[1]梁延连,杨 燕,吴明磊,等.临床患者血浆中β- 内酰胺类药物＆抗体致输血无效及对供者红细胞亲和力的研究[J].现代检验医学杂志,2023,38(01):156-160.[doi:10.3969/j.issn.1671-7414.2023.01.029]
　LIANG Yan-lian,YANG Yan,WU Ming-lei,et al.Study on β-lactam Drugs and Antibodies in Clinical Patients’ Plasma Causing Blood Transfusion Inefficiency and Affinity for Donor Red Blood Cells[J].Journal of Modern Laboratory Medicine,2023,38(01):156-160.[doi:10.3969/j.issn.1671-7414.2023.01.029]
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临床患者血浆中β- 内酰胺类药物＆抗体致输血无效及对供者红细胞亲和力的研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年01期
页码:
156-160
栏目:
论著
出版日期:
2023-01-15

文章信息/Info

Title:
Study on β-lactam Drugs and Antibodies in Clinical Patients’ Plasma Causing Blood Transfusion Inefficiency and Affinity for Donor Red Blood Cells
文章编号:
1671-7414（2023）01-156-05
作者:
梁延连1; 杨 燕2; 吴明磊3; 方泰石2; 苏宇清1; 吴亚飞2; 彭 龙1; 吴 凡1; 梁 爽1; 刘嘉婧2; 徐筠娉1
（1. 深圳市血液中心输血医学研究所，广东深圳 518035；2. 深圳市第三人民医院，广东深圳 518053；3. 江苏中济万泰生物医药有限公司，江苏无锡 214400）
Author(s):
LIANG Yan-lian1;  YANG Yan2; WU Ming-lei3; FANG Tai-shi2;  SU Yu-qing1;  WU Ya-fei1;  PENG Long1;  WU Fan1; LIANG Shuang1;  LIU Jia-jing2;  XU Yun-ping
（1.Institute of Transfusion Medicine, Shenzhen Blood Center, Guangdong Shenzhen 518035，China; 2.the Third People’s Hospital of Shenzhen, Guangdong Shenzhen 518053，China; 3.Jiangsu ZhongjiWantai Biomedical Co. LTD, Jiangsu Wuxi 214400, China）
关键词:
β- 内酰胺类药物; 药物抗体; 抗体亲和力; 免疫性溶血性贫血
分类号:
R457.12
DOI:
10.3969/j.issn.1671-7414.2023.01.029
文献标志码:
A
摘要:
目的 分析临床患者血浆中β- 内酰胺类药物＆抗体对供者红细胞的亲和力，探究药源性溶血性贫血及输血无效的临床特点。方法 选择2021 年11 月～ 2022 年4 月期间临床送检的4 例有β- 内酰胺类药物用药史的临床患者，检测ABO 与Rh 血型，直接抗球蛋白试验（direct antiglobulin test ，DAT）、不规则抗体鉴定（identification of irregularantibodies，IAT）与β- 内酰胺类药物抗体及效价，对DAT 阳性的患者红细胞进行酸放散并检测放散液中β- 内酰胺类药物抗体。选择ABO 和Rh 同型的供者红细胞与患者血浆在37℃无菌条件下体外致敏，监测β- 内酰胺类药物＆抗体在0 ，24，48 和72 h 与供者红细胞的亲和力，并观察加入补体后的溶血程度。结果 4 例患者血浆中均存在β- 内酰胺类药物抗体，停药前输血无效，停药后输血效果良好。患者1：A 型，RhCCDee，DAT 阳性（3+W），IAT 阴性，血浆中存在头孢哌酮药物抗体（效价：1∶64）、阿莫西林药物抗体（效价：1∶16），放散液中存在头孢哌酮药物抗体。患者2：A 型，RhCcDee，DAT 阳性（4+W），IAT 阴性，血浆中存在头孢哌酮药物抗体（效价：1∶128），放散液中存在头孢哌酮药物抗体。患者3：A 型，RhCcDee，DAT 阳性（4+），IAT 阳性，鉴定为抗 E 抗体，血浆中存在阿莫西林药物抗体（效价：1∶16）、亚胺培南药物抗体（效价：1∶64）、头孢哌酮药物抗体（效价：1∶128），放散液中存在亚胺培南、头孢哌酮药物抗体。患者4：A 型，RhCCDee ,DAT 阳性（1+），IAT 阳性，鉴定为抗-E.c 抗体，血浆中存在阿莫西林药物抗体（效价：1∶32），放散液中未检测到药物抗体。4 例患者血浆与供者红细胞体外致敏24 h 后DAT均为阳性，48 和72 h 内逐渐增强，加入补体后均可引起红细胞溶解。结论 头孢哌酮、阿莫西林和亚胺培南三种β-内酰胺类药物＆抗体可迅速结合到供者红细胞表面并随时间延长而增强，有补体存在的条件下可在24 ～ 72 h 内破坏供者红细胞引起溶血，导致输血无效。
Abstract:
Objective To analyze the affinity of β-lactam drugs & antibodies in plasma of clinical patients to donor erythrocytes, and explore the clinical characteristics of drug-induced hemolytic anemia and ineffective transfusion. Methods From November 2021 to April 2022, 4 clinical patients with a history of β-lactam drug use were selected for detection of ABO and Rh blood group, direct antiglobulin test (DAT), irregular antibody identification (IAT) and β-lactam drug antibody and titer. Erythrocytes of DAT positive patients were dispersed with acid and β-lactam antibodies were detected in the dispersed solution. ABO, Rh isotype donor erythrocytes and patient plasma were sensitized in vitro under sterile conditions of 37℃ . The affinity of β-lactam drugs & antibodies to donor erythrocytes at 0 , 24, 48 and 72 h were monitored, and the degree of hemolysis after complement addition was observed. Results There were β-lactam antibodies in the plasma of 4 patients. Blood transfusion was ineffective before drug withdrawal, but the blood transfusion effect was good after drug withdrawal. Patient 1: type A, RhCCDee, DAT positive (3+W), IAT negative, cefoperazone drug antibody in plasma (titer：1∶64), amoxicillin drug antibody (titer：1∶ 16), cefoperazone drug antibody in the discharge fluid. Patient 2: type A, RhCcDee, DAT positive (4+W), IAT negative, cefoperazone drug antibody in plasma (titer：1∶128), cefoperazone drug antibody in the discharge fluid. Patient 3: type A, RhCcDee, DAT positive (4+), IAT positive, identified as anti-E antibody, amoxicillin drug antibody (titer：1∶16), imipenem drug antibody (titer：1∶64), cefoperazone drug antibody (titer：1∶128) in plasma, imipenem drug antibody and cefoperazone drug antibody. Patient 4: type A, RhCCDee,DAT positive (1+), IAT positive, identified as anti-E.c antibody and amoxicillin antibody was present in plasma (titer：1∶32), but no drug antibody was detected in the release fluid. After sensitization of plasma and donor erythrocytes in vitro for 24 h, DAT was positive in all the 4 patients, and it was gradually enhanced within 48 h and 72 h. The addition of complement could cause erythrocyte lysis in all the 4 patients. Conclusion Cefoperazone, amoxicillin and imipenem were three β-lactam drugs & antibodies can bind to the surface of donor erythrocytes rapidly and enhance with time. In the presence of complement, they could destroy donor erythrocytes and cause hemolysis within 24 h to 72 h, resulting in ineffective transfusion.

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备注/Memo

备注/Memo:
基金项目： 广东省医学基金（项目编号：B2020179），深圳市医学三名工程(项目编号：SZSM201811092)，深圳市医学重点学科（项目编号：SZXK070）。
作者简介： 梁延连（1973-），女，本科，主任技师，研究方向：免疫血液学与临床输血，E-mail：lianviky@126.com。
杨燕（1976-），女，本科，副主任技师，研究方向：临床免疫学与输血学检验，E-mail：gy3488@163.com，并列第一作者。
通讯作者：徐筠娉（1982-），女，副教授，研
更新日期/Last Update: 2023-01-15