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&!(!'# $"%# u§2ö#9O HLA T^V I ÑDþjU` ]_a(Ig)T^VC=.>E.4=1Dù2- N! IgM }D HLA T^V I Ñ(IgM-HLA Ñ) 2 HLA T^V I ÑÊÑD 38'71,Í9O 6@2ù7P>.O 1)'3) "fëC!IgM-HLA ÑE!_a[yüã(LCT)K84E \YþjU`]_a&LCT (AHG-LCT)CLN °?3O@/MP!H;!Ølék¾?-N 1) ! Ï4E¤Ñ?-O6@1M 4) !±ê"î k¶Ó(platelet transfusion refractoriness#PTR) FDw$ß! ,²ÚCE¯&7P>6B1<;" :D;JÏ4DÇ?E! HLA ÑVT_$Za UC8!non-cytotoxic HLA ÑD°D;J C!LCT ûCn/!Monoclonal antibody-specific immobilization of platelet antigens (MAIPA)! ) * IgM } HLA T^V I ÑD±ê"îk¶ÓFDw$ %PTR u§C05OþjU`]_aT^Võ HLA Ñ'¾) Äà í 1) 3) {e ý 2) ÐÛ Áø 3) ÔÛ Õ 1) ±³ Àx 1) ô+ ù 1) {ÿ | 1) ½m ¬ 1) » © 1) ÉÎ 3) òÞ ó 3) !Î Èð 1) 1) ×!Æ®iWaX$ 2) S_a[Vt¥q¦ 3) ·«Ôsdsñ!ûds (ô¿ 17 å 10 20 ä¨ï) (ô¿ 17 å 12 19 ä¨() HLA T^V I Ñ2±ê"îk¶Ó(platelet transfusion refractoriness#PTR)Cw$9O6 @C=.>E¼Ï4Dù2-O2!IgM }D HLA T^V I Ñ(IgM-HLA Ñ)D PTR FDw $C=.>DùEG@RAB.":6?! PTR 121 ¹DÝ~öÍÂD HLA ÑVT_$Z aUQ!¢¾*Q%.; Mixed passive hemagglutination assay (M-MPHA)û!Flow cytometric reagents for detection of panel-reactive antibody against HLA Class I antigens (FlowPRA)û!Anti- human immunoglobulin lymphocyte cytotoxity test (AHG-LCT)ûCLN.! IgM-HLA ÑD PTR FDw$C=.>E!" 24 ¡vD÷Á±êËn¼(CCI24hours)CLO±ê"p1MºÌ 8;":D~p! M-MPHA ûCLN 121 ´-Ö 48 ´-1M IgM-HLA Ñ2°7P;"fú! Flow- PRA ûCLN°?3; IgM-HLA ÑE!:PM 48 -Ö 35 -! AHG-LCT û?E 20 -DI?-< ;"±ê"pE! IgM-HLA ÑQö#9O! 48 ´-Ö 7 ´- 74 "C0.>çÙ?3;" IgM- HLA ÑDâc¾CÒk9OQ ;B."?E!CCI24hours 2 19.7*4.7 (+10 9 ! L)Q£8" pQáO6@2?3;2!Òk9OQ ="?E!CCI24hours 2 2.0*1.9 (+10 9 ! L)Q£8" pQáMPB1<;"PTR u§CìÜCÍ9O IgM-HLA ÑE!PTR DgCBO@/M P!:Dè¼bµE AHG-LCT ûCLN°?3B1<;"M-MPHA Q HLA ÑVT_$ZaU! ±ê"DDC%.O6@?!PTR ´-DgrÅ@"pDµC?3Oo æ¾2-O" IgM-HLA Ñ! IgG-HLA Ñ!±ê"îk¶Ó(PTR)!¢¾*¨¸Æy z-û(M-MPHA)!FlowPRA Japanese Journal of Transfusion Medicine, Vol. 52. No. 3 52 (3)#405%413, 2006
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IgM HLA I NOP NQIRST U f gh i HLA J

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Page 1: IgM HLA I NOP NQIRST U f gh i HLA J

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����Ig����������� ��� !"IgM# HLA� I���IgM-HLA���� HLA� I��$� 38%71&'(��)*���+,���1�%3�-./�"IgM-HLA���"��0123456�LCT�78���9:�������;LCT�AHG-LCT��<!=

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HLA� I���NOP�NQIRS�platelet transfusion refractoriness�PTR��U���)*�����©K� ��� ��"IgM# HLA� I���IgM-HLA��� PTRT U����� ���ª*«¬[�-])?"PTR�� 121| ­®�'N� HLA����ab��¯"°J��¯��EMixed passive hemagglutination assay�M-MPHA�d"Flow cytometricreagents for detection of panel-reactive antibody against HLA Class I antigens�FlowPRA�d"Anti-human immunoglobulin lymphocyte cytotoxity test�AHG-LCT�d�<!±�"IgM-HLA�� PTRT U������"�N 24²³´ µsNOP¶e©�CCI24hours��<�NOP�N·¸�C¹º8E-] ®¸"M-MPHAd�<! 121» ¼ 48» �C IgM-HLA���=>+,E-.½"Flow-PRAd�<!=>?@E IgM-HLA���"],C 48 ¼ 35 "AHG-LCTd?� 20 ¾? \E-NOP�N·¸�"IgM-HLA��¯����"48» ¼ 7» 74�N�g��¿À?@E-IgM-HLA�� ÁÂJ�ÃI���įÅE[��N?�"CCI24hours� 19.7Æ4.7�Ç109�L�̄ È8�N·¸¯É�)*�?@E�"ÃI���įÅ��N?�"CCI24hours� 2.0Æ1.9�Ç109�L�̄ È8�N·¸¯ÉC,[�\E-PTR���ÊËÌ�'(�� IgM-HLA���"PTR ÄÍ�[�*ABC,"] ΩÏÐ� AHG-LCTd�<!=>?@[�\E-M-MPHA¯ HLA����ab��"NOP�N c ÑÒ56����)*?"PTR» ÄÍÓÔ*�N·¸ ÕÐ�Ö×?@�ØÙJ� �-

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Japanese Journal of Transfusion Medicine, Vol. 52. No. 3 52�3��405f413, 2006

Page 2: IgM HLA I NOP NQIRST U f gh i HLA J

Lymphocyte immunofluorescence test�LIFT��Flow Cytometric Reagents for Detection of Panel-Reactive antibody against HLA Class I antigens�FlowPRA�������� ��IgG��HLA��� I���IgG-HLA�������������IgM-HLA��������� ���5��� �Miller!�Godeaus!��IgM-HLA��

� PTR"�#$�%&'()�1�2��*+,-!��IgM-HLA-A24��./0 PTR1234�+6��56�IgM-HLA��7 PTR�89�� :;

#$� �0%&'��PTR.#$<0 IgM-HLA���=;7 AHG-LCT>���>?��@�7A!B.�C+�>34<0�

� �1���2002D 4EB! 2005D 3E*>� 3DF>�

G-HI�JKL#B! PTR�89MA�+N��OPQ7RC+ 12112�S' 49�T' 72��UVWXYZ.[� �HLA���HPA����\]^_`aC+�2�HLA���bcd/efg]� HLA��� Ihij_`

��klmnopid/eqrsopi���LCT7�./taC+�3��� ����1�HLA��12uv� O�\_wx�Yyz����{o

IgM���|}'~��!e.�{o IgG���|}'~���<0Mixed passive hemag-glutination assay�IgM-M-MPHA�IgG-M-MPHA�8��10��FlowPRA11��AHG-LCT12�� 4 ./t����\]^_`aC+�*+�����\]^_`�X�B!�12��.��'��.����8�[w���+.����IgM-M-MPHA�IgG-M-MPHA�AHG-LCT�3./0����\]^_`aC+�IgM-M-MPHA.d�0�|����|�F

��AHG-LCT�� 8�� IgM� HLA-A2���� ��������37�60���+�

FlowPRA� ¡]¢io£o\]�FCM¤FACSCalibur¤Becton Dickinson & Co. , Sunny-vale�CA����+������� �FITC-conjugated goat F�ab¥�2 anti-human IgM�Bio-source�CA¤IgM-FlowPRA�� FITC-conjugatedgoat F�ab¥�2 anti-human IgG�Biosource�CA¤IgG-FlowPRA����IgM-HLA��� IgG-HLA��¦§.��\]^_`�+�2�HPA��HPA-1a�2a�2b�3a�3b�4a�4b�5a�5b�

6a�6b�Naka�8¨©�+ 12uv� O�Yyz�¡¡ª_«¬��IgM-M-MPHA�IgG-M-MPHA./0��\]^_`aC+�4�HLA������HLA-PC��������

IgM-M-MPHA�IgG-M-MPHA�AHG-LCT��+�5�!�"#�$%­Y 24�F�� CCI�®¯Yyz°±²�³

��´./tµN¶��+�CCI24hours��CCI�109�L�·¸­Y�Yyz²�109�L�¹­YºYyz²�109�L�»¼�½¾¿�m2�À­YYyz²�1011�*+�IgM-HLA��7VÁ�+12.[�

��ÂÃ.ÄB�Åt�­Y.��!Æ+YyzsÇ�PCs�� HLA��È� PCs./0­YÉ�ÊË�IgM-HLA�����'.�Ì<0�8�[ PCs7­YÄÆ+12� CCI24hours���Ì<0�8�+�� PCs7­YÄÆ+12�CCI24hoursÍÎ���+�

& #1�IgM-M-MPHA'()�*+�',37�60�*+� 37�90���|��./t�

32�ÏÐ*>� HLA-A2����>?+7�4��22�>��ÈÆÑÆ 4��8�ÏÐ*>�HLA-A2���B��>?�BC+�Table 1��2��� ����IgM-M-MPHA./t 12112Ò 481 2

�39.7Ó�B! IgM-HLA��7��ÄÆ�È�ÔÕ 2512>� IgG-M-MPHA./t IgG-HLA�����ÄÆ+�Table 2��@Æ! 482Ò�IgM-

406 Japanese Journal of Transfusion Medicine, Vol. 52. No. 3

Page 3: IgM HLA I NOP NQIRST U f gh i HLA J

Table 1 Optimum conditions for the IgM-M-

MPHA screening test using IgM anti-HLA-A2 se-

rum

Serum titrationNegative control

MinutesTemperature1:321:161:81:4

(-)(-)(-)(-)(-)30 4℃

(-)(-)(-)(W)(-)60

(-)(-)(-)(W)(-)3022℃

(-)(-)(W)(2+)(-)60

(-)(-)(W)(2+)(-)30

37℃ (W)(2+)(2+)(2+)(-)60

(W)(2+)(2+)(2+)(-)90

Table 2 Comparison of IgM-HLA antibody detection in 121 sera samples from PTR patients

Number detected by other methods compared to the method at left

Numberdetected

MethodAHG-LCT

FlowPRAM-MPHA

IgG-IgM- & IgG-IgM-IgG-IgM- & IgG-IgM-

2083230252348IgM-M-MPHA

1803230231235IgM-FlowPRA

FlowPRA����� 3��IgM-FlowPRA��IgG-FlowPRA���� 32��IgG-FlowPRA����� 8��� ��IgM-FlowPRA����IgM-M-MPHA�������� 48�� 13�� IgM-HLA��������� ����IgM-FlowPRA�������� 35�� IgM-HLA���� !�IgM-M-MPHA������"#������$%�AHG-LCT����IgM-M-MPHA�������� 48��&'�20��IgM-HLA��(������� ��IgM-M-MPHA�)�� IgM-FlowPRA���

��(*�+�����,-. IgM-HLA�����(�IgG-M-MPHA�)�� IgG-FlowPRA�����(*�+�����,-. IgG-HLA������"#���/0123(� HLA����4��IgM-HLA������� 8�5967�IgM-HLA��8IgG-HLA����� 40�54367�IgG-HLA������� 45�54867�� �5Table 37�IgM-M-MPHA������IgG-M-MPHA��

9�� 23:���AHG-LCT���;�HLA-A2�<=��!>�:� A22.?* 12:�@>!�IgM-M-MPHA�.A>"#���#�)�<=�"#������ � HLA���BC�.<=�"#�����5Table 47�)��#�D 13:�� IgM-M-MPHA��"��EF��:� A1.?��GHI./JJKLMN�"#���O!9�P(��M-MPHA����IgM-HLA��� IgG-HLA

�������� 25:�� 13:�@>!�IgM-HLA��� IgG-HLA���BC�.Q�R�<=���5Table 57�IgM-HLA��� IgG-HLA���BC��<S:�� 5:��BC��O*C�":�� 7:��$T�C�":�� 1:��� ��IgM-HLA��� IgG-HLA���BC��<S:��UVW� 2X3�� ���BC��C�":���O!�V��� ��IgMY�IgG-M-MPHA��O!���EF��GHI./JJKLMN�"#���9�P(��3�����IgM-M-MPHA����IgM-HLA���BC

��<=��� 26:�� 7:�� PCsZG@>!�IgM-HLA���BC�[F�"�\9� PCs��[F�"�\�� PCs�ZG]^.�_���5Table 67�IgM-HLA���BC�[F�"�\9�� PCs���CCI24hours� 19.7`4.75a109�L7.b(ZG]^.c"#�������IgM-HLA���BC�[F�"�\���PCs���CCI24hours� 2.0`1.95a109�L7.b(ZG]^.cD��� ����1/defLg���IgM-HLA-B5

Cross Reactive Group Antigen5CREG7����

hiZGjklm n52o n 3p 407

Page 4: IgM HLA I NOP NQIRST U f gh i HLA J

Table 3 Summary of the estimated immunoglobulin classes of 93 HLA antibodies detected in 121 sera samples from PTR patients

FlowPRAM-MPHANumber ofreaction patternsNumber(%)Ig class of

HLA antibodies IgG-IgM-IgG-IgM-

(-)(-)(-)(+) 58(9)IgM

(-)(+)(-)(+) 3

(+)(+)(-)(+) 9

40(43)IgM+IgG(+)(-)(-)(+) 6(+)(-)(+)(+) 2(+)(+)(+)(+)23

(+)(-)(+)(-)3845(48)IgG

(+)(-)(-)(-) 7

93(100)Total

Table 4 Specificities of IgM-HLA antibodies positive on IgM-MPHA and negative on IgG-M-MPHA

SpecificityAHG-LCT

FlowPRAM-MPHAPatient HLA type

GenderBlood Type

Patient I.D. IgG-IgM-

IgG-IgM-

NTT‡NT†CwBA

(Anti-HPA3b+anti-HLA-A2)0/20(-)(-)0/2020/2020/20*52511124MO+A1

Anti-HLA-B13+B60+B610/20(-)(-)0/200/2010/20 9 154 2MB+A3

Anti-HLA-A31+A330/20(-)(-)0/200/206/2010526124 2FA+A4

Anti-HLA-B7+B48+B600/20(-)(-)0/200/205/20 4 962353126FA+A5

Anti-HLA-B51+B520/20(-)(+)0/200/208/20 94835 2FA+A6

Anti-HLA-Cw30/20(+)(-)0/200/2012/2052483124FO+A9

Anti-HLA-A26+A31+A330/20(+)(-)0/200/2010/20 9 735 711 1MA+A10

Anti-HLA-A2+B600/20(+)(-)0/200/2012/2010 155583311MA+A11

Anti-HLA-B13+B60+B610/20(+)(+)0/200/2010/20 862522624FB+A19

Anti-HLA-B48+B60+B610/20(+)(+)0/200/205/20 1545224 2FA+A20

Anti-HLA-A26+A330/20(+)(+)0/200/206/20 9 1556124 2FA+A21

Anti-HLA-A210/20(+)(+)0/200/2010/20 152511124MO+A22

Anti-HLA-B13+B60+B610/20(+)(+)0/200/2010/20 8 1463524 2FB+A23

†:M-MPHA with chloroquine-untreated platelets‡:M-MPHA with chloroquine-treated platelets*:Number of positive panels/Number of tested panels

���������� ���������A6����IgG-M-MPHA�� AHG-LCT�������IgM-M-MPHA�������� 3� PCs��!"��#�� CCI24hours� 0�����$%�&'�()*��������� 3� PCs��!" CCI24hours�+�, ��22.7�19.6�27.8-.109�L/�����$%�&'��-Table 7/0

� �1�IgM-HLA�������IgM-HLA12 ��34567��Miller

'"�89:;<=�>��1?@ABC����� 4D�E4!F*��GH���I�1/�JK�LM�>�� IgM-M-MPHA�!"�NO�P*� 3QR 56 ST�37D���E���U6�V)*�0�)���W>�� IgM-HLA12� HLA-A212 1QRXY!FIZ�)'��'[\ IgM-HLA12�>���W

408 Japanese Journal of Transfusion Medicine, Vol. 52. No. 3

Page 5: IgM HLA I NOP NQIRST U f gh i HLA J

Table 5 Specificities of IgM- and IgG-HLA antibodies positive on IgM- and IgG-M-MPHA

Screening methodPatient HLA type

Gen-der

Blood Type

Patient I.D.

FlowPRAAHG-LCTIgG-M-MPHAIgM-M-MPHA

IgGIgMSpecificitiesP/NSpecificitiesTNT

SpecificitiesT‡NT†

CwBAP/NP/NP/NP/N*

(+)(+)0/14B51+B520/144/14B51+B520/144/147 1556724 2MO+B10

(+)(+)0/12A260/124/12A260/124/12 7523924 2FB+B22

(+)(-)0/12A20/126/12A20/126/1252511124MO+B25

(+)(+)A26/12A20/126/12A20/126/121061522624FO+B7

(+)(+)B48+B60+B616/20B48+B60+B610/206/20B48+B60+B610/206/20 66237 2 1FA+B16

(+)(+)0/20B35+B510/206/20B600/204/201061443326FB+B15

(+)(+)0/16A330/164/16B440/164/16 1545224 2FA+B21

(+)(+)0/14B51+B520/144/14B600/143/149 1556124 2FO+B23

(+)(+)B13+B60+B616/20B13+B60+B610/206/20B51+B520/206/20 1541124FB+B9

(+)(+)B13+B60+B61+Cw3

13/20B13+B60+B61+Cw3

0/2013/20A240/207/20 7623926 2FO+B24

(+)(+)A11+B7+B48+B60

12/20A110/204/20B7+B48+B600/208/2010614426 2FO+B6

(+)(-)A24+B4414/20B440/206/20A240/208/20 9355131 2FB+B14

(+)(+)B7+B546/20B7+B540/206/20B540/203/20 1465224 2FO+B19

†:M-MPHA with chloroquine-untreated platelets‡:M-MPHA with chloroquine-treated platelets*:Number of positive panels/Number of tested panels

Table 6 Response(mean±SD)to platelet transfusion in patients with IgM HLA antibodies

PCs with corresponding antigensPCs without corresponding

antigensSpecificities ofIgM HLA antibodies

Patient HLA typeBlood Group

Patient I.D.

CCI24hours(×109/L)numberCCI24hours(×109/L)Number*CwBA

0222.7±4.3 6Anti-HLA-B13+B60+B619 154 2B+A3

1.3±1.9320.2±2.9 8Anti-HLA-A31+A3310526124 2A+A4

0.6±0.6225.2±6.1 5Anti-HLA-B7+B48+B604 962353126A+A5

0.5±1.9621.9±4.124Anti-HLA-B51+B52 94835 2A+A6

0.7±0.513 14.2±3.215Anti-HLA-B51+B52 1541124B+B9

5.4±4.7824.9±4.110Anti-HLA-B609 1556124 2O+B23

0.7±1.4416.0±3.9 6Anti-HLA-A24 7623926 2O+B24

2.0±1.938 19.7±4.774Total

*:Number of transfusions

��������2��������IgM-HLA�� �AHG-LCT��������

�������������������AHG-LCT�� IgM-M-MPHA������� 48� 20�!"��#$����%"&�IgG-HLA�����'�� FlowPRA��()*+�,-�M-MPHA� FCM./�� LIFT

��01+�234���135!"!�IgM-HLA�����'��� IgM-FlowPRA�� �IgM-M-MPHA������� 48� 35�������67�8&�HLA9:; I��� Ig9:;<��=+�>

�� �Miller�15�Godeau�25�Laundy�35����IgM���?@A�B�C� 28D�46D�23D�IgM��EIgG���)�@A�B�C�

FGHIJKLM N52O N 3P 409

Page 6: IgM HLA I NOP NQIRST U f gh i HLA J

Table 7 Response to platelet transfusion in patient A6 with IgM-HLA-B5CREG antibodies

CCI24hours(×109/L)

Crossmatch-testHLA-CwHLA-BHLA-A

Blood type

AHG-LCT

M-MPHA

IgG-IgM-8948352A+Patient

NTT‡NT†

0(-)(-)(-)(+)848512A+6907

Donor

0(-)(-)(-)(+)512A+4390

0(-)(-)(-)(+)848512A+2994

22.7(-)(-)(-)(-)9848352A+9417

19.6(-)(-)(-)(-)9352AB+1093

27.8(-)(-)(-)(-)960352O+1170

†:M-MPHA with chloroquine-untreated platelets‡:M-MPHA with chloroquine-treated platelets

36��8��15��IgG���������28��46��62� �������������������IgM������ 8��9���IgM���IgG�� ��� 40��43���IgG������ 45��48��!"#�IgM��$%�"��� IgG��&'() IgM-HLA��52��*+!,-��)�$%� IgM�� 9� .����/012����IgG-HLA��,-��,-34�*� FlowPRA5&6�)7 �8� 9:;���<)Miller;1���HLA=>? I��� 7�� IgM�IgA��@AB�7 ��C����DEF����� IgA�HLA=>? I���G���,H&I:2J()�KLM&=NNOPQRC� S�TC2�

IgG-HLA���@AU;�����IgM-HLA������ �KLM&=NNOPQRC)V�WXS�TC2� HLA��@AC)�Y� A1!��ZP[\�8�]^_`�8#HPA-3b��ab���HPA-3bS�KLM&6�)?=ZcdPe�8# HLA-A2���@Afb��)�=NNOPQRV� HLA-A2���gB�WX�S�TC2J()�hcijkl��mn?=ZcdPe������6�) 20[op� HPA-3bS�[opq� HLA-A2�r��!"())s�=NNOPQRV q[op��WX&lC����ab!t2

J()�uv�Y�������HLA���HPA���wx�=NNOPQRKLM&6��7 �y6 9:;���7�8z2{C�Y� @AB�)s�=NNOPQRKLM�WX|}! HLA���HPA���wx&~z0t!�2� 9:;���IgM-HLA�� IgG-HLA�� �,-

����������ab!t) 13Y������IgM-HLA�� IgG-HLA������a�Y��qv�2�Y��m��2�Y��3�@AC)��������������IgM�����������V IgG�?���B��m�� 9:;����7 J;��V�IgM-HLA������ Cv� IgG-HLA����?����G���Y�� �����T&�z7 �8(��3�����G��,H&I:���"� 9:��3�����KLM�K����b���K 1� V�16¡

24� V�KLM¢I£�/¤& CCI Cv��recovery�8#~z7 m��!"�14��Bishop;���KV 1�  20� �KLM¢I£&/¤C�¥¦����KLM¢I£�§¨&©:�ª«�¬�­�2v�CCI20hours� CCI1hour�® 64��r¯0.67�P°0.001� ��C���15����±��¬�8� PTR&²Cv³´B�)s���CCI1hour CCI24hours���&~z��

410 Japanese Journal of Transfusion Medicine, Vol. 52. No. 3

Page 7: IgM HLA I NOP NQIRST U f gh i HLA J

������������ ��HLA-PC��������������������������� 1� �!��"#�$%&'()(�*+,��-./0('� CCI24hours123��$4)�5+�6��789PTR:;4�&�<23�=>+,/��?)��@ABC:�D) E���:;4��FBGHIJBK IgMFL��MN78/0

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4uIwaki Y, Lau M, Terasaki PI¼Successful trans-

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plants across T warm-positive cross-matches dueto IgM antibodies. Clin Transplant, 2�81�84,1988.

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HLA class I and class II antibodies screeningwith flow cytometry. Hum Immunol, 59�313�322, 1998.

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412 Japanese Journal of Transfusion Medicine, Vol. 52. No. 3

Page 9: IgM HLA I NOP NQIRST U f gh i HLA J

PLATELET TRANSFUSION REFRACTORINESS ASSOCIATEDWITH IGM-HLA-CLASS I ANTIBODIES

�IMMUNOGLOBULIN CLASS HETEROGENEITY OF HLA CLASS IANTIBODIES IN PTR PATIENTS

Satoshi Saito1�3�, Toyohiro Tamai2�, Masao Ota3�, Satoshi Ota1�, Masayoshi Komatsu1�,Morito Hirabayashi1�, Keiko Tamaki1�, Hideyuki Seshimo1�, Hisashi Shimizu1�,

Hideki Asamura3�, Hirofumi Fukushima3�and Setsuo Nomura1�1�Japanese Red Cross Nagano Blood Center

2�Diagnostic Systems Department, Olympus Corporation3�Department of Legal Medicine, Shinshu University School of Medicine

Although HLA-class I antibodies�Abs�are considered one of the major obstacles in posttransfu-sion platelet increments for platelet transfusion refractory�PTR�patients, whether IgM-HLA-classI Abs are associated with accelerated platelet destruction and transfusion failure remains unclear. Ac-cordingly, we assessed the frequency of IgM-HLA-class I Abs development in 121 PTR patients usingthe magnetic-mixed passive hemagglutination assay�M-MPHA�, flow cytometric reagents for detec-tion of panel-reactive antibody against HLA Class I antigens�FlowPRA�and the anti-human immu-noglobulin lymphocyte cytotoxity test�AHG-LCT�. The relationship between IgM-HLA-class I Absand PTR was assessed by calculating 24 h post-transfusion corrected platelet count increments�CCI24hours�. Result showed that IgM-HLA-class I Abs were detected in 48 of 121 patients using the M-MPHA. Only 20 and 35 of these 48 IgM-HLA-class I Abs were detected using the AHG-LCT andFlowPRA respectively. In 7 of 48 patients positive for IgM-HLA-class I Abs, 74 transfusions withoutcorresponding antigen for specificities of IgM-HLA-class I Abs had CCI24hours of 19.7�4.7��109�L��Incontrast, 38 transfusions with corresponding antigens for specificities of the same Abs had CCI24hours of2.0�1.9��109�L�. Collectively, IgM-HLA-class I Abs were detected in 39.7� of PTR patients, andwere considered to play a role in mediating refractoriness to platelet transfusions. In 28 of 48 cases,IgM-HLA-class I Abs could not be detected by the AHG-LCT. Detection of IgM-HLA-class I Abs us-ing the M-MPHA may clarify the as yet unknown mechanism of the pathogenesis of PTR.

IgM-HLA-class I antibodies, IgG-HLA-class I antibodies, Platelet transfusion refractori-ness�PTR�, Magnetic�mixed passive hemagglutination assay�M-MPHA�Flow Cy-tometric Reagents for Detection of Panel-reactive antibody against HLA Class I antigens�FlowPRA�

Key words

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