Identification and transfusion strategies of anti-LW antibody and autoantibodies with anti-D in patients with autoimmune hemolytic anemia
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摘要: 目的 对自身免疫性溶血性贫血(AIHA)患者的不规则抗体进行鉴定分析，为其制定输血策略，指导临床科学合理用血。方法 在河北省血液中心进行疑难交叉配血的AIHA患者2例，分别采用试管法和微柱凝胶法对其进行ABO血型和Rh血型鉴定、直接抗球蛋白试验(DAT)、抗体筛查试验及交叉配血试验，采用二硫苏糖醇(DTT)处理和未经处理的谱细胞鉴定患者血浆抗体特异性。结果 2例患者均为RhD抗原阳性，DAT及抗体筛查试验阳性，其中1号患者血浆与DTT未处理谱细胞反应呈抗-D特异性，与DTT处理后谱细胞反应结果呈全阴性；2号标本血浆与DTT处理及未处理谱细胞反应均呈阴性。2例患者与同型RhD阴性红细胞均呈交叉配血相合状态。结论 1号患者体内的不规则抗体为抗-LW抗体，2号患者抗体为自身抗-D抗体，此类AIHA患者均可输注同型RhD阴性悬浮红细胞。
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关键词:
- 自身免疫性溶血性贫血 /
- 自身抗-D抗体 /
- 抗-LW抗体 /
- 抗体鉴定 /
- 输血策略
Abstract: Objective To identify and analyze irregular antibodies in patients with autoimmune hemolytic anemia(AIHA), in order to make the blood transfusion strategy and guide clinical scientific and rational blood use.Methods A total of 2 cases with autoimmune hemolytic anemia who took difficult cross matching in our center were carried on ABO positive and negative stereotyping and Rh group typing, direct anti-human globulin test(DAT), antibody screening and cross match test by test tube and microcolumn gel method, respectively. The antibodies in serum of patients were identified by dithiothreitol(DTT) treated and untreated panel cells.Results The two patients were both positive for RhD antigen, DAT and antibody screening test. Among them, the plasma of patient 1 showed anti-D-specific reaction with untreated DTT panel cells, and all negative reaction with treated DTT panel cells. The plasma of patient 2 showed negative reaction with both DTT treatment and untreated panel cells. Both patients were compatible with their RhD negative blood of the same type.Conclusion The antibody in patient 1 and patient 2 was anti-LW antibody and autoanti-D antibody, respectively. Such AIHA patients could be transfused with the same type of RhD negative suspended red blood cells -
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表 1 2例患者血型鉴定结果
标本 抗血清 试剂红细胞 自身细胞 -A -B -D Ac Bc Oc 1号患者 0 0 3+ 2+ 1+ 0 0 2号患者 0 4+ 4+ 4+ 0 0 0 
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表 3 抗体筛查结果
标本 检测方法 Ⅰ Ⅱ Ⅲ 自身 1号患者 盐水介质-IAT 0 0 0 0 Liss-IAT W+ W+ 0 1+ 2号患者 盐水介质-IAT 0 0 0 0 Liss-IAT W+ W+ 0 1+w
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表 4 16系谱细胞抗体鉴定结果
Rh-Hr Rh-Hr Kell Duffy Kidd Lewis P MNS Lurher 1号 2号 C D E c e Cw f V K k Kpa Kpb Jsq Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga 卡 卡 1 R1WR1 + + 0 0 + + / / 0 + 0 + / + + 0 + 0 0 + + + + + 0 0 + + 1+ ± 2 R1R1 + + 0 0 + 0 / / 0 + 0 + / + 0 + + 0 + 0 + 0 + 0 + 0 + / 1+ w+ 3 R2R2 0 + + + 0 0 / / 0 + 0 + / + 0 + 0 + 0 + + + + + 0 0 + + 1+ ± 4 R0 0 + 0 + + 0 / / 0 + 0 + / + + + + + 0 + + + + 0 + 0 + / 1+ ± 5 r′r′ + 0 0 0 + 0 / / 0 + 0 + / + + + + + 0 + + + 0 + + 0 + + 0 0 6 r″r″ 0 0 + + 0 0 / / 0 + 0 + / + 0 + + 0 0 + + + + 0 + 0 + + 0 0 7 rr 0 0 0 + + 0 / / + 0 0 + / + 0 + + + 0 + 0 + + + 0 0 + 0 0 0 8 rr 0 0 0 + + 0 / / 0 + + + 0 + 0 + 0 + + 0 + + + 0 + 0 + + 0 0 9 rr 0 0 0 + + 0 / / + + 0 + 0 + + 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 10 rr 0 0 0 + + 0 / / + + 0 + 0 + 0 + + + + 0 + + + + + 0 + + 0 0 11 RzR1 + + + 0 + 0 / / + + 0 + / + + + 0 + 0 + 0 + + + + 0 + + 1+ w+ 12 RzR2 W + + + 0 0 / / 0 + + + / + + 0 + + 0 + + + + + + 0 + + 1+ w+ 13 rr 0 0 + + + 0 / / 0 + 0 + / + 0 + + + 0 + + 0 + 0 + 0 + / 0 0 14 r1wr + 0 + + + 0 / / 0 + 0 + / + + 0 0 + + 0 + + + 0 + + + 0 1+ w+ 15 R2R2 + + 0 + + + / / 0 + 0 + / + 0 + + 0 + 0 + 0 0 + + 0 + + 0 0 16 R1R1 0 + 0 + + 0 / / 0 + 0 + / + 0 + + 0 + 0 + + + 0 + 0 + + 0 +
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表 5 DTT处理16系谱细胞抗体鉴定结果
Rh-Hr Rh-Hr Kell Duffy Kidd Lewis P MNS Lurher 1号 2号 C D E c e Cw f V K k Kpa Kpb Jsq Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga 卡 卡 1 R1WR1 + + 0 0 + + / / 0 + 0 + / + + 0 + 0 0 + + + + + 0 0 + + 0 1+ 2 R1R1 + + 0 0 + 0 / / 0 + 0 + / + 0 + + 0 + 0 + 0 + 0 + 0 + / 0 1+ 3 R2R2 0 + + + 0 0 / / 0 + 0 + / + 0 + 0 + 0 + + + + + 0 0 + + 0 1+ 4 R0 0 + 0 + + 0 / / 0 + 0 + / + + + + + 0 + + + + 0 + 0 + / 0 1+ 5 r′r′ + 0 0 0 + 0 / / 0 + 0 + / + + + + + 0 + + + 0 + + 0 + + 0 0 6 r″r″ 0 0 + + 0 0 / / 0 + 0 + / + 0 + + 0 0 + + + + 0 + 0 + + 0 0 7 rr 0 0 0 + + 0 / / + 0 0 + / + 0 + + + 0 + 0 + + + 0 0 + 0 0 0 8 rr 0 0 0 + + 0 / / 0 + + + 0 + 0 + 0 + + 0 + + + 0 + 0 + + 0 0 9 rr 0 0 0 + + 0 / / + + 0 + 0 + + 0 + 0 + 0 + 0 + 0 + 0 + + 0 0 10 rr 0 0 0 + + 0 / / + + 0 + 0 + 0 + + + + 0 + + + + + 0 + + 0 0 11 RzR1 + + + 0 + 0 / / + + 0 + / + + + 0 + 0 + 0 + + + + 0 + + 0 1+ 12 RzR2 W + + + 0 0 / / 0 + + + / + + 0 + + 0 + + + + + + 0 + + 0 1+ 13 rr 0 0 + + + 0 / / 0 + 0 + / + 0 + + + 0 + + 0 + 0 + 0 + / 0 0 14 r1wr + 0 + + + 0 / / 0 + 0 + / + + 0 0 + + 0 + + + 0 + + + 0 0 1+ 15 R2R2 + + 0 + + + / / 0 + 0 + / + 0 + + 0 + 0 + 0 0 + + 0 + + 0 0 16 R1R1 0 + 0 + + 0 / / 0 + 0 + / + 0 + + 0 + 0 + + + 0 + 0 + + 0 0
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[1] 田冬冬, 赵鼎, 李志浩, 等. 罕见抗LW抗体自身免疫性溶血性贫血合并新生儿溶血病患者的输血策略[J]. 中国实验血液学杂志, 2021, 29(6): 1935-1939. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202106044.htm
[2] 李占伟, 张琳, 韩丹. Rh血型中同种抗体和类同种自身抗体的血清学特征及交叉配血[J]. 实验与检验医学, 2021, 39(5): 1296-1299. doi: 10.3969/j.issn.1674-1129.2021.05.073
[3] 苏宇清, 喻琼, 刘旭, 等. 中国人群LW血型基因多态性的研究[J]. 中国实验血液学杂志, 2008, 16(3): 691-693. doi: 10.3969/j.issn.1009-2137.2008.03.049
[4] Lee MY, Lee WI, Kang SY, et al. Anti-LW Confused with Anti-D: a Case Transfused RhD-positive RBCs and Literature Review[J]. Clin Lab, 2022, 68(2).
[5] 杨乾坤, 王莉, 孔永奎, 等. 罕见的LW不规则抗体分析及输血策略——附1例报道并文献复习[J]. 中国输血杂志, 2019, 32(2): 168-170. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201902024.htm
[6] 桂嶸, 张志昇, 王勇军. 输血相容性检测及疑难病例分析[M]. 北京: 人民卫生出版社, 2018: 83-83
[7] 陈新春, 邓绍团, 龙韵洪, 等. 自身免疫性溶血性贫血抗体特征与不同输血方案疗效评估[J]. 临床血液学杂志, 2020, 33(12): 821-824. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202012002.htm
[8] 段厚全, 李树中. 红细胞LW血型抗原研究进展[J]. 临床血液学杂志, 2020, 33(6): 435-440. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202006017.htm
[9] Lopez GH, Wilson B, Millard GM, et al. A new high-prevalence LW antigen detected by an antibody in an Indigenous Australian homozygous for LW*A c. 309C>A variant[J]. Vox Sang, 2022, 117(7): 958-965. doi: 10.1111/vox.13276
[10] Devenish A. An example of anti-LWa in a 10-month-old infant[J]. Immunohematology, 1994, 10(4): 127-129.
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