血液腫瘤患者輸注紅血球所產生異體抗體的分析探討在南台灣的經驗

背景血液腫瘤科病患為最主要受血者族群之一，血液腫瘤病患不管在輸血數量或輸血頻率上都是相對比較高頻率的族群；輸血引起的異體抗體是長期輸血病患常見的併發症，長期輸血引起的異體抗體會引起溶血性輸血反應，甚至會引發危及生命的嚴重輸血反應及不易找到相符合的血袋輸血。目的此次作研究的目的是對於血液腫瘤患者輸注紅血球所產生異體抗體的分析探討，除了欲了解抗體頻率的分佈情形，並分析各個危險因子，以提供對此族群輸血經營管理的建議，故對此族群輸注紅血球產生異體抗體的狀況提出分析探討，以利未來輸血的規劃或建議。材料與方法此次我們收集奇美醫院永康院區的所有血液腫瘤病患(包括住院病患、門診病患及急診病患)自2007年1月1日到2011年12月31日，五年間輸血的案例，檢驗是否來院時即帶有抗體或在本院輸過血才產生抗體，並追查後者抗體產生的過程(即多次輸血病人抗體出現的情形)。此次經由血液腫瘤患者的血液作抗體篩檢，如有異體抗體並隨即作抗體鑑定。並分析各個危險因子，例如病名、輸血的年紀、性別、輸血的次數及紅血球製品等。結果奇美醫院永康院區的所有血液腫瘤病患 (包括住院病患、門診病患及急診病患)，到目前為止共有 636位血液腫瘤科病患，其中 369位有輸血的案例。在這 369位病患 (其中 106位是 non-Hodgkin’s lymphoma，4位是 Hodgkin’s lymphoma， 91位是 acute myeloid leukemia， 47位是 myelodysplastic syndrome，52位是 multiple myeloma，23位是 acute lymphocytic leukemia，42位是 myeloproliferative syndromes，4位是 chronic lymphocytic leukemia )，共有 26位 (7 %) 發現有異體抗體。在這二十六位病患 ( 12個女性、14個男性、年齡中位數 67歲、範圍 20-86歲)，2位有 anti-‘Mia’+ E，4位有 anti E+c， 8位有 anti-‘Mia’，8位有 anti-E，1位有 anti-C+e，1位有 anti-Dia，1位有 anti-Jkb及另一位有 anti-Lea。在診斷方面，七位是 acute myeloid leukemia、七位是 myelodysplastic syndrome、七位是 non-Hodgkin’s lymphoma、二位是 multiple myeloma、一位是 chronic myelogenous leukemia、一位是 myelofibrosis 及另一位是 acute lymphocytic leukemia。而這些病患因輸注紅血球濃厚液到產生異體抗體，輸注中位數8單位紅血球濃厚液 (範圍 2-35單位紅血球濃厚液) 。結論血液腫瘤病患有7 %發現有異體抗體，血液腫瘤病患不管在輸血數量或輸血頻率上都是相對比較高頻率的族群，與多次輸血的非血液腫瘤病患甚至有高達大於30%的異體抗體的頻率相比較，因輸血引起異體抗體在血液腫瘤病患並不是常見的併發症，也許接受免疫抑制劑及化學治療，會影響異體抗體產生。和國外文獻報告比較，也有相近的報告，在多次輸血的非血液腫瘤病患甚至有高達大於30%的異體抗體的頻率，不過在腫瘤病患異體抗體的頻率會降至10%，尤其在接受化學治療後異體抗體的頻率會小於10%。因輸血引起異體抗體在血液腫瘤病患並不是常見的併發症，應不需實施輸血前廣泛性的抗原配對(extensive antigen matching before transfusion) ，不過仍需更大型及更長期的追蹤觀察來進一步証實。

關鍵字

血液腫瘤病患；非血液腫瘤病患；異體抗體；抗體篩檢；抗體鑑定

並列摘要

The development of erythrocyte alloantibodies complicates transfusion therapy in patients with chronic transfusion. Because of intensive marrow depression and improved survival, patients with hematologic and oncologic malignancies are dependent on transfusion for a longer period. However, no data are available on the frequency of erythrocyte alloimmunization in patients with hematooncologic diseases in Taiwan. We analysed the clinical and transfusion records of all patient (n=636) with malignant myeloproliferative and lymphproliferative diseases diagnosed between 2007 and 2011 at Chi-Mei hospital, Tainan, Taiwan, a tertiary teaching hospital. Of Patients who never received a transfusion, who had autoantibodies, who had antibodies that were present before the study began and those who did not undergo at least one antibody screening after the first blood transfusion were excluded. This left 369 evaluable patients. Of the 369 patients, 26 (7%) were found to carry alloantibodies. The median age at diagnosis was 67 years (range 20-86 years), and the male- to-female ratio was 1.2. The total number of units transfused per patients before alloimmunization ranged from 2 to 35, with a median of 8 units. Gender and age had no influence on the rate of antibody formation. All alloantibodies were clinically significant specificities, including two of anti-‘Mia’+ E , four of anti-E + c, eight of anti-‘Mia’, eight of anti-E, one of anti-C+e, one of anti-Jkb, one of anti-Lea and one of anti-Dia. Alloimmunization to erythrocyte antigens is not a frequent complication in hematooncologic diseases. This probably due to patients with hematological disease is usually undergoing immunosuppressive treatment and intensive chemotherapy. No difficulty was encountered in finding compatible blood for these patients. Extensive antigen matching before transfusion of patients with hematologic and oncologic malignancies seems not necessary and leads to increased costs.

並列關鍵字

alloimmunization ； alloantibodies ； hematooncologic diseases ； myeloproliferative disease ； lymphproliferative diseases

參考文獻

18.Chang FJ, Chan YS, Wang CL, Chiou PY, Ho KN, Lin M. Frequency of alloantibodies in patients in Mackay Memorial Hospital. Formosan Journal of Medicine 2004;8:755-9(chineses)

6.雍建輝、薛樹清、林炯熙、邱宗傑。2009。紅血球異體抗體與自體抗體形成的原理與功能下。當代醫學36(12):981-7。

5.雍建輝、薛樹清、林炯熙、邱宗傑。2009。紅血球異體抗體與自體抗體形成的原理與功能上。當代醫學36(11):903-9。

4.雍建輝。2009。臨床醫師對懷疑輸血反應的確認與評估。台灣醫界52(12):19-21。

7.Alarif L, Castro O, Ofosu M, Dunston G, Scott RB. HLA-B35 is associated with red cell alloimmunization in sickle cell disease. Clin Immunol Immunopathol 1986;38:178-83

國際替代計量

血液腫瘤患者輸注紅血球所產生異體抗體的分析探討在南台灣的經驗

主題瀏覽