High-level long-term white blood cell microchimerism after transfusion of leukoreduced blood components to patients resuscitated after severe traumatic injury

Authors

  • Tzong-Hae Lee,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Teresa Paglieroni,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Garth H. Utter,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Daniel Chafets,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Robert C. Gosselin,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • William Reed,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • John T. Owings,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Paul V. Holland,

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author
  • Michael P. Busch

    1. From the Blood Systems Research Institute, Department of Pathology, the Department of Surgery, and the Department of Internal Medicine, University of California at Davis, Davis, California; the Department of Surgery, University of Washington, Seattle, Washington; and the Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
    Search for more papers by this author

  • This project was supported by a Specialized Center of Research (SCOR) grant in transfusion medicine (P50-HL-54476) from the National Heart Lung and Blood Institute and by a grant from the Blood Systems Foundation.

  • doi: 10.1111/j.1537-2995.2005.00201.x

    TRANSFUSION**;**:**-**.

Tzong-Hae Lee, MD, PhD, Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118; e-mail: tlee@bloodsystems.org.

Abstract

BACKGROUND: Long-term white blood cell (WBC) microchimerism (MC), of at least 2 years, has been reported in trauma patients receiving fresh nonleukoreduced (non-LR) blood. It is unknown, however, whether this occurs with LR blood products that are nearly devoid of WBCs. Twenty-seven patients transfused with LR and non-LR blood products were studied after severe traumatic injury. A secondary aim was to explore donor-recipient mixed lymphocyte reactivity in vitro.

STUDY DESIGN AND METHODS: To quantify MC, allele-specific real-time polymerase chain reaction assays were developed targeting HLA Class II sequence polymorphisms. Extensive validation showed that these assays reliably detect a single copy of target sequence in a complex allogeneic background without false positivity.

RESULTS: At a median follow-up of 26 months (range, 24-39 months), long-term MC was observed in 3 of 20 patients (15%) who received non-LR blood products and 2 of 7 (29%) who received LR blood products. The maximum MC ranged from 0.40 to 4.90 percent of circulating WBCs and appeared, by Class II genotype analysis, to be attributable to a single donor.

CONCLUSION: It is concluded that robust levels of long-term MC, apparently traceable to a single donor, occur at similar frequency despite leukoreduction of transfused blood products. Exploratory analysis of donor-recipient mixed lymphocyte reactivity suggests that long-term MC may require a state of bidirectional tolerance before transfusion.

Ancillary