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摘要: 目的 在不增加红细胞库存情况下，分析三级综合医院实施Rh(D、C、E、c、e)抗原配型输血的临床应用情况及效果。方法 2019—2020年对A医院所有实施Rh配型输血的患者为Ⅰ组，其中血液病患者输血为Ⅱ组；2020年8—9月在B医院实施Rh配型输血的血液病患者为Ⅲ组。比较3组供受者Rh表型分布，前后发血量、库存量、Rh意外抗体检出率的变化及各配型方案的输血率。结果 2家医院红细胞日均发血量与库存量之比，前后均无明显变化：18.69% vs 19.21%和8.96% vs 9.53%，即均未采取增加库存量以提高完全匹配率的措施。3组供受者前4位Rh表型分布相同：CCDee>CcDEe>CcDee>ccDEE。Ⅲ组Rh抗原完全匹配和抗原回避匹配方案的输血率之和为93.40%，明显高于Ⅰ组的80.63%及Ⅱ组的81.80%(P < 0.01)；3组CcDEe表型患者的Rh抗原完全匹配和抗原回避匹配输血率之和相同均为100.00%，其余表型Ⅲ组明显高于Ⅰ组(P < 0.05)。Ⅰ组和Ⅲ组引入1个Rh抗原的输血率8.22%和4.71%，差异无统计学意义；引入2个Rh抗原的输血率11.15%和1.89%，Ⅲ组明显低于Ⅰ组及Ⅱ组的10.85%(P < 0.05)。实施匹配输血前后Rh意外抗体检出率：Ⅰ组为0.23%和0.34%，Ⅱ组为0.39%和0.57%，Ⅲ组为0.86%和0。结论 三级综合医院在不增加红细胞库存条件下实施Rh配型输血，能实现80.00%以上的红细胞Rh(D、C、E、c、e)抗原完全匹配或抗原回避匹配输注；仅针对有反复输血需求的患者实施Rh匹配输注的策略，完全匹配和抗原回避匹配输血率可达90.00%以上。各医院需从自身实际出发选择匹配策略，以降低Rh抗体产生率，提高输血安全性。Abstract: Objective To study the feasibility of implementing Rh(D, C, E, c, e) antigen matching blood transfusion in tertiary general hospitals without increasing the red blood cell inventory.Methods From 2019 to 2020, the Rh matched blood transfusion be implemented for all patients in hospital A was Ⅰ group, the blood transfusion data of hematologic diseases was Ⅱ group, and the Rh matched blood transfusion be implemented for hematologic diseases in hospital B from August to September 2020 was Ⅲ group. The Rh phenotype distribution of the three groups of donors and recipients, the changes in blood volume, inventory, Rh accidental antibody detection rate, and blood transfusion rate of each matching scheme were compared.Results There was no significant change in the ratio of the daily average red blood cell volume to the inventory in each group: 18.69% vs 19.21% and 8.96% vs 9.53%, that is no increase in inventory was taken to improve the perfect match rate measures. The distribution of the top 4 Rh phenotypes of the three groups of donors and recipients was the same: CCDee>CcDEe>CcDee>ccDEE. The sum of the blood transfusion rate of Ⅲ group Rh antigen complete matching and antigen avoidance matching scheme was 93.40%, which was significantly higher than 80.63% of Ⅰ group, and 81.80% of Ⅱ group(P < 0.01). The sum of the transfusion rate of Rh antigen complete matching and antigen avoidance matching of the three groups of patients with CcDEe phenotype was the same as 100.00%, and the other phenotype of Ⅲ group was significantly higher than that of Ⅰ group(P < 0.05). The blood transfusion rate of 1 Rh antigen introduced in Ⅰ group and Ⅲ group was 8.22% and 4.71%, the difference was not obvious; the blood transfusion rate of 2 Rh antigens introduced was 11.15% and 1.89%, Ⅲ group was significantly lower than Ⅰ group, and also significantly lower than Ⅱgroup 10.85%(P < 0.05). The detection rates of Rh accidental antibodies before and after matched blood transfusion were 0.23% and 0.34% in Ⅰ group, 0.39% and 0.57% in Ⅱ group, and 0.86% and 0 in Ⅲ group.Conclusion It may be feasible for a tertiary general hospital to implement Rh matched blood transfusion without increasing the red blood cell inventory, and it can achieve more than 80.00% of the red blood cell Rh(D, C, E, c, e) antigen complete match or antigen avoidance matched transfusion. The strategy of Rh matching transfusion is implemented only for patients with repeated blood transfusion needs, and the transfusion rate of perfect matching and antigen avoidance matching can reach more than 90.00%.
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Key words:
- Rh phenotype /
- matching transfusion /
- strategy
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表 1 实施匹配输血前后日均红细胞发血量与日均红细胞库存量变化情况
U 组别 红细胞成分 实施前 实施后 Ⅰ、Ⅱ组 日均发血量 47.05/35.64 51.58/39.08 日均储血量 251.65/190.64 265.85/201.40 Ⅲ组 日均发血量 42.19/24.98 41.43/24.53 日均储血量 470.87/278.76 434.52/257.94 
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表 2 各组Rh表型分布情况
% 组别 样本量/例 CCDee CcDEe CcDee ccDEE ccDEe CCDEe ccDee CcDEE CCDEE Ⅰ组供者 15 829 48.00 33.39 8.66 6.02 2.75 0.45 0.32 0.19 0 Ⅰ组受者 5392 44.68 40.88 7.12 5.60 2.71 0.63 0.26 0.26 0.02 Ⅱ组供者 2000 50.57 32.45 8.40 4.85 2.55 0.45 0.35 0.15 0 Ⅱ组受者 440 50.91 31.25 9.77 6.36 2.95 0.68 0.68 0.23 0 Ⅲ组供者 212 43.95 34.53 8.07 4.48 1.79 4.93 0 0.45 1.79 Ⅲ组受者 119 45.38 31.93 6.72 5.88 3.36 5.04 0 0.84 0.84
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表 3 各配型方案输血率情况
% 组别 样本量/袋 方案Ⅰ 方案Ⅱ 方案Ⅲ 方案Ⅳ Ⅰ组 15 706 63.45 17.18 8.22 11.15 Ⅱ组 2000 64.50 17.30 7.35 10.85 Ⅲ组 212 83.02 10.38 4.71 1.89 输血率为匹配输血袋数/总输注袋数。
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表 4 各Rh表型患者匹配输血率情况
%/%/% Rh表型 样本量/袋 方案Ⅰ 方案Ⅱ 方案Ⅲ 方案Ⅳ 方案Ⅰ+Ⅱ CCDee 7963/1006/85 73.92/61.20/91.58 0.01/0/0 9.21/7.75/4.21 16.86/16.00/4.21 73.93/61.20/91.58 CcDEe 5346/698/75 64.00/61.60/82.67 36.00/38.40/17.33 0/0/0 0/0/0 100.00/100.00/100.00 CcDee 1189/155/17 24.52/23.23/94.12 51.64/50.97/5.88 23.85/25.81/0 23.85/0/0 76.16/74.00/100.00 ccDEE 904/136/12 47.94/41.91/58.33 0/0/25.00 0.26/16.92/16.67 51.80/41.18/0 47.94/41.91/83.33 CcDEE 30/5/1 0/0/0 16.17/20.00/100.00 83.33/80.00/0 0/0/0 16.17/20.00/100.00 CCDEe 89/7/6 0/0/33.33 52.81/71.43/66.67 47.19/28.57/0 0/0/0 52.58/71.43/100.00 CCDEE 1/0/2 0/0/0 0/0/0 100.00/0/100.00 0/0/0 0/0/0 ccDEe 397/0/4 20.40/0/50.00 35.26/0/50.00 44.33/0/0 0/0/0 55.66/0/100.00 ccDee 47/0/0 4.25/0/0 0/0/0 65.96/0/0 29.78/0/0 4.25/0/0
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表 5 实施匹配输血前后血型以外抗体检出率变化情况
组别 实施前 实施后 Ⅰ组 检测总数/例 34 577 36 951 血型以外抗体阳性/例(%) 217(0.63) 313(0.85) Rh血型以外抗体阳性/例(%) 80(0.23) 127(0.34) Ⅱ组 检测总数/例 1286 2822 血型以外抗体阳性/例(%) 36(2.80) 75(2.66) Rh血型以外抗体阳性/例(%) 5(0.39) 16(0.57) Ⅲ组 检测总数/例 350 341 血型以外抗体阳性/例(%) 10(2.86) 0(0) Rh血型以外抗体阳性/例(%) 3(0.86) 0(0) 血型以外抗体检出率=检出血型以外抗体阳性数/总检测数；Rh血型以外抗体检出率=Rh血型以外抗体阳性数/总检测数。
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| 引用本文: |
张利, 杨洪军, 彭涛, 等. Rh抗原配型输血的临床应用分析[J]. 临床血液学杂志, 2022, 35(10): 695-699. doi: 10.13201/j.issn.1004-2806.2022.10.001
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| Citation: |
ZHANG Li, YANG Hongjun, PENG Tao, et al. Analysis of Rh antigen matching in clinical blood transfusion[J]. J Clin Hematol, 2022, 35(10): 695-699. doi: 10.13201/j.issn.1004-2806.2022.10.001
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