使用Anti-CD38治療病人之輸血前檢驗

Pretransfusion Testing Adapted for Patients on Anti-CD38 Therapy

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。 Background: Anti-CD38 is a novel targeted monoclonal antibody (MoAb) for treating multiplemyeloma and other malignancy. Anti-CD38 can bind to CD38 on reagent RBCs, causingpanreactive reactions in vitro. Plasma samples from anti-CD38-treated patients could cause positiveresults in indirect antiglobulin tests, complicating the red cell compatibility test.Study Design and Methods: From Jan 2015 to May 2018, our blood bank received pretransfusiontesting samples from 17 patients on anti-CD38 MoAb treatment. We applied a modifiedpretransfusion test that included employing DTT-treatment of red cells for screening and issuingphenotypically matched red cells.Results: We reported the phenotypes and antibody screen results from patients receivinganti-CD38. Panreactive patterns were a common finding, being detected by column agglutinationtest and traditional anitglobulin test in 15 of 17 patients. DTT-treated cells can be used to eliminatethe inference. We provided the phenotypically matched RBC units for the patients and noalloantibody was detected among them after multiple red cell transfusions.Conclusion: Our hospital has set up a pre-transfusion procedure to minimize the delays in redtransfusion for patients receiving anti-CD38 MoAb drugs.