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摘要: 目的 探讨RhD--缺失型患者的血型血清学特征，分析抗-Rh17抗体产生及其临床意义。方法 采用直接/间接凝集和吸收放散试验检测患者红细胞Rh抗原及血清中抗体，结合生育史和输血史进行分析。结果 患者为B型RhD阳性，缺失C/c、E/e抗原，抗体鉴定强阳性，特异性为抗-Rh17抗体。结论 RhD--缺失型个体妊娠或输血极易产生抗-Rh17高频抗体，输血前进行RhCcEe抗原鉴定，为患者制定合适的输血方案，对保障临床输血安全，提高救治率有重要意义。Abstract: Objective To investigate the serological characteristics in patient with RhD--phenotype, and analyze the generation of anti-Rh17 antibody and its clinical significance.Methods The Rh antigen of erythrocytes and antibodies in serum were detected by agglutination test, absorption and eluate test, respectively. The clinical significance combined with the history of fertility and blood transfusion was analyzed.Results Detailed typing and antibody identification showed that the patient had a B RhD--phenotype with anti-Rh17 antibodies.Conclusion The individual with RhD--phenotype would be sensitized by Rh antigens and produce anti-Rh17 antibodies against highly prevalent antigens by blood transfusion or pregnancy. The identification of RhCcEe antigen before blood transfusion was great significant. It could contribute to formulate appropriate blood transfusion scheme for patients, ensuring the safety of clinical blood transfusion and improving the treatment rate.
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Key words:
- RhD-- /
- anti-Rh17 antibody /
- serological characteristics
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表 1 患者及子女的血型血清学结果
被检者 抗-A 抗-B Ac Bc 抗-D 抗-C 抗-c 抗-E 抗-e 直抗 抗-D1(IS/IAT) 抗-D2 抗-D3 抗体鉴定 结果 患者 0 4+ 2+ 0 4+ 0 0 0 0 0 w/4+ 3+ 3+ + B D-- 长女 0 0 4+ 4+ 4+ 3+ 0 0 3+ 0 0/4+w 3+ 3+ 0 O DCCee 儿子 0 0 3+s 4+ 4+ 3+ 0 0 3+ 0 0/4+w 3+ 3+ 0 O DCCee 次女 0 0 4+ 4+ 3+s 3+ 0 0 3+ 0 0/4+w 3+ 3+ 0 O DCCee 三女 0 0 3+s 3+s 4+ 3+ 0 0 3+ 0 0/4+w 3+ 3+ 0 O DCCee 抗-D为IgM抗体，抗-D1为IgG抗体，抗-D2和D3为IgM+IgG抗体。 
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表 2 患者血清抗体鉴定反应格局
序号 谱细胞反应格局 试验条件 C D E c e Cw K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga IS 凝聚胺 IAT 1 + + 0 0 + + 0 + 0 + 0 + + + 0 + 0 + + + 0 + 0 0 + + 1+ 3+ 4+ 2 + + 0 0 + 0 + 0 0 + 0 + + 0 + 0 0 + 0 0 + 0 + 0 + 0 1+s 3+ 4+ 3 0 + + + 0 0 0 + 0 + 0 + + 0 + 0 0 + + + + + + 0 + + 1+ 3+ 4+ 4 0 + 0 + + 0 0 + 0 + 0 + 0 + + 0 0 + 0 + + 0 + 0 + + 1+ 3+ 4+ 5 + 0 0 0 + 0 0 + 0 + / + 0 + + + 0 + + + 0 + + 0 + + 1+ 3+ 4+ 6 0 0 + + 0 0 0 + 0 + / + + + + 0 0 0 + + 0 + + 0 + + 1+ 3+ 4+ 7 0 0 0 + + 0 0 + 0 + / + 0 + + 0 + 0 + + 0 + + 0 + 0 1+ 3+ 4+ 8 0 0 0 + + 0 + 0 0 + / + 0 + 0 + 0 + + 0 + 0 + 0 + 0 1+ 3+ 4+ 9 0 0 0 + + 0 + + 0 + / + + 0 + + 0 0 + + + + 0 0 + 0 1+ 3+ 4+ 10 0 0 0 + + 0 0 + 0 + 0 + + 0 + 0 0 + + 0 + + + + + + 1+ 3+ 4+ 11 + + + 0 + 0 0 + 0 + / + 0 + + + 0 + 0 + + + + 0 + + 1+ 3+ 4+ 自身c 0 0 0
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表 3 不同表型红细胞测定患者血清效价
红细胞表型 128 256 512 1024 DccEE 4+w 3+s 2+w 1+w dCCee 4+w 3+s 2+s 1+s dccee 4+w 3+ 2+ 1+ dCcee 4+w 3+s 2+w 1+w dccEe 4+w 3+ 2+ 1+
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表 4 患者血清吸收放散试验结果
细胞表型 DccEE dCCee dccee dCcee dccEe 上清液 放散液 上清液 放散液 上清液 放散液 上清液 放散液 上清液 放散液 DccEE 1+ 4+w 1+ 4+w 1+ 4+w 1+s 4+w 1+ 4+w dCCee 2+ 4+w ± 4+w 1+ 4+w 2+ 4+w 1+ 4+ dccee 2+s 4+w 1+ 4+w ± 4+w 2+ 4+w 1+ 4+ dCcee 2+ 4+w 1+ 4+w 1+ 4+w ± 4+ 1+ 4+ dccEe 2+ 4+w 1+ 4+w 1+ 4+w 2+ 4+ 0 4+w
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表 5 患者红细胞与单克隆抗体的吸收放散试验
抗体 吸收试验 放散试验 试剂细胞 吸收前效价 吸收后效价 放散液 患者细胞 阳性对照 患者细胞 阳性对照 抗-C 16 16 < 2 0 2+ CCee 抗-c 16 16 < 2 0 2+ ccEE 抗-E 32 32 < 2 0 2+ ccEE 抗-e 8 8 < 2 0 4+w CCee
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| 引用本文: |
强文, 瞿珍, 何鸣镝, 等. RhD--缺失型患者的血型血清学特征及临床意义分析[J]. 临床血液学杂志, 2022, 35(8): 595-597. doi: 10.13201/j.issn.1004-2806.2022.08.014
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| Citation: |
QIANG Wen, QU Zhen, HE Mingdi, et al. Analysis of serological characteristics and clinical significance of RhD--patient[J]. J Clin Hematol, 2022, 35(8): 595-597. doi: 10.13201/j.issn.1004-2806.2022.08.014
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