The hypothesis that some otherwise unexplained febrile reactions to blood transfusions may be caused by isoimmunization of patients against the donors' leukocytes was tested in 10 patients who needed transfusions. Five patients (group A) had previously had from 20 to 85 transfusions, had histories of repeated transfusion reactions, and had demonstrable antibodies against the specific normal leukocytes administered during this study. The other five patients (group B) had had only seven or less previous transfusions, with no histories of transfusion reactions. Group A did not experience adverse effects when the blood used for transfusion was so prepared, by centrifuging, as to remove as much as possible of the buffy layer, but all reacted with fever, typical symptoms, and characteristic laboratory findings to subsequent transfusion of the buffy coat which had been so removed. Group B did not react adversely to either fraction of the donors' blood. Immunologic evidence suggested that it was the leukocytes rather than the platelets in the buffy layer that caused the reactions. Techniques for removing the buffy coat when blood is prepared for transfusion offer a means of preventing the dangerous reactions that occur when patients, after multiple transfusions, become isoimmunized to donor leukocytes.
Brittingham TE, Chaplin H. FEBRILE TRANSFUSION REACTIONS CAUSED BY SENSITIVITY TO DONOR LEUKOCYTES AND PLATELETS. JAMA. 1957;165(7):819–825. doi:10.1001/jama.1957.02980250053013
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