earlier onset of HLA alloimmunization with fewer transfusions when leukocyte concentrates from non-HLA-matched donors are transfused as compared to leukocyte concentrates from HLA-matched donors. Once HLA alloimmunization occurs, immune response patterns appear similar with either leukocyte product.
The characteristics and natural history of alloimmunization to HLA were studied in five patients with Hunter's syndrome receiving long term transfusions of leukocytes collected from human leukocyte antigen (HLA) matched donors. Patients were not given any other blood component transfusions. All patients became alloimmunized at an average interval of eight months following an average of 15 transfusions. All patients developed HLA alloantibodies to transfused cross-reactive HLA antigens. Antibodies to transfused incompatible HLA antigens also developed in all patients. Multispecific HLA antibodies in which specificity determination could not be made were also seen in four patients. In a small number of patients in this study, despite matching for the private HLA specificities, HLA alloimmunization was not prevented. In fact, broad alloimmunization was seen uniformly in our patients.
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