Book Review

Immunobiology of Transfusion Medicine

N Engl J Med 1994; 330:1626June 2, 1994

Article

Immunobiology of Transfusion Medicine
Edited by George Garratty. 712 pp. New York, Marcel Dekker, 1993. $195. ISBN: 0-8247-9122-3

Transfusion medicine has undergone many changes over the century since its inception in the laboratory of Karl Landsteiner, and so have textbooks on the subject. Discoveries of numerous red-cell antigens and associated antibodies made blood-group serology the core of many of the earliest reference books. In recent years, a sharper clinical focus has emerged; information about the proper preparation and judicious use of blood components has become critical to medical practice and thus to textbooks. Now the results of research into the biochemistry and genetics of blood groups, and laboratory clues to the effects of blood transfusions on the immune system, have introduced a new view of transfusion medicine. The need to reflect such material in reference books is growing, and George Garratty's Immunobiology of Transfusion Medicine is one of the first to tackle this task.

The beauty of this book is the fresh light it sheds on old transfusion issues. Its 23 chapters are grouped into five sections on the immunochemistry of blood-group antigens, the relation of blood groups to diseases, red-cell antibodies, immune destruction of blood cells, and the effect of transfusion on the immune response. Many of the chapters are masterly reviews by leading researchers. A stellar example is the chapter on phosphatidylinositol glycan-linked proteins, which provides a virtually seamless bridge between established serologic data on Cartwright and related blood-group antigens and new biochemical and genetic discoveries, especially in relation to the syndrome of paroxysmal nocturnal hemoglobinuria. The chapter on hemolytic disease of the newborn, a comprehensive review by an internationally respected practitioner in this area, merges research hypotheses and data on alloimmunization to red-cell antigens with clinical approaches for the prevention and management of this problem.

The topics of some chapters have never been addressed as thoroughly and directly in a transfusion medicine-oriented textbook, in particular, the chapters on cellular immunoassays useful in the prediction of the clinical importance of red-cell antibodies and the pathophysiology of macrophage-mediated red-cell destruction. Even the more clinically oriented chapters have been refashioned and invigorated with recently published research. For example, although Dr. Garratty has written many previous reviews in his area of interest, the drug- and autoimmune-mediated hemolytic anemias, the two chapters in this book benefit from the incorporation of many references to works published between 1990 and 1992.

My main disappointment with this book was the very slim section devoted to the effect of transfusion on the immune response, which contains only two chapters (on transfusion-associated graft-versus-host disease and retroviral infections). One or more chapters devoted to the immunosuppressive effects of transfusion in relation to graft rejection and infection would have made important and fascinating reading. In addition, multiple authorship has resulted in some not unexpected variability in writing style; in a number of chapters, a small but repetitive annoyance was the presence of incomplete citations among the references. I suspect that these two problems were the price paid for swift publication.

Future editions of Dr. Garratty's book are almost imperative, given the rapid pace of developments in this field. Furthermore, the book is likely to be only one of many new works that strive to reflect the changes in our understanding of the effects of transfusion. Even so, this book is a fine investment for those who want to stay as current in transfusion medicine as a textbook allows.

Margot S. Kruskall, M.D.
Beth Israel Hospital, Boston, MA 02215