Anti-CD47單株抗體藥物於輸血前檢驗之影響與輸血策略

The Impact of Anti-CD47 Monoclonal Antibody on Pre-Transfusion Test and Transfusion Management

Magrolimab為anti-CD47單株抗體藥物，藉由干擾吞噬細胞上的SIRPα受器和癌細胞上CD47抗原的結合，強化吞噬細胞攻擊癌細胞。然而CD47抗原也廣泛的表現在紅血球與血小板上，因此當病人使用藥物時，輸血前檢驗（包含ABO血清型檢驗、抗體篩檢及交叉試驗）呈現泛陽性反應[2]。為了避免藥物干擾而增加檢驗時間，本篇論文探討藥物濃度對輸血前檢驗之影響，並分享本院建立之流程。首先讓病人在用藥前先測定ABO血型和常見的次要血型系統，如此便可在藥物干擾的情況下，給予病人抗原相符血品，避免產生異體抗體[3]。並規劃讓病人攜帶相關的警示小卡，向他院傳達必要且完備之輸血資訊，減少檢驗量能之浪費和保障病人的用血安全。

Magrolimab is ananti-CD47 monoclonal antibody, inducing phagocytosis by interrupting the binding of SIRPαreceptor on phagocytes and CD47 antigens on cancer cells[1]. However, the ubiquity ofCD47 on RBCs and PLTs results in the interference of pre-transfusion test(including ABO reverse typing, antibody screening and crossmatch)when patients took this medicine[2].To avoid the effect, we setup a SOP to perform pre-transfusion test and minor antigen test prior to take magrolimab. In this way, patients would be given with antigen-matched red blood cells to minimize alloimmunization [3].On the other hands, we prepare alert cards for patients to convey complete information of transfusion to other hospitals to avoid unnecessary serological tests and to ensure the safety of transfusion.