摘要
目的探讨达雷妥尤单抗(daratumomab,Dara)对多发性骨髓瘤(multiple myeloma,MM)患者输血相容性检测的干扰模式,并评估相应的解决策略。方法对15例在2022年2月—2023年1月在厦门大学附属第一医院接受达雷妥尤单抗治疗的MM患者进行治疗前的血型鉴定、抗体筛查进行检测,并用盐水置换、血浆稀释后重新检测;接受Dara治疗后用盐水试管法、凝聚胺法、微柱凝胶法进行抗体筛查检测,再并分别用0.2 mol/L、0.1 mol/L、0.01 mol/L浓度二硫苏糖醇(dithiothreitol,DTT)、0.2 mol/L2-巯基乙醇(2-Mercaptoethanol,2-Me)及1%木瓜蛋白酶处理抗筛细胞后重新进行微柱法抗体筛查。结果治疗前,患者血样经盐水置换和血浆稀释后,可消除原有疾病引起的缗钱状凝集的干扰。在接受达雷妥尤单抗治疗后,用盐水试管法凝聚胺法进行抗体筛查,可不受药物影响,而用微柱凝胶法进行抗体筛查均为阳性。用不同浓度的DTT处理抗筛细胞和献血员红细胞后,抗体筛查结果均为阴性,主侧交叉配血结果相合;而被2-Me及木瓜蛋白酶处理后的抗筛细胞反应并未达到预期的效果。结论MM患者在使用达雷妥尤单抗治疗前,若血型鉴定、抗体筛查和交叉配血受到干扰,可以采用盐水置换、血浆稀释等方法消除干扰。在使用达雷妥尤单抗治疗后,可采用DTT处理抗筛细胞和献血员红细胞,或用凝聚胺法来消除药物对输血相容性检测的影响。
Objective To explore the interference patterns of Daratumomab in transfusion compatibility testing for multiple myeloma patients and evaluate the corresponding solution strategies.Methods Blood type identification and antibody screening were tested on 15 patients who received Daratumomab treatment at the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University from February 2022 to January 2023 before treatment,then the blood samples were tested again after replacement with saline and plasma dilution;after receiving the treatment of Daratumomab,the antibody screening were tested by saline method,polybrene method and microcolumn gel method,then the cells used to antibody screening were treated with 0.2 mol/L、0.1 mol/L、0.01 mol/L DTT、0.2 mol/L 2-Me and 1%papain,the antibody screening were tested again by microcolumn gel method.Results Before treatment,the interference of money-shaped agglutination caused by the original disease could be eliminated by saline replacement and plasma dilution;after receiving the treatment of Daratumomab,the antibody screening using saline and polybrene method is not affectd by the drug,but the micro-column gel method showed pan agglutination.After the screening cells and donor red blood cells were treated with different concentrations of DTT,the results of antibody screening were all negative,and the results of major-side cross-matching were consistent;but the screening cells treated with 2-Me and papain did not achieve the desired effect.Conclusion The interference of blood group identification,antibody screening and cross matching in MM patients before DARA treatment can be eliminated by saline replacement and plasma dilution.Anti-screening cells and donor red blood cells can be treated with DTT or use polybrene method after treatment with Dara to eliminate the effect of the drug on transfusion compatibility testing.
作者
江慧
洪强
JIANG Hui;HONG Qiang(Department of Blood Transfusion,the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen Fujian 361000,China)
出处
《中国卫生标准管理》
2025年第11期153-158,共6页
China Health Standard Management
