使用二硫苏糖醇消除达雷木单抗对输血前检测的干扰

DTT can be used to resolve the daratumumab interference with blood compatibility testing

目的通过二硫苏糖醇(Dithiothreitol,DTT)处理抗筛细胞和/或供者红细胞来消除达雷木单抗(Daratumumab,DARA)对输血前检测的干扰,为使用抗CD38单抗治疗的患者的安全有效用血提供保障。方法使用微柱凝胶卡对DARA治疗的患者进行抗体筛查、直接抗人球蛋白(DAT)检测及交叉配血。采用0.2 M的DTT破坏抗筛细胞和供者红细胞表面的CD38抗原的完整性后进行输血前检测。向患者血浆中加入已知类型的不规则抗体(抗D-IgG),检测0.2 M DTT处理前后的抗体筛查结果。结果使用DARA治疗患者的抗体筛查均为阳性、DAT均为阴性且交叉配血不合。采用0.2 M DTT处理后抗体筛查均为阴性,交叉配血相合。DTT方法不影响加入的抗D抗体的检出。结论DTT处理的方法可以为使用DARA治疗的患者提供安全的血液。

Objective To resolve the daratumumab interference with blood compatibility testing by treating antibody screening cells and donor red blood cells with dithiothreitol(DTT),so as to provide compatible and effective blood for patients treated with Daratumumab(DARA).Methods For patients received DARA,microcolumn gel card was used for antibody detection test,direct antiglobulin testing(DAT)and crossmatch.Pre-transfusion testing was performed after degrading the presence of CD38 antigens on the surface of antibody screening cells and donor's red blood cells using 0.2 M DTT.Plasma specimens containing known antibody(anti-D-IgG)was added to the patient's plasma to observe antibody screening results before and after 0.2 M DTT treatment.Results The blood samples of patients treated with DARA therapy presented panreactivity in the antibody screen,negative DATs and incompatible crossmatch.After treating RBCs with 0.2 M DTT,they presented negative antibody screen and compatible crossmatch.Otherwise,DDT didn't destroy or weaken anti-D that we added.Conclusion The nonspecific interference in blood bank tests,produced by DARA,can be overcome by 0.2 M DTT treatment as proposed here.