Klinični pomen in obstojnost aloprotiteles v bolnišnični populaciji

Hamelec, Lea (avtor), Zupan, Janja (mentor), Raos, Mirela (komentor)

Uvod: Aloimunizacija je imunski odziv na antigene eritrocitov, s katerimi se bolnik sreča med transfuzijskim zdravljenjem, nosečnostjo ali transplantacijo. Imunski sistem prejemnika te antigene prepozna kot tuje in sproži tvorbo protiteles. Ponavljajoče transfuzije povečujejo tveganje za nastanek klinično pomembnih aloprotiteles, ki lahko povzročijo hemolitične transfuzijske reakcije ali hemolitično bolezen ploda in novorojenčka. Spremljanje transfuzijskega zdravljenja in razvoja protiteles je pomembno za varnost bolnikov. Namen raziskave: Preučiti klinični pomen in obstojnost aloprotiteles pri hospitaliziranih bolnikih z uporabo dveh neodvisnih bolnišničnih informacijskih sistemov: UKC Zagreb in e-Delphyn, ki ga upravlja Hrvaški zavod za transfuzijsko medicino. Metode: V retrospektivno raziskavo so bili vključeni vsi bolniki, pri katerih je bila med hospitalizacijo v UKC Zagreb leta 2021 odkrita aloimunizacija. Imunohematološke preiskave so bile izvedene z indirektnim antiglobulinskim testom. Pri teh bolnikih so bili podatki o protitelesih spremljani v obeh sistemih od začetka njunega delovanja do decembra 2024, skupaj s podatki o transfuzijskem zdravljenju in spremembah v obstojnosti aloprotiteles. Za analizo je bila uporabljena deskriptivna statistika. Rezultati: Skupno je bilo v UKC prepoznanih 284 aloimuniziranih bolnikov, od tega je bila skoraj polovica evidentirana tudi v e-Delphynu. Večina bolnikov so bile ženske (71 %), mediana starosti pa je bila 68 let. V obeh sistemih je delež klinično pomembnih protiteles presegal 70 %, najpogosteje anti-K, anti-E in anti-D. V obdobju spremljanja se je število aloprotiteles na bolnika povečalo, prav tako pa se je povečalo število večkratnih aloimunizacij. Dinamika sprememb v pojavnosti aloprotiteles je bila opažena pri 9 % bolnikov, s skoraj enakim deležem pojava in izginotja. Skoraj polovica bolnikov je prejela transfuzijsko zdravljenje, večina od teh v obdobju spremljanja. Zaključek: Med aloimuniziranimi bolniki prevladujejo ženske in starejši bolniki, zlasti tisti z visokim tveganjem. Najpogostejša klinično pomembna aloprotitelesa so predvsem iz sistema Rhesus in Kell in lahko povzročijo hude reakcije pri transfundiranih bolnikih. Spremljanje z obema sistemoma nam omogoča določiti vrsto aloprotiteles in poudarja pomen stalnega testiranja ter integracije podatkov za zagotavljanje varnosti bolnikov.

• Jezik: Slovenski jezik
• Ključne besede: aloimunizacija, klinično pomembno antieritrocitno protitelo, hemolitična transfuzijska reakcija, hemolitična bolezen ploda in novorojenčka, indirektni antiglobulinski test
• Vrsta gradiva: Magistrsko delo/naloga
• Organizacija: FFA - Fakulteta za farmacijo
• Leto izida: 2025
• PID: 20.500.12556/RUL-171676
• Datum objave v RUL: 30.08.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Clinical significance and persistence of alloantibodies in the hospital population

Izvleček

Introduction: Alloimmunization is an immune response to red blood cell antigens, which meet the patient during transfusion therapy, pregnancy, or transplantation. Recipient's immune system recognizes these antigens as foreign and trigger antibody production. Repeated transfusions increase the risk of clinically significant alloantibodies, which may lead to hemolytic transfusion reactions or hemolytic disease of the fetus and newborn. Monitoring transfusion therapy and antibody development is important for patient safety. Aim of the study: To examine the clinical significance and persistence of alloantibodies in hospizalized patients using two independent hospital information systems: UHC Zagreb and e Delphyn, managed by the Croatian Institute of Transfusion Medicine. Methods: This retrospective study included all patients in whom RBC alloimmunization was detected during hospitalization at the UHC Zagreb in 2021. Immunohematological testing was performed using the indirect antiglobulin test. For these patients, antbody data were monitored through both systems from the beginning of the system’s operation until end of December 2024, with transfusion treatment and changes in alloantibodies’ persistence. Descriptive statistics were used in analysis. Results: A total of 284 alloimmunized patients were identified at the UHC, with nearly half also recorded in e-Delphyn. Most of the patients were women (71%) and median age was 68 years. In both systems clinically significant antibodies exceeded 70%, most commonly anti-K, anti-E and anti-D. In the follow-up period, the number of alloantibodies per patient increased, such as number of multiple alloimmunizations. Dynamics of alloantibodies was observed in 9% of patients with nearly equal percentage of appearance and disappearance. Nearly half of patients received transfusion therapy, with a higher intensity observed in the follow-up period. Conclusion: In alloimmunized population, women and older patients, especially high-risk patients, are predominant. Clinically significant alloantibodies, particularly from Rhesus and Kell systems, are the most prevalent and can cause severe reactions in transfused patients. Monitoring through both systems shows the nature of alloantibodies and highlights the importance of continuous testing and data integration to ensure patient safety.

• Ključne besede: Alloimmunization, clinically significant red blood cell alloantibody, hemolytic transfusion reaction, hemolytic disease of the fetus and newborn, indirect antiglobulin test