抗-CD38单克隆抗体对输血前检测试验的干扰及其处理措施  

Interference of CD38 monoclonal antibody in pre-transfusion testing and treatments used to eliminate such interference

作　　者：骆宏[1] 王贞[1] 廖志坚[1] 罗广平[1] 汪传喜[1] 付涌水[1] LUO Hong;WANG Zhen;LIAO Zhijian;LUO Guangping;WANG Chuanxi;FU Yongshui(Guangzhou Blood Center,the Key Medical Laboratory of Guangzhou,Guangzhou 510095,China)

机构地区：[1]广州血液中心广州市医学(血液安全)重点实验室,广东广州510095

出　　处：《中国输血杂志》2020年第3期272-275,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨抗-CD38单克隆抗体对输血前检测实验的干扰及其处理措施。方法收集2名接受抗-CD38单克隆抗体治疗的多发性骨髓瘤患者血样,分别进行ABO和Rh血型抗原定型、直接抗人球蛋白实验、不规则抗体筛选和鉴定、交叉配血实验;将不规则抗体筛选用试剂红细胞、抗体鉴定谱细胞、交叉配血用的献血者红细胞、平行对照用的O型K(+)E(+)红细胞与0.2 mol/L的DTT按照红细胞:DTT为1∶4的比例进行混合后,放入37℃水浴箱水浴30 min;再用上述DTT处理后的红细胞分别对患者血浆进行不规则抗体筛选实验、抗体鉴定实验和交叉配血实验。结果2名患者的ABO和Rh血型均为O,CCDee;直接抗人球蛋白实验分别为阴性和阳性;未经DTT处理的抗体筛选红细胞、抗体鉴定细胞和献血者红细胞与患者血浆反应均呈阳性;DTT处理后的抗体筛选红细胞、抗体鉴定细胞和献血者红细胞与患者血浆反应均呈阴性;平行对照用的O型K(+)E(+)红细胞经DTT处理后转变为O型K(-)E(+)。结论抗-CD38单克隆抗体治疗多发性骨髓瘤,可干扰患者的血型血清学实验,用0.2 mol/L的DTT灭活红细胞表面的CD38抗原后,可以较好的去除这种干扰。Objective To discuss the interference of CD38 monoclonal antibodies in pre-transfusion testing and treatments used to eliminate such interference.Methods Blood samples of two patients receiving anti-CD38 monoclonal antibody for the treatment of multiple myeloma were collected to perform rountine serologic tests including ABO and Rh typing,direct anti-human globulin test,irregular antibody screening,antibody identification and crossmatch in gel card.Reagent cells such as irregular antibody screening cells,antibody identification cells and donor′s RBCs were treated with 0.2 mol/L DTT(one volume hematocrit RBC mixed with four volumes DTT and then incubated at 37℃for 30 min).O group RBC with K(+)E(+)was used as control RBC to verify whether DTT treatment had denatured the CD38 antigen successfully.Post-treated reagent cells were used to perform irregular antibody screening and antibody identification,donor′s RBCs were used to carry out crossmatching with gel card.Results ABO and Rh group in both patients were O,DCCee;direct anti-human globulin test in one patient showed negative while the other showed positive.Positive results were observed in antibody screening,antibody identification and crossmatching when using DTT-untreated reagent cells and donor′s RBCs to react with patients′plasma.On the contrary,negative results could be observed in tests using reagent cells and donor′s RBCs treated with DTT.K antigen of control RBC was negative after it had been treated with DTT,while E antigen kept positive consistently.Conclusion CD38 monoclonal antibody used for treating multiple myeloma can interfere patient′s pre-transfusion testing,using 0.2 mol/L dithiothreitol to disrupt the CD38 antigen on RBC surface could be a first-line approach to eliminate such interference.

关 键 词：红细胞 输血 抗-CD38单克隆抗体 多发性骨髓瘤 二硫苏糖醇 

分 类 号：R392.7[医药卫生—免疫学] R446.61[医药卫生—基础医学]