[由内在因子抗体干扰引起的虚假正常维生素B12水平的恶性贫血:病例报告]
Wiame Ghammad1, Aurélie Sarthou1, Marion Dutkiewicz1
1Service d'Hématologie biologique, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
Annales de biologie clinique
|November 21, 2023
概括
由于自抗体对维生素B12检测的干扰,恶性贫血的诊断可能具有挑战性. 这一案例凸显了为准确评估可巴拉胺水平而需要标准化测试方法的必要性.
科学领域:
- 临床医学 临床医学
- 血液学 血液学 血液学
- 临床化学 临床化学
背景情况:
- 宏细胞贫血和血小板缺血可以呈现出正常的血清维生素B12水平.
- 高水平的同类氨酸和甲基马龙酸,以及骨髓异质化,尽管进行了正常的维生素B12测定,但暗示着科巴拉缺乏.
- 恶性贫血是一种影响维生素B12吸收的自身免疫性疾病.
研究的目的:
- 报告一种患有恶性贫血的病例,与维生素B12测试干扰相关的诊断挑战.
- 研究自身抗体对维生素B12测量技术的影响.
- 为了强调测试标准化在诊断维生素B12缺乏障碍中的重要性.
主要方法:
- 一个48岁的妇女患有宏细胞性贫血和血小板缺血的案例介绍.
- 使用了标准实验室检测,包括血清叶酸,维生素B12,同类半氨酸和甲基马龙酸.
- 雇员骨髓吸取物用于形态评估.
- 使用竞争性结合化学发光 (CBLA) 和电化学发光进行了连续维生素B12测定.
- 对抗内在因子抗体进行了测试,并进行了免疫球蛋白吸附研究.
主要成果:
- 最初的维生素B12水平正常,但间接标志物表明缺乏.
- 检测到高水平的抗内在因子抗体,导致CBLA测定干扰.
- 通过电化学发光测量的维生素B12水平明显较低.
- 免疫球蛋白吸附证实自抗体干扰与科巴胺试验.
结论:
- 自体抗体,特别是抗内在因子抗体,可以干扰标准维生素B12测定,导致不准确的结果.
- 准确诊断恶性贫血需要仔细考虑测试方法和潜在干扰.
- 维生素B12测定标准化对于可靠的诊断和治疗科巴拉明缺乏症至关重要.
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