비예기 항체선별검사에 의해 검출된 복합항체의 특성 = The Characteristics of Concurrent Blood Group Antibodies Detected by Unexpected Antibody Screening Tests

다국어 초록 (Multilingual Abstract)

Background: Multiple alloimmunization is the production of two or more alloantibodies by an individual. These antibodies are significant because they can present major problems in compatibility testing. The goal of this study was to determine the properties of concurrent blood group (BG) antibodies in Korea.
Methods: The transfusion records of 540 patients from Dong-A University Hospital were reviewed to identify alloimmunized individuals. The records spanned a time period from September 2002 to March 2010. The data regarding transfusions and the clinical characteristics of those patients making concurrent antibodies were gathered.
Results: Concurrent blood group antibodies were found in 23.9% (45/188) of alloimmunized patients, constituting 40.7% (100/246) of all antibodies. The most common alloantibody pair were anti-E/-c and anti-C/-e. The mean transfused RBC units, mean interval, and mean transfusion frequencies before detection of two or more antibodies were 2.4 units, 92 days, and 2.4 times, respectively. The majority of alloantibody pairs appeared and were undetectable at the same time. Among 45 patients (mean age 55.9 years, range 32 to 82 years), twenty-six (57.8%) were female and the remaining nineteen were male. Non-hematological malignancy accounted for a major share (26.7%) in the underlying disease.
Conclusion: Antibody concurrence varied by BG antigenic specificity. Rh antibodies, in particular anti-E with anti-c appeared to be highly linked. Unlike in Western countries, anti-K was less common in Korea and so the pairs involving this antibody were scarce. More prospective investigations are needed to delineate the immunologic phenomenon of multiple alloimmunization. (Korean J Blood Transfus 2010;21:115-121)

국문 초록 (Abstract)

배경: 복합면역반응은 한 개인에서 두 개 이상의 적혈구 동종 항체가 만들어지는 것이다. 이러한 항체는 수혈 적합성 검사에서 중요한 문제를일으킬 수 있어 의의가 있다. 우리는 한국인에서존재하는 복합 항체의 특성과 빈도를 알아보고자하였다.
방법: 2002년 9월부터 2010년 3월까지 동아대학교병원에서 항체동정검사를 실시한 540명의수혈기록과 병력을 후향적으로 검토하였다. 복합항체의 종류와 빈도, 지속성에 대해 조사하였고,복합항체 생성에 영향을 미치는 인자들 중에서수혈자의 성별, 나이, 질환군별로 분석하고 적혈구 수혈량, 수혈기간 및 수혈횟수 등을 분석하였다.
결과: 적혈구 복합항체는 전체 동종면역환자의23.9% (45/188)에서 발견되었고 전체 동정된 항체의 40.7% (100/246)를 차지했다. 가장 흔한 복합항체 조합은 anti-E+c 그리고 anti-C+e였다. 복합항체가 동정된 환자들의 평균 수혈량은 2.4단위,마지막 비예기항체 선별검사 음성에서 양성 사이의 기간은 평균 92일, 평균 수혈횟수는 2.4회였다. 대부분 같은 시기에 나타나고 수혈 후 함께지속되거나 역가가 감소하였다. 복합항체가 동정된 45명의 평균 나이는 55.9세, 범위는 32∼82세였고, 26명(57.8%)이 여성이었고 나머지 19명이남성이었다. 기저질환으로는 악성종양이 가장 높은 비율(26.7%)을 나타냈다.
결론: 복합항체는 적혈구 항체 특이성에 따라다양하게 나타났다. 복합면역은 Rh계열의 항체가 가장 많았으며, 서구와 달리 항-E+c의 빈도가가장 높았고 항-K와 조합을 이룬 복합항체의 빈도는 매우 낮았다. 복합면역반응을 이해하기 위해서는 보다 전향적인 연구가 필요할 것으로 생각된다.

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