Transfusionsmedizin 2015; 5(2): 74-79
DOI: 10.1055/s-0035-1545924
Praxistipp
Georg Thieme Verlag KG Stuttgart · New York

Stellenwert löslicher rekombinanter Blutgruppenproteine im immunhämatologischen Labor

Rating of Soluble Recombinant Blood Group Proteins in the Immunohematological Laboratory
H.-G. Heuft
Institut für Transfusionsmedizin, Medizinische Hochschule Hannover, Hannover
› Author Affiliations
Further Information

Publication History

Publication Date:
26 May 2015 (online)

Zusammenfassung

Seit den 1990er-Jahren sind eine Reihe löslicher rekombinanter Blutgruppenproteine (rBGP) mit einer breiten Palette von klinischen und labortechnischen Einsatzmöglichkeiten entwickelt worden. Das derzeitige rBGP-Portfolio umfasst Substanzen, die auch im klinischen Alltag häufige Erythrozytenalloantikörper mit hoher klinischer Relevanz neutralisieren (z. B. rekombinante Kell-, Duffy-, Lutheran-Blutgruppensystemproteine), und solche, die seltene Alloantikörper unterschiedlicher klinischer Relevanz binden. Von besonderem Interesse sind rBGP, die Antikörper gegen hochfrequente Erythrozytenantigene hemmen. Solche Antikörper sind zwar vergleichsweise selten, decken aber das gesamte Spektrum transfusionsmedizinischer Relevanz (von völliger Asymptomatik bis zu schweren Transfusionsreaktionen und Fällen von Morbus haemolyticus neonatorum, Abk.: MHN) ab und verursachen immer deutlichen Mehraufwand im Labor. Die Daten aus mono- und multizentrischen Studien sowie eigene Untersuchungen zeigen, dass lösliche rBGP ihre Zielantikörper zuverlässig hemmen, während die antithetischen Antikörper im Sinne einer hohen Spezifität nicht neutralisiert werden, und Antikörper gegen andere Blutgruppensysteme unverändert reaktiv bleiben, d. h. in Antikörpergemischen demaskiert und identifiziert werden können. Bei der Differenzierung von Erythrozytenalloantikörpern in Antikörpergemischen und von Antikörpern gegen hochfrequente Erythrozytenantigene machen rBGP die Befundung sicherer und erzielen eine deutliche Beschleunigung der prätransfusionellen Diagnostik.

Abstract

Since the mid-1990s a considerable number of recombinant soluble blood group proteins (rBGP) with a broad range of clinical and laboratory applicability have been developed. The current portfolio of rBGP consists of substances that reliably neutralize frequent red blood cell alloantibodies with high clinical significance encountered in every-day routine (e.g. Kell-, Duffy-, Lutheran red cell antibodies) as well as proteins that bind to rare alloantibodies of different clinical relevance. Of special interest are rBGP that inhibit antibodies to high incidence red cell antigens. These antibodies are relatively rare, but cover the complete range of clinical relevance from symptomlessness to severe transfusion reactions and hemolytic disease of the newborn (HDN) and always cause a significant work load in the immunohematological laboratory. Data from mono- and multicentric studies and from own investigations show that soluble rBGP reliably inhibit their target antibodies while antithetic antibodies remain unaffected suggesting a highly specific binding to the target antibody. Antibodies to other blood group systems in antibody mixtures remain reactive so that they are unmasked and can be more easily recognized by additional antibody testing. In cases of red cell antibody mixtures and in cases of antibodies to high incidence red cell antigens rBGP substantially increase the diagnostic safety and accelerate pretransfusion diagnostic measures.

 
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