恶性血液病患者抗-CD38单克隆抗体达雷木单抗治疗后配血方法探讨  

Study on the method of blood matching after treatment with Anti-CD38 monoclonal antibody Daratumab in patients with hematologic malignancies

作　　者：高晓云[1] 王新华[1] 田华[1] 贾军会[1] 邸彦辉 白宇[1] 白薇[1] 寇立舵 Gao Xiaoyun;Wang Xinhua;Tianhua;Jia Junhui;Di Yanhui;Baiyu;Baiwei;Kou Liduo(Department of Blood Transfusion,Aerospace Center Hospital,Beijing,100049,China)

机构地区：[1]航天中心医院输血科,北京100049

出　　处：《中国输血杂志》2020年第3期227-230,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨恶性血液病患者达雷木单抗(Daratumumab,DARA)治疗后合理有效的配血方法,保障患者输血安全。方法对2018年7月至2019年7月本院收治的9例恶性血液病患者DARA治疗前后进行ABO血型、Rh血型鉴定、红细胞抗体筛查及交叉配血试验,用0.2 mol/L二硫苏糖醇(DL-Dithiothreitol,DTT)灭活处理红细胞抗体筛查细胞及献血者红细胞后重复试验,排除DARA的干扰。结果9例恶性血液病患者DARA治疗前后ABO、Rh血型鉴定结果无差异,治疗前红细胞抗体筛查均阴性,治疗后均阳性,且谱细胞抗体鉴定未显示抗体特异性,患者与献血者红细胞交叉配血主次侧均凝集,配血不相合。用0.2 mol/L DTT灭活处理红细胞抗体筛查细胞及献血者红细胞后重复试验显示红细胞抗体筛查及鉴定均阴性,交叉配血主侧均阴性,次侧与灭活前患者自身对照一致,交叉配血相合,给予患者输注后复查血常规显示血红蛋白增量有效。结论0.2 mol/L DTT灭活红细胞可有效消除DARA对于配血的干扰,可作为恶性血液病患者DARA治疗后常规配血方法,可进行应用及推广。Objective To explore a reasonable blood matching method for patients with malignant hematological diseases after treatmented with Daratumumab(DARA).Methods ABO blood group,Rh blood group identification,erythrocyte antibody screening and cross matching test were performed in nine patients with malignant hematological diseases before and after DARA treatmented,and these trials were repeated after the blood cell of erythrocyte antibody and donors was inactivated with 0.2 mol/L dithiothreotol(DTT)to eliminate the interference of DARA.Results There was no difference in ABO and Rh blood group identification before and after treatmented with DARA in nine patients with malignant hematological diseases.The result of erythrocyte antibody screening were all negative before treatment,and all positive after treatment,and the panel cell erythrocyte identification did not show antibody specificity.The red blood cell cross matching between patients and blood donors were agglutinated.After the blood cell of erythrocyte antibody and donors was inactivated with 0.2 mol/L dithiothreotol(DTT),the antibody screening and identification results were all negative,and the main side of cross matching was negative,while the secondary side was same as the self-control of the patients before inactivation.Conclusion The method of inactivated red blood cells with 0.2 mol/L DTT can effectively eliminate the interference of DARA on blood matching,it can be used as a routine blood matching method for patients with malignant hematological diseases after DARA treatment.

关 键 词：恶性血液病 抗-CD38 达雷木单抗 交叉配血 

分 类 号：R457.1[医药卫生—治疗学] R714.254[医药卫生—临床医学]