多发性骨髓瘤患者经达雷妥尤单抗治疗后的输血前检查及输血策略  

Pre-Transfusion Testing and Transfusion Strategy in Patients with Multiple Myeloma after Daratumumab Treatment

作　　者：方小敏[1] 郭兆旺[1] 杨军权 杨斌[1] 肖艳辉 刘岩 许美玲[3] FANG Xiao-Min;GUO Zhao-Wang;YANG Jun-Quan;Yang Bin;XIAO Yan-Hui;LIU Yan;XU Mei-Ling(Department of Experimental Medicine(Department of Laboratory,Department of Blood Transfusion),The Fifth Ajfiliated Hospital,Sun Yat-sen University,Zhuhai 519000,Guangdong Province,China;Zhuhai Besso Biotechnology Co.,Ltd.,Zhuhai 519000,Guangdong Province,China;Department of Pharmacy,The Fifth Affiliated Hospital,Sun Yat-sen University,Zhuhai 519000,Guangdong Province,China)

机构地区：[1]中山大学附属第五医院实验医学部(检验科、输血科) [2]珠海贝索生物技术有限公司 [3]中山大学附属第五医院药学部,广东珠海519000

出　　处：《中国实验血液学杂志》2021年第5期1595-1600,共6页Journal of Experimental Hematology

基　　金：广东省基础与应用基础研究基金项目(2019A1515110566)。

摘　　要：目的:探讨达雷妥尤单抗(daratumumab,Dar A)治疗后的多发性骨髓瘤患者输血前检查流程及输血策略。方法:收集中山大学附属第五医院近期收治的多发性骨髓瘤患者达雷妥尤单抗治疗前后的血标本,比较治疗前后患者的ABO/Rh血型抗原鉴定、DAT试验;比较分析0.2 mol/L二硫苏糖醇(DL-Dithiothreitol,DTT)灭活处理前后,患者抗体筛查、交叉配血的结果。结果:注射达雷妥尤单抗后患者ABO/Rh血型抗原定型未受影响;DAT试验阴性;不规则抗体筛查Ⅰ号、Ⅱ号、Ⅲ号细胞均阳性(强度1+至2+),而自身对照阴性,微柱凝胶卡法交叉配血多袋主侧均不相合,次侧均相合,用DTT溶液处理试剂红细胞和献血者红细胞后,交叉配血均相合,不规则抗体筛查阴性,平行对照用的K(+) O型红细胞经DTT处理后转为K(-) O型红细胞,E(+) O型红细胞DTT处理前后无明显变化;凝聚胺法配血主次侧均未出现凝聚,盐水法配血主次侧均相合。结论:多发性骨髓瘤患者达雷妥尤单抗治疗后血浆中残留的抗体可干扰微柱凝胶法配血结果,0.2 mol/L DTT溶液处理献血者红细胞上的CD38抗原可消除干扰;凝聚胺法和盐水法配血不受干扰。根据临床输血紧急程度选择对应的输血方案,以保障安全、及时输血。Objective:To investigate the procedure of pre-transfusion testing and transfusion strategy of patients with multiple myeloma(MM)treated by daratumumab(DarA).Methods:The blood samples of MM patients before and after DarA treatment from the Fifth Affiliated Hospital of Sun Yat-sen University were collected,and the ABO/Rh blood group antigen identification and DAT test results were compared.The results of antibody screening and cross matching of the patients before and after inactivation of red blood cells with 0.2 mol/L dithiothreitol(DTT)were compared and analyzed.Results:ABO/Rh blood group antigen typing showed no affecting in patients after treated by DarA;the result of DAT test showed negative.Irregular antibody screening showed that all the three cells(Ⅰ,ⅡandⅢ)were positive(1+~2+)and the self-control was negative.By microcolumn agglutination method,the main side of the multi-bag of blood showed no matched,while the secondary side showed all identical.After treated by DTT solution,the cross matching results in reagent red blood cells and the red blood cells of blood donors were both consistent,and the irregular antibody screening was negative.The K(+)O type erythrocytes used in parallel control were transformed into K(-)O type erythrocytes after DTT treatment.However,there was no significant changes in E(+)O type erythrocytes before and after DTT treatment.There was no condensation on the primary and secondary side of the condensed amine method.The primary and secondary sides of blood matching by saline method showed negative.Conclusion:After treated by DarA,cross matching results from microcolumn agglutination method can be interfered by the residual drug antibody in MM patients,while the interference was eliminated in the presence of 0.2 mol/L DTT solution.However,no disturbance was observed when using condensed amine method or saline method.Therefore,corresponding transfusion procedures should be selected according to the emergency degree of blood transfusion to ensure the safety and timeliness of bloo

关 键 词：多发性骨髓瘤 达雷妥尤单抗 交叉配血 输血安全 

分 类 号：R457.1[医药卫生—治疗学] R733.3[医药卫生—临床医学]