Treatment measures for transfusion compatibility test results and interfering factors in patients with multiple myeloma
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摘要: 目的 研究多发性骨髓瘤患者(MM)输血相容性检测结果对其干扰因素采取相应的处理措施。方法 选择2021年12月—2023年12月医院收治的26例MM患者为研究对象，经输血相容性检测并分析结果，通过盐水置换法、凝聚胺试验、2巯基乙醇(2-Me)预处理红细胞等方法，处理相容性检测中遇到的干扰因素。结果 26例MM患者输血相容性检测结果中，3例因蛋白凝聚干扰，处理措施：盐水置换法；11例患者因接受了CD38单抗类药物治疗干扰，处理措施：不规则抗体筛查红细胞可以用2-Me预处理，交叉配血试验可用凝聚胺法；2例患者存在抗-E抗体干扰，处理措施：选择E抗原阴性的红细胞输注；1例为冷凝集素干扰血型鉴定，处理措施：37℃孵育15 min后正反定型相符，26例MM患者多次接受输血治疗，无不良输血反应。结论 MM患者输血相容性检测可通过这些处理措施的不断强化和完善，加强输血的质量和安全。输血实验室可根据具体情况制定工作流程，结合检验科、病理科相关项目检查报告，并与临床医生建立有效沟通模式，为人们的输血安全保驾护航。Abstract: Objective To study the interference factors of transfusion compatibility test results in patients with multiple myeloma(MM) and take corresponding treatment measures.Methods A total of 26 MM patients admitted to our hospital from December 2021 to December 2023 were selected as the research subjects. After blood transfusion compatibility testing and analysis of the results, interference factors encountered in compatibility testing were treated using methods such as saline replacement, polyamine test and 2-Me pretreatment of red blood cells.Results Among the 26 cases of MM patients, 3 cases were treated with saline replacement method due to protein coagulation interference; 11 patients received interference from CD38 monoclonal antibody therapy, and the treatment measures were as follows: irregular antibody screening red blood cells could be pre treated with 2-Me, and cross matching tests could be performed using the polyamine method; Two patients had interference from anti E antibodies, and the treatment measures were as follows: infusion of red blood cells with negative E antigens; One case was caused by interference of cold agglutinin in blood type identification. Treatment measures: After incubation at 37 ℃ for 15 minutes, the positive and negative typing matched. 26 cases of MM patients received multiple transfusion treatments without any adverse transfusion reactions.Conclusion The transfusion compatibility test of MM patients could enhance the quality and safety of blood transfusion through the continuous strengthening and improvement of these treatment measures. The blood transfusion laboratory could formulate a workflow according to the specific situation, combine the inspection reports of relevant items of the laboratory department and the pathology department, and establish an effective communication mode with clinicians to escort the safety of people's blood transfusion.
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表 1 患者ABO/Rh血型鉴定结果
例数 正定型 Rh血型 反定型 抗A 抗B RhD抗原 Ac Bc Oc 自身 3 — — 4+ 4+ 4+ — — 2 — — 4+ 4+ 3+ — — 1 1+ 1+ 4+ 4+ 4+ 1+ 1+ 3 4+ — 4+ — 4+ — — 1 4+ — 4+ 1+ 3+ 1+ 1+ 4 4+ — 4+ — 3+ — — 1 4+ 2+ 4+ 2+ 3+ 2+ 2+ 4 — 4+ 4+ 4+ — — — 2 — 4+ 4+ 3+ — — — 1 — 4+ 4+ 2+ — — — 1 — 4+ 4+ 3+ 1+ 1+ 1+ 1 3+ 4+ 4+ — — — — 2 4+ 4+ 4+ — — — — 
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表 2 3例MM患者用盐水置换法复查血型
例数 正定型 反定型 抗A 抗B Ac Bc Oc 自身 1 — — 3+ 4+ — — 1 4+ — — 3+ — — 1 — 4+ — 3+ — —
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表 4 MM患者不规则抗体筛查结果及干扰因素处理结果
次数 不规则抗体筛查 盐水置换法处理后 2-Me试剂处理后 Ⅰ Ⅱ Ⅲ Ⅰ Ⅱ Ⅲ Ⅰ Ⅱ Ⅲ 63 — — — 无需此处理 无需此处理 28 + + + — — — 无需此处理 49 2+ 2+ 2+ 无需此处理 — — — 8 — 2+ — — 2+ — — 2+ —
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表 5 26例MM患者多次输血的交叉配血试验结果
次数 交叉配血 DAT 盐水置换法后 凝聚胺法 主 次 主 次 主 次 128 — — — 无需此处理 无需此处理 67 + + 2+ — — 无需此处理 50 2+ 2+ 1+ 无需此处理 — — 29 2+ — — 无需此处理 — —
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[1] 龚盈盈, 闫晓爽, 王叶敏, 等. 多发性骨髓瘤患者的临床特征及预后因素分析[J]. 中国实验血液学杂志, 2021, 29(3): 772-780. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202103023.htm
[2] 葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018: 602.
[3] Krejcik J, Casneuf T, Nijhof IS, et al. Daratumumab depletes CD38+immune regulatory cells, promotes T-cell expansion, and skews T-cell repertoire in multiple myeloma[J]. Blood, 2016, 128(3): 384-394. doi: 10.1182/blood-2015-12-687749
[4] Quach H, Benson S, Haysom H, et al. Considerations for pre-transfusion immunohaematology testing in patients receiving the anti-CD38 monoclonal antibody daratumumab for the treatment of multiple myeloma[J]. Intern Med J, 2018, 48(2): 210-220. doi: 10.1111/imj.13707
[5] 邵林楠, 张树婷, 王霓, 等. 三种试剂对红细胞表面CD38抗原去除效果的研究[J]. 临床输血与检验, 2021, 23(1): 65-67. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202101016.htm
[6] Zhou Y, Chen LY, Jiang TS, et al. 2-mercaptoethanol(2-ME)-based IATs or polybrene method mitigates the interference of anti-CD38 immunotherapy on blood compatibility tests[EB/OL]. (2020-12-14)[2020-12-17].
https//www.medrxiv.org/content/10.1101/2020.12.14.2023831lvl .[7] 张晔, 梁霞, 王芳, 等. 血清β2-MG与总蛋白、球蛋白、IgG检测对多发性骨髓瘤的诊断价值[J]. 中国实验诊断学, 2023, 27(6): 686-689. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD202306014.htm
[8] 项秋晴, 陆敏秋, 褚彬, 等. 达雷妥尤单抗治疗复发/难治性多发性骨髓瘤疗效观察研究[J]. 中国全科医学, 2021, 24(2): 237-242. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202102036.htm
[9] 中国医师协会血液科医师分会, 中华医学会血液学分会, 中国医师协会多发性骨髓瘤专业委员会. 中国多发性骨髓瘤诊治指南(2020年修订)[J]. 中华内科杂志, 2020, 59(5): 341-346. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201611020.htm
[10] 刘进, 何海燕, 李璐, 等. 达雷妥尤单抗治疗复发/难治多发性骨髓瘤的疗效与安全性[J]. 中华血液学杂志, 2021, 42(1): 27-32. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYN202405030.htm
[11] Morandi F, Horenstein AL, Costa F, et al. CD38: a target for immunotherapeutic approaches in multiple myeloma[J]. Front Immunol, 2018, 9: 2722. doi: 10.3389/fimmu.2018.02722
[12] Albeniz I, Demir O, Türker-Sener L, et al. Erythrocyte CD38 as a prognostic marker in cancer[J]. Hematology, 2007, 12(5): 409-414. doi: 10.1080/10245330701383841
[13] 张警丹, 李鹏, 李强, 等. 抗CD38单克隆抗体对多发性骨髓瘤患者交叉配血干扰及输血疗效的影响[J]. 临床血液学杂志, 2022, 35(8): 539-542. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.08.001
[14] Sullivan HC, Gerner-Smidt C, Nooka AK, et al. Daratumumab(anti-CD38) induces loss of CD38 on red blood cells[J]. Blood, 2017, 129(22): 3033-3037. doi: 10.1182/blood-2016-11-749432
[15] 杨鑫鑫, 彭卓越, 罗政莲, 等. 使用二硫苏糖醇消除达雷木单抗对输血前检测的干扰[J]. 中国输血杂志, 2020, 33(4): 376-378. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202004026.htm
[16] 陈烨, 李楠, 张琪. 多发性骨髓瘤患者输血相容性检测相关影响因素的分析及处理[J]. 基层医学论坛, 2022, 26(25): 75-77. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT202225025.htm
[17] Sun JB. The prenatal intervention of pregnancy complicated with anti-Kell isoimmunization: a review[J]. J Matern Fetal Neonatal Med, 2019: 1-7.
[18] Bras AE, Beishuizen A, Langerak AW, et al. CD38 expression in paediatric leukaemia and lymphoma: implications for antibody targeted therapy[J]. Br J Haematol, 2018, 180(2): 292-296. doi: 10.1111/bjh.14310
[19] 刘凤霞, 黄蓉, 王勇军, 等. 自身抗体干扰输血相容性检测处理对策[J]. 中国输血杂志, 2021, 34(8): 803-808. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202108001.htm
[20] 马晨. 冷自身抗体伴IgG抗-S致配血不合1例[J]. 中国输血杂志, 2023, 36(12): 1165-1167. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202312021.htm
[21] 孔存权, 朱伟彦, 连利霞, 等. 多发性骨髓瘤全凝集血型处理及输血实践[J]. 临床血液学杂志, 2019, 32(4): 257-260. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806-b.2019.04.003
[22] 吴敏华, 蔡葵, 刘棋枫. Rh血型抗原抗体检测对保障输血安全的意义[J]. 国际检验医学杂志, 2015, 36(3): 308-309, 312. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201503011.htm
[23] 李莺, 朱永亮, 许进明, 等. Rh血型主要抗原配合性输注的可行性研究及效果分析[J]. 南京医科大学学报: 自然科学版, 2022, 42(9): 1305-1308. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK202209017.htm
[24] 马砚敏, 赵凤莲, 支君. Rh血型抗原CcEe在住院患者中的分布情况及在临床输血中的意义研究[J]. 齐齐哈尔医学院学报, 2021, 42(3): 204-206. https://www.cnki.com.cn/Article/CJFDTOTAL-QQHB202103009.htm
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