两例由抗CD36抗体引起的血小板输注无效
发布时间：2011年05月18日
来源：南宁输血医学研究所血小板免疫学网 阅读次数：
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| 作者：Saw CL, Szykoluk H, Curtis BR, Zelcer S, Eckert K, Forrest D, Nickerson P, Petraszko T, Goldman M.来源：Transfusion. 2010 Dec;50(12):2638-42. 摘要 背景：由抗GPIV(CD36)抗体引起的血小板输注无效比较少见，特别是在非高加索人种中。现我们报告两例由抗CD36抗体引起的血小板输注无效。研究设计及方法：一名黎巴嫩后裔的5岁女孩及一名70岁的中国籍男子在急性髓性白血病化疗期间，输注HLA相配合血小板后仍出现血小板输注无效。使用血小板抗体筛选试剂盒（PAKPLUS, GTI Diagnostics）及血小板抗原单克隆抗体特异性免疫固定检测技术（MAIPA）进行检测，第二个病例还使用了ELISA改良的抗原捕获试验(MACE)进行检测。 结果：PAKPLUS试剂盒结果证实两个患者均含有抗GPIV(CD36)抗体。MAIPA结果证实两名患者均为CD36缺失型个体。使用MAIPA技术证实第一例患者含有抗CD36抗体，但未能证实第二例患者也含有抗CD36抗体。第二例患者还使用了MACE技术进行检测，MACE结果依据所使用血小板糖蛋白单克隆抗体不同而出现不同结果。由于在加拿大人群中没有CD36抗原阴性献血员，故从威斯康星血液中心紧急调来CD36阴性血小板并给患者成功输注。 结论：报道了两例有临床意义的抗CD36抗体。其中一例较为复杂，使用了不同血小板糖蛋白单克隆抗体进行MAIPA和MACE实验。通过这两例病例，提示我们在日常工作中需保存不同种族罕见献血员血液制品，并且在处理类似情况时，国际间的合作也是非常重要的。 Two cases of platelet transfusion refractoriness associated with anti-CD36 Saw CL, Szykoluk H, Curtis BR, Zelcer S, Eckert K, Forrest D, Nickerson P, Petraszko T, Goldman M.Transfusion.2010 Dec;50(12):2638-42. Abstract BACKGROUND: Antibodies to platelet (PLT) glycoprotein (GP) IV (CD36) have been implicated in rare cases of PLT refractoriness, particularly in non-Caucasians. We report two cases of PLT transfusion refractoriness linked to anti-CD36.STUDY DESIGN AND METHODS: A 5-year-old female of Lebanese descent and a 70-year-old male of Chinese descent both failed to respond to HLA-matched PLT transfusions during acute myelogenous leukemia induction therapy. Antibody screening was performed using a PLT antibody solid-phase kit (PAKPLUS, GTI Diagnostics), followed by the monoclonal antibody-specific immobilization of PLT antigen (MAIPA) test and, for the second case, the modified antigen capture enzyme-linked immunosorbent assay (MACE).RESULTS: Both patients demonstrated antibody to GP IV (CD36) on the PAKPLUS assay. On MAIPA testing, both phenotyped as CD36 negative. Anti-CD36 was demonstrated by MAIPA in the first case. In the second case, antibodies were not detected by MAIPA and variably detectable by MACE, depending on the mouse monoclonal antibody (MoAb) used. Because no Canadian CD36-negative donors were available, antigen-negative plateletpheresis units from the BloodCenter of Wisconsin were successfully transfused.CONCLUSION: Two cases of clinically significant CD36 antibodies are reported. Investigation of one case was complicated by steric inhibition of binding in the MAIPA and MACE assays with certain MoAbs. The cases demonstrate the importance of maintaining an ethnically diverse pool of rare donors and the value of international cooperation in the management of these patients. 翻译：周燕 校对：何保仁 |
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