抗-CD47单克隆抗体对输血前检测试验的干扰及处理措施——附1例报告

Monoclonal anti-CD47 interference in pre-transfusion test and mitigation measures,a case report

目的探讨抗-CD47单克隆抗体对输血前检测试验的干扰及处理措施。方法收集1名接受抗-CD47单克隆抗体治疗的骨髓增生异常综合征受试者标本,进行ABO和Rh血型抗原鉴定,直接抗球蛋白试验,不规则抗体筛选和抗体鉴定试验,交叉配血试验;收集多人份O型献血者血小板制备成压积血小板,与受试者血浆进行吸收试验;收集Rh抗原分型分别为CCDee、ccDEE和ccdee的O型红细胞各1人份,分别与受试者血浆进行吸收试验;使用缺乏IgG4的抗球蛋白试剂Gamma-clone进行抗体筛选与交叉配血试验,使用Immucor Capture-R固相凝集试剂盒进行不规则抗体筛选试验。结果受试者直接抗球蛋白为阳性,游离抗体筛选和鉴定试验在所有介质中均为阳性(3+~4+);血浆与红细胞多次吸收后,抗体筛选和抗体鉴定为阴性;与多次血小板吸收后,抗体筛选和抗体鉴定仍为阳性;使用Gamma-clone抗球试剂进行不规则抗体筛选和配血试验,结果均为阴性;Immucor Capture-R固相凝集试剂盒进行不规则抗体筛选试验,结果为阴性。结论抗-CD47单克隆抗体可干扰输血前检测及交叉配血,使用缺乏检测IgG4的抗球蛋白试剂Gamma-clone和Immucor capture-R固相凝集法可较好去除抗-CD47干扰。

Objective To discuss the interference of anti-CD47 in pre-transfusion test and the mitigation measures. Methods Blood sample of one patient received anti-CD47 treatment was collected to conduct routine serological tests including ABO/Rh phenotype, direct anti-human globulin test, irregular antibody screening, antibody identification and cross-match. Packed platelet from multiple type O blood donors was used to absorb with patient′s plasma. The patient′s plasma was absorbed with CCDee, ccDEE and ccdee red cells, respectively. Anti-IgG monoclonal Gamma-clone which lacks reactivity with human subclass IgG4 was used to perform antibody screening and cross-match. Capture-R was used to perform antibody screening. Results The direct anti-human globulin test was positive(1+), the reactivity in all phases was strong positive(3+-4+). The anti-CD47 was eliminated after platelet and red cells absorption. Antibody screening became negative using Gamma-clone and Capture-R, and cross-match successfully using Gamma-clone. Conclusion Anti-CD47 monoclonal antibody can interfere with pre-transfusion test and cross matching. To remove the interference of anti-CD47 requires the use of Gamma-clone anti-IgG in the indirect antiglobulin testing or Capture-R.