HLA-antigen matched platelet and granulocyte transfusions for patients with leukaemia and aplastic anaemia

Abstract

About 1500 blood donors in Perth have been typed for HLA-A and -B antigens and donate platelets and white cells when required for transfusion to patients with leukaemia or aplastic anaemia if suitable HLA-compatible related donors are not available. Selection of HLA-matched donors is achieved by an on-line computer search, using matching criteria based on those developed by Duquesnoy, Aster and their colleagues at the Milwaukee Blood Center for platelet transfusions. Cells are collected using an Haemonetics 30 cell separator. ACD solution B (USP) is the preferred anticoagulant, and dextran 150 is added for granulocyte collection to enhance red cell sedimentation. To date HLA-matched cell concentrates have been provided for 38 patients, of whom 15 received only platelets, 4 only granulocytes and 19 have had both. In only one case have major difficulties been encountered with reactions to transfusion associated with immunization to many HLA-antigens. Good HLA matches (no incompatible antigens) have been achieved for 23% of 334 transfusions given, acceptable matches (only one incompatible) for 46% and poor matches (two or more incompatible) for the remainder. Platelet concentrates have been effective in controlling bleeding in most cases. In a few instances febrile reactions have occured, usually to platelets with one or more incompatible HLA antigens, which were then less effective than better matched cells given to the same patient. Effects of granulocyte transfusions have been difficult to assess, on account of variations in the number of cells given and in other measures taken to treat the patient's infections. For example, one hospital regularly uses ‘life island’ isolation for these patients, but the others do not have this facility. A clinical impression that granulocyte transfusions have been of value in control of systemic infections has been confirmed by study of a larger number of patients. About 1500 blood donors in Perth have been typed for HLA-A and -B antigens and donate platelets and white cells when required for transfusion to patients with leukaemia or aplastic anaemia if suitable HLA-compatible related donors are not available. Selection of HLA-matched donors is achieved by an on-line computer search, using matching criteria based on those developed by Duquesnoy, Aster and their colleagues at the Milwaukee Blood Center for platelet transfusions. Cells are collected using an Haemonetics 30 cell separator. ACD solution B (USP) is the preferred anticoagulant, and dextran 150 is added for granulocyte collection to enhance red cell sedimentation. To date HLA-matched cell concentrates have been provided for 38 patients, of whom 15 received only platelets, 4 only granulocytes and 19 have had both. In only one case have major difficulties been encountered with reactions to transfusion associated with immunization to many HLA-antigens. Good HLA matches (no incompatible antigens) have been achieved for 23% of 334 transfusions given, acceptable matches (only one incompatible) for 46% and poor matches (two or more incompatible) for the remainder. Platelet concentrates have been effective in controlling bleeding in most cases. In a few instances febrile reactions have occured, usually to platelets with one or more incompatible HLA antigens, which were then less effective than better matched cells given to the same patient. Effects of granulocyte transfusions have been difficult to assess, on account of variations in the number of cells given and in other measures taken to treat the patient's infections. For example, one hospital regularly uses ‘life island’ isolation for these patients, but the others do not have this facility. A clinical impression that granulocyte transfusions have been of value in control of systemic infections has been confirmed by study of a larger number of patients.