Survival of transfused donor white blood cells in HIV-infected recipients

Abstract

The appearance and expansion of donor white blood cells in a recipient after transfusion has many potential biologic ramifications. Although patients with HIV infection are ostensibly at high risk for microchimerism, transfusion-associated graft-versus-host disease (TA-GVHD) is rare. The purpose of this study was to search for sustained microchimerism in such patients. Blood samples were collected from 93 HIV-infected women (a subset from the Viral Activation Transfusion Study, an NHLBI multicenter randomized trial comparing leukoreduced versus unmodified red blood cell [RBC] transfusions) before and after transfusions from male donors. Donor lymphocytes were detected in posttransfusion specimens using a quantitative Y-chromosome-specific polymerase chain reaction (PCR) assay, and donor-specific human leukocyte antigen (HLA) alleles were identified with allele-specific PCR primers and probes. Five of 47 subjects randomized to receive nonleukoreduced RBCs had detectable male lymphocytes 1 to 2 weeks after transfusion, but no subject had detectable male cells more than 4 weeks after a transfusion. In 4 subjects studied, donorspecific HLA haplotypes were detected in posttransfusion specimens, consistent with one or more donors' cells. None of 46 subjects randomized to receive leukoreduced RBCs had detectable male lymphocytes in the month after transfusion. Development of sustained microchimerism after transfusion in HIV-infected patients is rare; HIV-infected patients do not appear to be at risk for TA-GVHD. (Blood. 2001;98:272-279)

Transfusion-Associated Microchimerism in Combat Casualties

“…In a more recent study, Kruskall et al detected MC after allogenic RBC transfusions in 11% of HIV patients, though no MC was detected in these patients by 4 weeks after transfusion. 26 TA-MC has also been identified in critically injured patients. Evidence of MC was documented in 10 female trauma patients who received blood from male donors.…”

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

“…The evidence of TAMC has thus far been demonstrated among patients with trauma undergoing blood transfusion, pregnancy and transplantation. It has not been demonstrated among patients receiving blood transfusion for other reasons in the setting of immunodeficiency virus (HIV) infection [67], hemoglobinopathies [68] and pediatric structural heart disease [54]. It could be speculated that TA-MC is not identified among these patients due to variations in the assays used to detect TAMC in various studies.…”

Transfusion‐Related Immunomodulation:

“…19 This is in contrast to what had been reported previously for victims of traumatic injury receiving fresh units of blood. 20 If fresh blood does not mediate TRIM effects, 16,19 however, perhaps the TRIM effects are mediated instead by cellular blood components stored for long periods.…”