Aspek Imunologi

Transfusi Darah
Umi S Intansari
Fakultas Kedokteran UGM/
RSUP Dr. Sardjito
Beneficial and harmful immune responses
Immunological Complication of Blood Transfusion

• Hemolytic transfusion reaction

• Febrile, non-hemolytic transfusion reaction
Acute/ • Urticarial reaction
immediate • Anaphylatic reaction
• Transfusion-Related Acute Lung Injury

• Delayed hemolytic transfusion

• Post-transfusion purpura
Delayed • Graft-versus-host disease
• Immunological refractoriness to platelet
transfusion
 Blood Transfusion and the Immune System

Transfusion Recognition Secondar

primary
y

Immune
Presentation response

Humoral Cellular

Immune
Antibodies
cells
Antigen
Components of the immune system
White blood cells
Lymphoid organ
Body tissues
effector sites for immune responses
Key molecules
Antigens: molecules that recognized by immune system
Receptors: Pattern, BCR, TCR
MHC/ HLA (Human Leucocyte Antgen)
Soluble mediator: ab, complement, cytokine, chemokine
 Recognition
• Different pathogen/ antigen require different
response mechanism for detection, recognition
& destroying them
• Receptors:
 Recognition
Antigen presenting cells (APCs)

Dendritic cells catch antigen in the periphery and present it in lymph nodes
Macrophages catch extracelular pathogen
B cells catch soluble antigens in the circulation and presents it in lymph nodes
 Antigen Presentation

Phagocytes internalize
pathogens, degrade
them in endosomes
and present the
peptides on MHC II

B cells bind antigens on

the BCR, degrade them
in vesicles and present
the peptides also on
MHC II
Recognition
TCR BCR

Dendritic cells stimulate T B cells need help from activated T

cells for their activation
cells by the presentation of
antigen → APC
Molecular
Basis of Direct
Recognition
Erythrocyte antigen
Antibody

IgM is the first to produced before

isotype switching

low affinity but compensate by

pentameric form
 immune response

Step of immune response

The response to an initial infection occurs in three phases
Innate & adaptive immune responses
Figure 9-19 part 1 of 2
Complement
Three pathway of complement system
Effector action of complement
Phagocytosis is activate by C5a via CR1
Membrane-attack complex formation
Antibody function

Fc role

so far FAB determine specific function

of antibody
But, Fc also plays role
Antibody function : Fc role

1. macrophage ingestion

Figure 9-31

2. Ig: Ag:C complex in complement

activation
 The course of typical antibody response

B cells response to antigenic

stimulation:

1. Proliferation and
maturation: formation of
plasma cells
2. Secretion of antibodies

Repeated stimulation
with the same antigen
increases the antibody
concentration to that
antigen

Immunological memory
Ability of immune system to make second response to same ag more effective & efficiently
 Application in Transfusion
Medicine

Agglutination
reaction

Blood type

Cross match
Immune-mediated Red Cell Destruction
 Red cell alloimmunization
• The mechanism of red cell alloimmunization is not well
understood.
Allogeneic RBC
tranfused,degraded

Ab Blood
production circulation

Uptake by APCs,
B cells, presented
to T cell
Recognition of Alloantigens
Direct Presentation
Recognition of an intact MHC molecule displayed by donor APC in the
graft
Basically, self MHC molecule recognizes the structure of an intact
allogeneic MHC molecule
Involves both CD8+ and CD4+ T cells.
 Indirect Presentation

Donor MHC is processed and presented by recipient APC

Basically, donor MHC molecule is handled like any other
foreign antigen
Involve only CD4+ T cells.
Antigen presentation by class II MHC molecules.
Figure A-13 • Rh- mothers make anti Rh Ab when
they exposed to Rh+ fetal RBC

• Maternal IgG antibodies are

transported across the placenta to the
fetus

• IgG anti Rh coated the fetal RBC

• destroyed by phagocytic cells

• Hemolytic anemia
38
 Hemolytic Transfusio Reaction
Acute
• Occur 24 hours of transfusion
• Intravascular:
• Most common: ABO incompatibility
• Involve Ab that strongly activate Comp
• Extravascular:
• RBC’s coated with recipient’s Ab/ Compl
• IgG-Fc/ Compl are recognized by MΦ receptors

Delayed
• 1 – 14 days after transfusion
• Ab are present in low amounts
Febrile non-hemolytic transfusion
reaction (FNHTR)

• White blood cell incompatibility

• Most common TR
• The cause:
• patients’s preformed ab attacking transfused
WBC
• WBCs release cytokine during storage
• Leucodepletion reduce the risk
Post Transfusion Purpura

• Thrombocytopenia after platelet transfusion

• Recipient’s platelet-specific ab react with donor
platelets

Allergic Reaction: IgE anti-allergen ab

• More common in patients who have allergic history

• Existing IgE Ab bind to Ag from recipient’s blood
• Recipient’s Ab bind to Ag in transfused blood

Anaphylaxis
TRALI
• Donor anti-leukocyte antibodies attack recipient’s
WBC
• WBC release inflammatory mediators increase
lung’s capillary permeability

Transfusion associated graft-versus-

host disease (TA-GVD)
• Transfused blood cells (the graft) attack patient’s cells
(the host)
• More common in immunocompromised patients
(immune system fail to eliminate transfused cells
• Surviving donor T cell attack cells that bear HLA Ag
mechanism of HLA alloimmunization due to
leukocytes present in platelet transfusion