不同疾病阶段多发性骨髓瘤患者的疑难配血与解决策略

The challenging blood cross-matching and resolution for multiple myeloma patients in different disease stages

目的探讨不同疾病阶段多发性骨髓瘤(MM)患者的疑难配血及解决策略。方法对1名首诊MM、拟输血患者的血液采用微柱凝胶法、试管法与献血者的血液做交叉配血,对于主侧凝集者,取患者的血浆采用凝聚胺法及患者血浆稀释后采用微柱凝胶法再与献血者悬浮红细胞做交叉配血;对1名复发难治MM、拟输血患者的血液采用微柱凝胶法与献血者的血液做交叉配血试验。结果(1)病例1:为首诊MM患者,采用微柱凝胶法患者血液与2名献血者血液交叉配血的主侧均呈细线状凝集,试管法配血主侧同样凝集--显微镜下凝集呈缗钱状;接着用凝聚胺法及患者血浆稀释后用微柱凝胶法和上述2名献血者的血液再次配血:患者血液与献血者血液的交叉配血相合。(2)病例2:诊断为复发难治的MM,用微柱凝胶法患者血液与2名献血者血液交叉配血的主次侧均呈颗粒状凝集;针对患者在使用达雷妥尤单抗(CD38单抗)治疗,以二硫苏糖醇(DTT)处理献血者红细胞后,再用微柱凝胶法与患者的血浆交叉配血,结果配得相合的悬浮红细胞。结论凝聚胺法和患者血浆稀释后微柱凝胶法交叉配血适用于初诊MM的配血;对于CD38单抗治疗的MM患者,加做DTT法即可消除药物对其交叉配血的影响。

Objective To explore the challenging blood cross-matching and resolution for multiple myeloma(MM)patients in different disease stages.Methods For a patient who was first diagnosed as MM and scheduled for blood transfusion,his blood was cross matched with donors’blood by microcolumn gel method and tube test.When the major side of cross-matching was agglutinated,the patient’s plasma was cross matched with donors’red blood cell(RBC)by polybrene test,then plasma dilution cross matched with donors’RBC by microcolumn gel method.For a patient who was diagnosed as recurrent refractory MM and scheduled for blood transfusion,his blood was cross matched with donors’blood by microcolumn gel method.Results (1)Case 1 was a first-visit outpatient.The major side of microcolumn cross-match test was agglutinated with the shape of fine line.The result of tube method also showed agglutination of major sides,and the rouleaux were detected by the microscopy.Then polybrene method and microcolumn gel method(after plasma diluted)were applied for cross-matching again with the above two donors’blood and showed compatibility.(2)Case 2 was a recurrent refractory MM patient.The major and minor sides of microcolumn cross-match test were both agglutinated with the shape of granular.The patient was treated with anti-CD38 monoclonal antibody.The RBCs,after treated with dithiothreitol(DTT)was used to cross match with patient plasma by microcolumn test,and the result was compatible.Conclusion Polybrene method and microcolumn gel method after plasma diluted are suitable for blood cross-matching of newly diagnosed MM patients,also for those treated with CD38 monoclonal antibody,as the drug interference with cross-matching can be eliminated by DTT.