达雷妥尤单抗治疗患者检出抗-K、抗-Wr^(a)的血清学分析  

Serological analysis of anti-K and anti-Wr^(a) detected in patient treated with daratumumab:a case report

作　　者：黄娴 赵瑛 李彤彤[1] 杨扬 马蕾 解金辉 种靖慧 HUANG Xian;ZHAO Ying;LI Tongtong;YANG Yang;MA Lei;JIE Jinhui;ZHONG Jinghui(Immunohematology Laboratory,Tianjin Blood Center,Tianjin 300110,China)

机构地区：[1]天津市血液中心,天津300110

出　　处：《中国输血杂志》2024年第4期466-470,共5页Chinese Journal of Blood Transfusion

基　　金：天津市卫生健康委员会科技项目(TJWJ2021MS047)。

摘　　要：目的 通过对1例使用达雷妥尤单抗患者的抗-K、抗-Wr^(a)标本特点进行分析,以研究合理的血清学检测途径。方法 选取盐水法、凝聚胺、卡式抗人球蛋白方法、二硫苏糖醇(Dithiothreitol, DTT)处理、胰蛋白酶处理、木瓜蛋白酶处理等方法,对患者血浆、酸放散液进行意外抗体筛查和鉴定。用K抗原阴性红细胞吸收患者血清后热放散。分析抗体性质,持续检测效价。排除达雷妥尤单抗干扰后进行交叉配血。结果 患者血浆在盐水、凝聚胺介质中检出抗-K、抗-Wr^(a),患者自身放散液中应为达雷妥尤单抗。木瓜酶不能排除达雷妥尤单抗干扰;DTT、胰蛋白酶处理红细胞后可排除达雷妥尤单抗干扰。但DTT处理破坏K抗原,漏检Kell系统IgG抗体;胰蛋白酶处理不影响K抗原,可检出达雷妥尤单抗治疗患者血清中的Kell系统IgG抗体(抗-k)。该患者抗-K为IgM,盐水法效价4,39 d后减弱至盐水法室温不凝集;抗-Wr^(a)为IgG,凝聚胺法效价4,39 d后减弱为1;76 d后抗-K、抗-Wr^(a)均测不出。选择K、Wr^(a)抗原阴性的红细胞输注,安全有效。结论 DTT处理红细胞可排除达雷妥尤单抗干扰,但要注意Kell系统抗体的漏检。为避免达雷妥尤单抗掩盖同种抗体,可联合使用DTT处理、凝聚胺法、胰蛋白酶处理等多种方法。Objective To investigate the reasonable serological detection method by analyzing the characteristics of anti-K and anti-Wr^(a) from a patient who received treatment with daratumumab.Methods Unexpected antibody screening and identification were performed by saline method,polybrene,cardioagglutinin,dithiothreitol(DTT)treatment,trypsin treatment and papain treatment in the patient's plasma and acid elution solution.Heat elution test was detected after absorbing patient serum with K antigen negative red blood cells.The characteristics of antibodies were analyzed and their titer was continuously detected.Cross matching was performed after excluding interference of daratumumab.Results Anti-K and anti-Wr^(a) were detected in saline and polybrene in the patient's plasma.The patient's elution solution contained daratumumab.DTT or trypsin treatment excluded interference of daratumumab but papain treatment did not.DTT treatment destroyed K antigen and missed the detection of IgG antibodies in the Kell system.Trypsin treatment did not affect K antigen and can detect IgG antibodies of Kell system(anti-k)in the serum of the patient treated with daratumumab.Anti K was IgM and the titer was 4 by saline method and it decreased to no agglutination in room temperature after 39 days.Anti-Wr^(a) was IgG and the titer by polybrene method was 4,and it decreased to 1 after 39 days.After 76 days,neither anti-K nor anti-Wr^(a) could be detected.Transfusions of K and Wr^(a) antigen negative red blood cells were safe and effective.Conclusion DTT treatment can exclude interference of daratumumab,but attention should be paid to missed detection of anti-K.To avoid interference of daratumumab and identify unexpected antibody,multiple methods such as DTT treatment,polybrene and trypsin treatment in combination are recommended.

关 键 词：达雷妥尤 抗-K 抗-Wr^(a) 血清学试验 

分 类 号：R457.11[医药卫生—治疗学]