抗-CD36患者造血干细胞移植前后血小板输注1例

Platelet transfusion analysis in one patient containing anti-CD36 antibody before and after hematopoietic stem cell transplantation

目的对1例疑为CD36抗体引起的血小板输注无效患者进行CD36抗体鉴定、CD36缺失表型及CD36基因突变类型分析,借助血小板稀有血型库为该患者寻找相匹配的血小板输注,确保移植成功。方法采用商品化的ELISA试剂盒进行血小板抗体检测;对患者血小板和单核细胞上CD36的表达进行流式分析;运用PCR-SBT方法分析患者CD36基因突变类型;利用查询功能在血小板稀有血型库中查询与患者ABO血型相符且CD36缺失表达的供者血小板给予配型输注。结果血小板抗体检测显示该患者呈CD36抗体阳性(移植前CD36+4.2%,移植后CD36+22.1%),且血小板和单核细胞均缺乏表达CD36抗原(Ⅰ型CD36缺失);基因测序分析发现该患者存在纯合A1163T基因突变。在造血干细胞移植前后,给予CD36-/-血小板配型输注可明显提高患者的血小板数量,从而确保移植成功。结论由CD36抗体引起的血小板输注无效患者(尤其是需要进行造血干细胞移植的患者)应给予CD36-/-血小板输注以确保血小板输注疗效。

Objective To identify CD36 antibody,to analyze the CD36 expression and CD36 gene mutations for one PTR patient suspected of containing CD36 antibody, and to explore matching platelets for transfusion facilitated by rare blood bank. Methods Commercialized ELISA kit was used to identify platelet antibodies. The CD36 expression on platelets and monocytes of this patient was measured using flow cytometry. PCRSBT was used to analyze CD36 sequence and confirm the type of gene mutations. Matching ABO and CD36 deficient platelets were searched from the platelet rare blood bank for transfusion.Results This patient was tested for platelet antibodies and was shown to be anti-CD36 antibody positive（ Before： CD36 ＋4. 2%,After： CD36 ＋ 22. 1%）. The expression of CD36 on platelets and monocytes were negative（ CD36 Type I）. Sequencing analysis showed that this patient had A1163 T mutation. CD36-/- platelets transfusion can significantly improve platelet count and ensure successful transplant. Conclusion PTR patients caused by CD36 antibody,especially for patients that need to do hematopoietic stem cell transplantation,should be given CD36-/- platelets to ensure the efficacy of platelet transfusion.