替加环素药物抗体致溶血危象的临床诊断及检测的探索  

Clinical diagnosis and detection of hemolytic crisis caused by anti-tigecycline antibody

作　　者：李婧薇 马婷[2] 何屹[1] 袁红[1] 谢映春 范亮峰[3] 年青 向东[3] Li Jingwei;Ma Ting;He Yi;Yuan Hong;Xie Yingchun;Fan Liangfeng;Nian Qing;Xiang Dong(Department of Transfusion,Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital,Chengdu 610072,China;Department of Blood Transfusion,Shaanxi Provincial People′s Hospital,Xi′an 710038,China;Immunohematology Reference Lab of Shanghai Blood Center,Shanghai 200051,China)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)输血科,成都610072 [2]陕西省人民医院输血科,西安710038 [3]上海市血液中心血型参比实验室,上海200051

出　　处：《中华微生物学和免疫学杂志》2024年第7期614-619,共6页Chinese Journal of Microbiology and Immunology

基　　金：国家自然科学基金(82204858);四川省科技厅项目(2023NSFSC1761)。

摘　　要：目的探讨替加环素药物抗体引起免疫性溶血性输血反应的实验室检测方法及1例患者的临床诊疗。方法分析该患者溶血相关检测指标与用药时间的关联性,对患者血样进行直接抗人球蛋白试验、血清游离抗体鉴定、红细胞放散液抗体鉴定,运用红细胞致敏法和免疫复合物法检测患者血清内的替加环素药物抗体,并检测药物抗体的性质及效价。结果患者体内通过致敏红细胞途径和免疫复合物途径均检测出替加环素药物抗体,直接抗人球蛋白试验阳性,停药及输血后患者临床症状和体征迅速改善。辅以免疫球蛋白和激素治疗,患者在治疗后14 d出院。结论替加环素可导致药物溶血性不良反应,血清学检测结果是药物性溶血性贫血的重要诊断依据。当患者出现与药物相关的贫血溶血时,应立即停药和对症治疗。Objective To investigate the laboratory detection methods for immune hemolytic transfusion reactions caused by anti-tigecycline antibody and the clinical diagnosis and treatment of one patient.Methods The correlation between hemolysis-related laboratory indexes of the patient and the duration of medication was analyzed.Blood samples of the patient were tested using direct anti-human globulin test,free antibody test,and release test.Erythrocyte sensitization method and immune complexome analysis were used to detect the antibody against tigecycline in the serum of the patient.The properties and the titers of anti-tigecycline antibody were analyzed.Results Anti-tigecycline antibody was found in the patient through the erythrocyte sensitization method and the immune complexome analysis,and the result of the direct anti-human globulin test was positive.The clinical symptoms and physical signs of the patient improved rapidly after withdrawal of tigecycline and blood transfusion.The patient was discharged after 14-day treatment with immunoglobulin and hormone.Conclusions Tigecycline can cause hemolytic transfusion reactions.Serological tests are essential for the diagnosis of drug-induced hemolytic anemia.Withdrawal of medications and symptomatic treatment should be conduceted immediately when patients develop drug-related hemolytic anemia.

关 键 词：溶血性贫血 替加环素 药物抗体 输血治疗 

分 类 号：R457.1[医药卫生—治疗学]