抗-E、抗-Lea合并抗-Jkb、抗-Cw致疑难配血及输血反应分析

杨红梅; 虞茜; 邹昕; 马思飞; 许飞; 徐立

doi:10.13201/j.issn.1004-2806.2022.12.013

抗-E、抗-Lea合并抗-Jkb、抗-Cw致疑难配血及输血反应分析

- 1.
  常州市中心血站(江苏常州, 213000)
- 2.
  常州市临床输血重点专科实验室
基金项目:
常州市卫健委青年人才项目(No: QN202133)；江苏省英科新创科研基金课题(No: JS2020001)

详细信息

通讯作者: 徐立，E-mail: xulion@126.com

中图分类号: R457.1

收稿日期: 2022-05-23

修回日期: 2022-06-27

刊出日期: 2022-12-01

Analysis of complicated blood matching and transfusion reaction caused by anti-E, anti-Lea combined with anti-Jkb, anti-Cw

- 1.
  Changzhou Blood Center, Changzhou, 213000, China
- 2.
  Changzhou Key Laboratory of Clinical Blood Transfusion

More Information

Corresponding author: XU Li, E-mail: xulion@126.com

Received Date: 23 May 2022

Revised Date: 27 June 2022

Publish Date: 01 December 2022

摘要

摘要: 探讨交叉配血中抗-E、抗-Lea合并抗-Jkb、抗-Cw抗体引起患者配血不合及输血反应原因。通过试管法鉴定ABO血型，毛细管离心法抗原分型和直接抗人球蛋白试验，盐水、聚凝胺、抗人球蛋白三种介质联用多套谱细胞进行抗体筛选试验及抗体特异性鉴定试验对患者配血不合进行分析。对照谱细胞格局表采用剂量效应，该患者血清中检出抗-E、抗-Lea合并抗-Jkb、抗-Cw，酸放散液中检出抗-E和抗-Jkb抗体。患者血清中多种不规则抗体是导致交叉配血不合的主要原因，该患者连续多次输注E抗原阳性及Jkb阳性红细胞是引起输血反应的主要原因，多抗体联合存在时应运用剂量效应以减少易漏检抗体概率，保证输血安全性。
- 输血反应 /
- 交叉配血 /
- 抗体筛查 /
- 抗-Lea /
- 抗-Jkb
Abstract: To investigate the reason of anti-E, anti-Lea combined with anti-Jkb, anti-Cw inducing incompatibility in blood crossmatching and blood transfusion reaction. The blood mismatch of patients was analyzed through ABO blood group typing, blood group typing by capillary centrifugation and direct coombs testing, antibody screening test and antibody specificity identification test using saline, polycoagulant and anti-human globulin combined with multiple sets of panel cells. The dose-effect grading system was used to compare the pattern of cell spectra, which existed anti-E, anti-Lea combined with anti-Jkb antibodies in the serum of this patient, anti-Cw could be excluded. Anti-E and anti-Jkb antibodies were detected in acid release fluid. The presence of irregular antibodies in the serum of patients was the main factor leading to incompatibility in blood crossmatching. Continuous infusion of E antigen positive and Jkb positive red blood cells was the main cause of blood transfusion reaction. Applying the dose-effect combined antibodies could reduce the probability of missing weak antibodies and ensure the safety of clinical transfusion.
- transfusion reaction /
- crossmatching blood /
- antibody screening /
- anti-Lea /
- anti-Jkb

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表 1 患者Rh血型系统定型及直抗试验结果

项目	抗-D	抗-C	抗-c	抗-E	抗-e	多抗	抗-IgG	抗C3d
IS	4+	3+	2+^s	1+	3+	1+^mf	1+^mf	0
多次IS	4+	3+^s	3+	1+^mf	3+^s
近心端IS		3+	2+^s	0	3+	0	0	0
远心端IS		3+	2+^s	1+	3+	1+^mf	1+^mf	0
0代表阴性；±代表极小的细胞凝集混合众多游离红细胞；1+、2+、3+、4+代表凝集强度；s表示稍强；w表示稍弱。

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表 2 患者血清与抗筛细胞反应格局及结果(REAGENS，702121)

序号	Rh-hr	D	C	E	c	e	Cw	M	N	S	s	P1	Le^a	Le^b	Fy^a	Fy^b	Jk^a	Jk^b	Di^a	Lu^a	Lu^b	IS	多次IS	IAT	poly
Ⅰ	R₁R_1w	+	+	0	0	+	+	+	0	+	0	0	+	0	+	0	+	0	0	0	+	±	1+^w	1+	±
Ⅱ	R₂R₂	+	0	+	+	0	0	0	+	0	+	+	+	0	+	+	+	+	0	0	+	±	1+^w	1+	1+
Ⅲ	rr K+	0	0	0	+	+	0	+	0	+	+	+	0	+	0	+	0	+	0	0	+	0	0	2+	1+
																					自c	0	0	1+	0

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表 3 患者血清与谱细胞反应格局及结果(REAGENS，732119)

序号	Rh-hr	D	C	E	c	e	Cw	M	N	S	s	P1	Le^a	Le^b	Fy^a	Fy^b	Jk^a	Jk^b	Di^a	Lu^a	Lu^b	3IS	poly	IAT	放IAT
1	R1R2K+	+	+	0	0	+	0	+	+	0	+	+	0	+	0	+	+	+	0	0	+	0	0	1+^w/±	±
2	R2R2	+	0	+	+	0	0	+	+	+	+	0	0	+	0	+	+	+	+	0	+	0	1+	1+^s	1+^w
3	r’r	0	+	0	+	+	0	+	+	0	+	+	+	0	+	0	+	+	0	0	+	1+^w	0	1+^w/±	±
4	r''r	0	0	+	+	+	0	+	0	+	0	+	0	+	+	+	+	0	0	0	+	0	1+^s	1+	1+^w
5	rrK+	0	0	0	+	+	0	+	0	+	+	+	+	0	+	0	0	+	0	0	+	1+^w	0	1+	±
6	R0r	+	0	0	+	+	0	+	0	0	+	0	0	0	0	+	+	0	0	0	+	0	0	0	0
7	R1R1W	+	+	0	0	+	+	+	0	+	0	+	0	0	0	+	0	+	0	0	+	0	0	1+	1+^w
8	rr	0	0	0	+	+	0	0	+	+	+	0	0	+	+	0	+	0	0	0	+	0	0	0	0
9	R1R2	+	+	+	+	+	0	0	+	0	+	+	0	+	0	+	0	+	0	+	+	0	1+	2+	1+
10	R1R1	+	+	0	0	+	0	+	0	0	+	+	+	0	+	+*	0	+	0	0	+	1+^w	1+w	1+	1+
11	rr	0	0	0	+	+	0	+	+	0	+	+	0	+	+	0	+	0	0	0	+	0	0	0	0

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表 4 患者血清与进口谱细胞反应格局与结果(sanquin，8000454945)

序号	Rh-Hr	Rh-Hr						Duffy		Kidd		Lewis		P	MNS				Lurher		Xg		IAT	放IAT
序号	Rh-Hr	C	D	E	c	e	C^w	Fy^a	Fy^b	Jk^a	Jk^b	Le^a	Le^b	P₁	M	N	S	s	Lu^a	Lu^b	Xg^a		IAT	放IAT
1	R1wR1	+	+	0	0	+	+	+	0	0	+	0	+	+	+	0	+	+	0	+	0		1+/1+^s	1+^w
2	R1R1	+	+	0	0	+	0	+	0	+	0	0	+	0	0	+	0	+	0	+	0		0	0
3	R2R2	0	+	+	+	0	0	0	+	+	+	+	0	+	+	+	+	0	0	+	+		1+^s/2+	1+
4	R0	0	+	0	+	+	0	+	0	+	0	0	+	+	+	+	0	+	+	+	/		0	0
5	r’r’	+	0	0	0	+	0	0	+	+	+	0	+	+	+	0	+	+	0	+	+		±	±
6	r’r’’	0	0	+	+	0	0	+	+	+	0	0	0	+	+	0	+	+	0	+	+		1+^s	1+^w
7	rr	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		1+^w	1+^w
9	rr	0	0	0	+	+	0	+	0	+	+	0	0	+	+	+	+	0	0	+	0		±/0	0
10	rr	0	0	0	+	+	0	+	+	+	0	0	0	+	0	+	0	+	+	+	+	Co(b+)	0	0
11	RzR1	+	+	+	0	+	0	0	+	0	+	+	0	+	+	0	+	+	0	+	+		1+^s	1+
12	RzR2	w	+	+	+	0	0	+	+	+	+	0	+	+	+	+	+	+	0	+	+		1+^s	1+
13	r’wr	+	0	0	+	+	+	+	+	+	0	+	0	+	+	+	+	+	0	+	0		1+^w/±	0
14	R2R2	0	+	+	+	0	0	0	+	+	0	0	+	0	0	+	0	+	0	+	+	JK01W	1+	1+^w
15	R1R1	+	+	0	0	+	0	+	+	0	+	+	0	+	+	0	+	0	0	+	+	Co(b+)	1+^w/1+	±
16	rr	0	0	0	+	+	0	+	0	0	+	+	0	+	+	+	0	+	0	+	+	Wr(a+)	1+^w/1+	±

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表 5 血型系统抗原分型及剂量效应积分制原则结果

序号	REAGENS，732119							序号	sanquin，8000454945
序号	Cw	Le^a	E		Jk^b	IAT	放IAT	序号	Cw	Le^a	E	Jk^b	IAT	放IAT
1		0	0	1	1+^w/±		±	1	+	0	0	2	1+/1+^s	1+^w
2		0	2	1	1+^s		1+^w	2		0	0	0	0	0
3		2	0	1	1+^w/±		±	3		2	2	1	1+^s/2+	1+
4		0	1	0	1+		1+^w	4		0	0	0	0	0
5		2	0	2	1+		±	5		0	0	1	±	±
6		0	0	0	0		0	6		0	2	0	1+^s	1+^w
7	+	0	0	2	1+		1+	7		2	0	0	0	0
8		0	0	0	0		0	8		0	0	2	1+^w	1+^w
9		0	1	2	2+		1+	9		0	0	1	±	0
10		2	0	2	1+		1+	10		0	0	0	0	0
11		0	0	0	0		0	11		2	1	2	1+^s	1+
	Lewis系统				Kidd系统		Rh系统	12		0	2	1	1+^s	1+
	抗-Lea		抗-Leb		抗-Jka	抗-Jkb	抗-Cw	13	+	2	0	0	1+^w/±	0
IS	0		1+		1+^s	±^mf	0	14		0	2	0	1+	1+^w
近心端	0		1+		1+	0	0	15		2	0	2	1+^w/1+	±
远心端	0		1+		1+^w	1+^w	0	16		2	0	2	1+^w/1+	±

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表 6 吸收放散结果(REAGENS，732119)

细胞			1	2	3	4	5	6	7	8	9	10	11
S6	吸收后血清	IAT	1+^w/±	1+^w/±	1+^w/±	0	1+^s	0	1+^s	0	1+	1+^s	0
	放散液	IAT	0	1+	0	1+	0	0	0	0	1+	0	0
S1	吸收后血清	IAT	0	1+	0	1+^w	0	0	1+^w/±	0	1+^w	0	0
	放散液	IAT	±	±	±	0	1+^w	0	1+	0	1+^w	1+^w	0
S6为Sanquin谱细胞6号[ccDEE、Jk(a+b-)]；S1[CCDee、Jk(a-b+)]。

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