Nezavisna uloga interleukina-6 i interleukina-8 u etiologioji transfuzijskih reakcija nakon primene koncentrovanih trombocita kod dece
Sažetak
Uvod/Cilj. Transfuzijske reakcije su neželjeni događaji koji se manifestuju tokom ili nakon primene krvnih komponenti. Prikazani su manje poznati aspekti najčešćih transfuzijskih reakcija (alergijske i febrilne nehemolizne transfuzijske reakcije – FNHTR) posle primene koncentrovanih trombocita u pedijatrijskoj populaciji. Cilj rada bio je da se ispita uloga akumuliranih citokina, interleukina-6 (IL-6) i interleukina-8 (IL-8) i prisustvo humanih anti-leukocitnih antitela (anti-HLA) i humanih anti-trombocitnih antitela (anti-HPA) kao etioloških faktora transfuzijskih reakcija kod dece. Metode. Studijom je bilo obuhvaćeno 239 pedijatrijskih bolesnika koji su dobili transfuziju koncentrovanih trombocita. Podaci o prijavljenim transfuzijskim reakcijama prikupljani su i obrađivani prospektivno. Nivoi IL-6 i IL-8 određivani su metodom indirektne hemiluminiscencije. Anti-HLA i anti-HPA identifikovana su Luminex protočnom citometrijom. Rezultati. Kod ukupno 52 bolesnika zabeleženo je 70 transfuzijskih reakcija. Najčešće su bile alergijske reakcije (74,3%), FNHTR (17,1%). Najveći broj reakcija izazvali su koncentrovani trombociti dobijeni iz "buffy coat" (73,5%). Bolesnici sa infekcijom su posle transfuzije trombocita na koje su ispoljili FNHTR imali najviši nivo IL-6 [483.30 ± 1 041.79 pg/mL (p = 0.020)], slede bolesnici sa febrilnošću [IL-6, 302.52 ± 720.04 pg/mL (p = 0.004)]. Nivo IL-8 u jedinicama trombocita koje su izazvale transfuzijsku reakciju bio je 95.66 ± 319.10 pg/mL, što je bilo značajno više (p = 0.001) u poređenju sa kontrolom. Zaključak. Dominantan etiološki mehanizam za FNHTR u ovoj studiji su citokini produkovani leukocitima akumulirani tokom skladištenja. Etiopatogeneza FNHTR izazvane IL-6 i IL 8 je različita. Zato smo zaključili da značajan faktor u nastanku FNHTR izazvane IL-6 u dečijoj populaciji predstavljaju faktori vezani za status bolesnika (prisustvo infekcije, inflamacije).
Reference
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