Abstract

Unexpected anti-red blood cell (RBC) alloantibodies are routinely investigated in immunohematology and blood banking since their existence in pregnant women may induce haemolytic disease of the foetus and newborn, and their presence in donors may induce haemolytic transfusion reactions or hyperacute rejection in solid organ transplantation. Unexpected anti-RBC alloantibodies may target antigens of the most blood types excluding the expected antibodies targeting the ABO antigens. Their incidence in humans was originally linked to alloimmunization events such as blood transfusions, transplants, or pregnancies. But later, many findings revealed their existence in pathogenic processes such as malignancies, infections, and autoimmune diseases; and usually (but not always) associated to autoimmune haemolytic anaemia (AIHA). Nevertheless, unexpected anti-RBC autoantibodies are also occasionally found in healthy individuals in the absence of AIHA and with no history of alloimmunization or the associated pathologic processes. Hence, they are generally known as non-clinically significant, are excluded for typification and called “silent red blood cell autoantibodies (SRBCAA)”. This review highlights evidence related to genetic predisposition, molecular mimicry, immune dysregulation, and immune tolerance loss surrounding the existence of anti-RBC antibodies, describing the presence of SRBCAA as possible early witnesses of the development of autoimmune diseases.

摘要

在免疫血液学和血库中常规研究意外的抗红细胞 (RBC) 同种抗体，因为它们在孕妇中的存在可能导致胎儿和新生儿的溶血病，并且它们在供体中的存在可能导致溶血性输血反应或实体器官的超急性排斥反应移植。意外的抗红细胞同种抗体可能针对大多数血型的抗原，但预期的针对 ABO 抗原的抗体除外。它们在人类中的发病率最初与同种免疫事件有关，例如输血、移植或怀孕。但后来，许多发现揭示了它们在恶性肿瘤、感染和自身免疫性疾病等致病过程中的存在；并且通常（但不总是）与自身免疫性溶血性贫血 (AIHA) 相关。尽管如此，在没有 AIHA 且没有同种免疫病史或相关病理过程的健康个体中偶尔也会发现意外的抗红细胞自身抗体。因此，它们通常被认为具有非临床意义，被排除在外，被称为“沉默红细胞自身抗体（SRBCAA）”。本综述强调了与抗红细胞抗体存在相关的遗传易感性、分子模拟、免疫失调和免疫耐受性丧失相关的证据，将 SRBCAA 的存在描述为自身免疫性疾病发展的可能早期见证。它们通常被认为是无临床意义的，被排除在外，被称为“沉默红细胞自身抗体（SRBCAA）”。本综述强调了与抗红细胞抗体存在相关的遗传易感性、分子模拟、免疫失调和免疫耐受性丧失相关的证据，将 SRBCAA 的存在描述为自身免疫性疾病发展的可能早期见证。它们通常被认为是无临床意义的，被排除在外，被称为“沉默红细胞自身抗体（SRBCAA）”。本综述强调了与抗红细胞抗体存在相关的遗传易感性、分子模拟、免疫失调和免疫耐受性丧失相关的证据，将 SRBCAA 的存在描述为自身免疫性疾病发展的可能早期见证。