The utility of a monocyte monolayer assay in the assessment of intravenous immunoglobulin-associated hemolysis.

Autor: Tong TN; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada., Blacquiere M; Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada., Sakac D; Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada., Burke-Murphy E; Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada., Yi Q; Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada., Callum J; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Cserti-Gazdewich C; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada., Parmar N; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada., Shehata N; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.; Canadian Blood Services, Toronto, Ontario, Canada., Pavenski K; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada., Lau W; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Canadian Blood Services, Toronto, Ontario, Canada.; Department of Transfusion Medicine, Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada., Lin Y; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Lieberman L; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada., Branch DR; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada.; Departments of Medicine, University of Toronto, Toronto, Ontario, Canada., Pendergrast J; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2020 Dec; Vol. 60 (12), pp. 3010-3018. Date of Electronic Publication: 2020 Oct 22.
DOI: 10.1111/trf.16131
Abstrakt: Background: Hemolysis following the administration of intravenous immunoglobulin (IVIG) is an important adverse event (AE). While the monocyte monolayer assay (MMA) has been used to predict in vivo hemolysis when serologically incompatible blood may be transfused, it has also been shown to correlate with IVIG-associated hemolysis. In this study, the MMA was examined for its utility in assessing the risk of hemolysis after IVIG.
Study Design and Methods: Forty-two non-blood group O patients receiving high-dose IVIG (≥2 g/kg) were examined using an autologous and allogeneic MMA. Hemolysis was defined by a drop in hemoglobin of ≥1 g/L, a positive direct antiglobulin test (DAT) and eluate, and a decrease in haptoglobin or increase in lactate dehydrogenase and/or reticulocytes.
Results: Forty-two patients provided 50 assessable postinfusion samples, with hemolysis observed in 20 (40%) of cases. Autologous MMA using post-IVIG red blood cells significantly correlated with clinical outcomes when compared to allogeneic MMA (P = .0320 vs .5806, t test). No significant difference in receiver operating characteristics was observed when comparing autologous MMA testing against DAT for the diagnosis of IVIG-associated hemolysis. However, when using samples collected 5 to 10 days after receipt of high-dose IVIG, the autologous MMA had higher sensitivity than the DAT.
Conclusion: MMA testing with autologous monocytes collected 5 to 10 days after receipt of high-dose IVIG can be used for the diagnosis of IVIG-associated hemolysis and may be of particular value in cases in which the Day 5 to 10 DAT is negative.
(© 2020 AABB.)
Databáze: MEDLINE
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