- 期刊
使用Anti-CD38治療病人之輸血前檢驗
Pretransfusion Testing Adapted for Patients on Anti-CD38 Therapy
摘要
背景：anti-CD38藥物為一種新的標靶藥物，可有效治療多發性骨髓瘤，使用此藥物的病人血清會和試劑紅血球上CD38結合，干擾輸血前檢驗，表現泛陽性，影響血品供應時效。研究方法及設計：收集台大醫院自2015年至2018年5月接受anti-CD38治療之17名病患，分析使用藥物前、中、後的免疫血清血檢驗及輸血策略。結果：17位病人中有14人在使用藥物前，已先開立次要血型抗原及篩檢異體抗原檢驗，使用藥物後有15位病人進行備輸血，所有的人之抗體篩檢、鑑定及交叉試驗，在管柱凝集法、傳統抗球蛋白三項法皆呈1~2+反應，在以DTT處理血球後，可有效去除干擾，抗體篩檢呈陰性，並給予抗原相同的紅血球，分析多次輸血病人，無人產生異體抗體產生。結果：本院因應anti-CD38藥物干擾輸血前檢驗，訂定特殊輸備血流程，能在時效內提供更安全血品。
並列摘要
Background: Anti-CD38 is a novel targeted monoclonal antibody (MoAb) for treating multiple myeloma and other malignancy. Anti-CD38 can bind to CD38 on reagent RBCs, causing panreactive reactions in vitro. Plasma samples from anti-CD38-treated patients could cause positive results in indirect antiglobulin tests, complicating the red cell compatibility test. Study Design and Methods: From Jan 2015 to May 2018, our blood bank received pretransfusion testing samples from 17 patients on anti-CD38 MoAb treatment. We applied a modified pretransfusion test that included employing DTT-treatment of red cells for screening and issuing phenotypically matched red cells. Results: We reported the phenotypes and antibody screen results from patients receiving anti-CD38. Panreactive patterns were a common finding, being detected by column agglutination test and traditional anitglobulin test in 15 of 17 patients. DTT-treated cells can be used to eliminate the inference. We provided the phenotypically matched RBC units for the patients and no alloantibody was detected among them after multiple red cell transfusions. Conclusion: Our hospital has set up a pre-transfusion procedure to minimize the delays in red transfusion for patients receiving anti-CD38 MoAb drugs.