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Transient increase in circulating donor leukocytes after allogeneic
transfusions in immunocompetent recipients compatible with donor cell
proliferation
TH Lee, E Donegan, S Slichter and MP Busch
Irwin Memorial Blood Centers, San Francisco, CA 94118.
Donor leukocytes in therapeutic blood components are implicated in
transfusion-related complications ranging from alloimmunization to
graft-versus-host disease (GVHD) to viral transmission and reactivation. To
further characterize the kinetics of donor leukocyte clearance after
allogeneic transfusion, we developed allele-specific polymerase chain
reaction (PCR) assays directed at a single-copy Y chromosome gene and HLA
class II alleles. These assays enable sensitive detection and quantitation
of donor leukocytes at concentrations ranging from one cell to greater than
1,000 cells per 125 microL of recipient blood. When applied to serial
samples from five consecutive orthopedic surgery patients who met study
criteria, we observed 99.9% clearance of donor leukocytes over the initial
2 days posttransfusion, followed by a transient, 1-log increase in
circulating donor leukocytes on days 3 to 5. This phenomenon was reproduced
in a canine transfusion model, where the transient donor leukocyte
expansion phase was prevented by gamma irradiation of donor blood, and was
not observed after transfusions into alloimmunized dogs. We hypothesize
that this transient increase in circulating allogeneic donor cells
represents one arm of an in vivo mixed lymphocyte reaction, with activated
donor T lymphocytes proliferating in an abortive GVHD reaction to HLA-
incompatible recipient cells. Further investigation of this phenomenon
should provide insight into the mechanisms involved in donor-recipient
leukocyte interactions posttransfusion and the relationship of these
interactions to leukocyte-induced complications.
Volume 85,
Issue 5,
pp. 1207-1214,
03/01/1995
Copyright © 1995 by The American Society of Hematology
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