Nhân một trường hợp có kháng thể bất thường ở bệnh nhân điều trị Daratumumab=A case report: The patient using Daratumumab had irregular antibodies

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Tác giả: Thị Thanh Nga Hoàng, Quang Tùng Nguyễn, Quang Thịnh Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.469-477

Bộ sưu tập: Metadata

ID: 478307

Thêm vào giỏ

Daratumumab is a CD38 inhibitor monoclonal antibody and indicated in the treatment of multiple myeloma. Beside of destroying plasmocyte, Daratumumab also binds to CD38 on red blood cell membranes leading to a positive Coombs test result. Therefore, the presence of anti-CD38 antibodies may mask the subsistence of other allogeneic antibodies in the patient's serum. Objectives: Identify irregular antibodies and select appropriate RBCs to transfuse blood for patient with multiple myeloma using Daratumumab. Subjects: A case of multiple myeloma using daratumumab with irregular antibodies at the National Institute of Hematology and Blood Transfusion in 2023. Research method: Case description. Results: The patient's serum reacted to all red blood cells which used for identifying the irregular antibodies at 37°C with antiglobulin
after treating CD38 on the red blood cell membranes with 0.2M DTT, the patient's serum only reacted to red blood cells with E antigen. Transfusion of RBCs without E antigen to the patient has no responses
the hemoglobin increased 12 g/L and the values of hemolysis markers have unchanged after blood transfusion. Conclusion: Anti-E was determined in the serum of patient by using erythrocytes to identify irregular antibodies that have removed CD38 with 0.2M DTT. We selected of RBCs without E antigen for patient in order to ensure the safety and efficiency in blood transfusion.Daratumumab là kháng thể đơn dòng kháng CD38 được chỉ định trong điều trị đa u tủy xương. Ngoài phá hủy tương bào, Daratumumab còn liên kết với CD38 trên màng hồng cầu làm kết quả xét nghiệm Coombs dương tính. Do đó, sự có mặt của kháng thể chống CD38 có thể che lấp sự tồn tại của kháng thể đồng loài khác trong huyết thanh bệnh nhân. Mục tiêu: Xác định kháng thể bất thường và lựa chọn chế phẩm hồng cầu phù hợp để truyền cho bệnh nhân đa u tủy xương sử dụng Daratumumab. Đối tượng nghiên cứu: Một trường hợp đa u tủy xương sử dụng Daratumumab có kháng thể bất thường tại Viện Huyết học – Truyền máu Trung ương năm 2023. Phương pháp nghiên cứu: Mô tả ca bệnh. Kết quả: Ở điều kiện 370C có kháng globulin, huyết thanh bệnh nhân phản ứng với tất cả hồng cầu được sử dụng để định danh kháng thể bất thường
sau khi xử lý CD38 trên màng hồng cầu bằng DTT 0,2M, huyết thanh bệnh nhân chỉ phản ứng với những hồng cầu có kháng nguyên E. Truyền khối hồng cầu không có kháng nguyên E cho bệnh nhân không thấy xuất hiện phản ứng truyền máu. Sau truyền máu, nồng độ huyết sắc tố của bệnh nhân tăng 12 g/l và giá trị của các dấu ấn tan máu không thay đổi. Kết luận: Sử dụng hồng cầu định danh kháng thể bất thường đã loại bỏ CD38 bằng DTT 0,2M xác định được huyết thanh bệnh nhân có kháng thể chống E. Lựa chọn khối hồng cầu không có kháng nguyên E truyền cho bệnh nhân đảm bảo an toàn và hiệu quả truyền máu.

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