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Blood, 15 July 2001, Vol. 98, No. 2, pp. 272-279
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Survival of transfused donor white blood cells in HIV-infected
recipients
Margot S. Kruskall,
Tzong-Hae Lee,
Susan F. Assmann,
Megan Laycock,
Leslie A. Kalish,
Michael M. Lederman, and
Michael P. Busch for the Viral Activation Transfusion Study
Group
From the Departments of Pathology and Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
the New England Research Institutes, Watertown, MA; the Blood Centers
of the Pacific, Irwin Center and the University of California, San
Francisco; and the Division of Infectious Diseases and Center for AIDS
Research, Case Western Reserve University School of Medicine and
University Hospitals of Cleveland, OH.
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, donor-specific 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.
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