兆珂治疗导致疑难配血的处理及血液制品输注效果观察

The treatment of difficult blood matching caused by daratumumab and observation on the infusion effect of blood products

目的通过对临床血液制品输注效果的观察,探讨建立兆珂治疗导致疑难配血患者输血的处理方案,并为方案提供理论支持。方法采用盐水法、凝胶微柱法、凝聚胺法、二硫苏糖醇处理等方法,对患者进行输血相容性实验为患者筛选相合的血液制品;通过医院HIS系统、LIS系统、电话回访等方式获得患者基本信息、血液制品输注前后血常规、大便常规等临床检查结果对血液制品的输注效果进行分析。结果应用兆珂治疗可干扰输血相容性实验的结果,导致疑难配血,该干扰可用0.2mol/L的二硫苏糖醇去除,筛选ABO,Rh血型系统表型相同的去白细胞悬浮红细胞,ABO、RhD血型相同的X射线辐照单采少白细胞血小板的进行临床输注,输注效果均良好。结论临床应用兆珂治疗患者前需建立疑难输血处理方案,治疗前做好输血相容性检测,疑难配血时可应0.2mol/L的二硫苏糖醇处理后再做血清学相关检测。

Objective To observe the infusion effect of blood products,and to explore the establishment of blood transfusion program for patients with difficult matching caused by daratumumab and provide theoretical support for the program.Methods Saline method,gel microcolumn method,polybrene method and dithiothreitol treatment were used to screen matched blood products for patients in transfusion compatibility test.The Basic information of patients,blood routines before and after blood product transfusion,stool routines and other clinical examination results were obtained by hospital HIS system,LIS system and telephone follow-up.The transfusion effect of blood products was analyzed.Results The application of daratumumab treatmentcould interfere with the results of transfusion compatibility test,resulting in difficult blood matching.This interference could be removed with 0.2mol/L dithiothreitol.The clinical transfusion effect was good when leukocytedepleted suspended red blood cells with the same phenotype of ABO and Rh blood group systems and X-ray irradiated leukocyte-poor platelets with the same ABO and RhD blood groups were screened.Conclusion It is necessary to establish a difficult blood transfusion treatment plan before clinical application of daratumumab treatment.Blood transfusion compatibility test should be done before treatment.Serological correlation test should be done after treatment with 0.2mol/L dithiothreitol during difficult blood matching.