Current problems and future directions of transfusion-induced alloimmunization: summary of an NHLBI working group
James C. Zimring
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorLis Welniak
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorJohn W. Semple
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorPaul M. Ness
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorSherrill J. Slichter
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorSteven L. Spitalnik
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorfor the NHLBI Alloimmunization Working Group
Search for more papers by this authorJames C. Zimring
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorLis Welniak
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorJohn W. Semple
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorPaul M. Ness
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorSherrill J. Slichter
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorSteven L. Spitalnik
From the Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine and the Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia; the National Heart, Lung, and Blood Institute, Bethesda, Maryland; the Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canadian Blood Services, Departments of Pharmacology, University of Toronto, Toronto, Ontario, Canada; the Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland; the Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; and the Department of Pathology and Cell Biology, Columbia University, New York, New York.
Search for more papers by this authorfor the NHLBI Alloimmunization Working Group
Search for more papers by this authorAbstract
In April 2010, a working group sponsored by the National Heart, Lung, and Blood Institute was assembled to identify research strategies to improve our understanding of alloimmunization caused by the transfusion of allogeneic blood components and to evaluate potential approaches to both reduce its occurrence and manage its effects. Significant sequelae of alloimmunization were discussed and identified, including difficulties in maintaining chronic transfusion of red blood cells and platelets, hemolytic disease of the newborn, neonatal alloimmune thrombocytopenia, and rejection of transplanted cells and tissues. The discussions resulted in a consensus that identified key areas of future research and developmental areas, including genetic and epigenetic recipient factors that regulate alloimmunization, biochemical specifics of transfused products that affect alloimmunization, and novel technologies for high-throughput genotyping to facilitate extensive and efficient antigen matching between donor and recipient. Additional areas of importance included analysis of unappreciated medical sequelae of alloimmunization, such as cellular immunity and its effect upon transplant and autoimmunity. In addition, support for research infrastructure was discussed, with an emphasis on encouraging collaboration and synergy of animal models biology and human clinical research. Finally, training future investigators was identified as an area of importance. In aggregate, this communication provides a synopsis of the opinions of the working group on the above issues and presents both a list of suggested priorities and the rationale for the topics of focus. The areas of research identified in this report represent potential fertile ground for the medical advancement of preventing and managing alloimmunization in its different forms and mitigating the clinical problems it presents to multiple patient populations.
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