Analysis of false negative results of blood matching due to dose effect of anti-E with different titers
-
摘要: 目的 评估不同效价抗-E与Rh表型为CcDEe及ccDEE红细胞，采用手工凝聚胺法及微柱凝胶卡式法交叉配血出现假阴性发生率情况。方法 收集2021年7月—2022年5月意外抗体鉴定为单纯抗-E的23例患者血样。使用微柱凝胶卡式法进行抗-E效价测定并分成≤8组和≥16组；用手工凝聚胺法及微柱凝胶卡式法与CcDEe和ccDEE的红细胞制剂同步进行交叉配血试验。结果 ① 抗-E效价≥16组的患者血浆样本与CcDEe和ccDEE的红细胞分别采用2种配血方法均未出现假阴性结果；②抗-E效价≤8组的的患者血浆与CcDEe红细胞配血时：凝聚胺法出现10例假阴性，漏检率90.91%(10/11)，而微柱凝胶卡式法出现5例假阴性，漏检率45.45%(5/11)，两者差异有统计学意义(P=0.008)；而与ccDEE红细胞配血时：凝聚胺法出现3例假阴性，漏检率27.27%(3/11)，微柱凝胶卡式法未出现假阴性，两者差异有统计学意义(P=0.035)。结论 患者检出低效价的具有剂量效应意外抗体时，最佳输血选择应为表型抗原阴性而非仅配血相合的红细胞制剂。Abstract: Objective To evaluate the false negative incidences in cross-matching test between different titers of anti-E and CcDEe or ccDEE red cells by manual polybrene test and microcolumn gel test.Methods Blood samples from 23 patients with unexpected antibody identified with pure anti-E were collected from July 2021 to May 2022 in our hospital. The titer of anti-E was determined by microcolumn gel test and the research subjects were divided into two groups by the titer≤8 and ≥16. The cross-matching tests between the corresponding titers of anti-E with CcDEe and ccDEE red cells were performed simultaneously by manual polybrene test and microcolumn gel test.Results ① In the group of anti-E titer ≥16, none of false negative results were found in corss-matching test with CcDEe or ccDEE red cells by the two different matching methods. ②In the group of anti-E titer ≤8, 10 cases of false negative results were found and the incidence was 90.9%(10/11) when using CcDEe red cells by manual polybrene test, however, 5 cases of false negative results were found and the incidence was 45.45%(5/11) by microcolumn gel card method, which the difference of the two above incidence were statistically significant(P=0.008). When cross-matching with ccDEE red cells, 3 cases of false negative results were found and the incidence was 27.27%(3/11) by manual polybrene test, and none of false negative cases were found by the microcolumn gel card method, which the difference of the two above incidence were statistically significant(P=0.035).Conclusion When unexpected antibody with low titer and dose effect were encounted, the best selection of red cell components for transfusion supports may be the corresponding negative antigen rather than only negative results of cross-matching test.
-
Key words:
- anti-E /
- dose effect /
- cross matching /
- manual polybrene test /
- microcolumn gel test
-
-
表 1 患者抗体效价与配血结果表
病例 抗E效价 与RhCcDEe配血 与RhccDEE配血 凝聚胺法 微柱凝胶卡法 凝聚胺法 微柱凝胶卡法 患者1 1 0 0 0 1+ 患者2 1 0 0 0 2+ 患者3 1 0 0 0 1+ 患者4 2 0 0 1+ 2+ 患者5 4 0 0.5+ 2+ 3+ 患者6 4 0 0.5+ 2+ 3+ 患者7 4 0 2+ 2+ 2+ 患者8 4 0 0 2+ 3+ 患者9 4 2+ 3+ 2+ 3+ 患者10 8 0 2+ 2+ 2+ 患者11 8 0 3+ 2+ 3+ 患者12 16 1+ 2+ 2+ 3+ 患者13 32 1+ 4+ 3+ 4+ 患者14 32 0.5+ 3+ 2+ 3+ 患者15 32 0.5+ 3+ 2+ 3+ 患者16 32 1+ 3+ 2+ 3+ 患者17 32 1+ 3+ 2+ 3+ 患者18 64 2+ 3+ 3+ 3+ 患者19 64 2+ 3+ 2+ 3+ 患者20 128 4+ 4+ 4+ 4+ 患者21 128 3+ 3+ 3+ 3+ 患者22 128 2+ 4+ 3+ 4+ 患者23 128 2+ 3+ 3+ 3+ 
下载: 导出CSV
表 2 抗-E效价≤8组假阴性结果发生率比较
例 配血方法 阳性 假阴性 P 凝聚胺法(Rh血型CcDEe) 1 10 0.063 凝聚胺法(Rh血型ccDEE) 6 5 凝聚胺法(Rh血型CcDEe) 1 10 0.008 微柱凝胶卡式法(Rh血型CcDEe) 8 3 凝聚胺法(Rh血型ccDEE) 6 5 0.035 微柱凝胶卡式法(Rh血型ccDEE) 11 0 微柱凝胶卡式法(Rh血型CcDEe) 8 3 0.214 微柱凝胶卡式法(Rh血型ccDEE) 11 0
下载: 导出CSV
-
[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] 马筱洁, 王儒彬, 李强, 等. 147例Rh血型系统意外抗体致新生儿溶血病回顾性分析[J]. 临床血液学杂志, 2021, 34(2): 102-104. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202102006.htm
[3] 孙红, 马春娅, 朱正荣, 等. 92例不规则抗体筛查弱阳性检测结果分析[J]. 临床血液学杂志, 2019, 32(8): 609-611. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201908011.htm
[4] 张敏, 孙浩然, 李坚, 等. AUTOVUE INNOVA全自动血型分析仪意外抗体筛查性能评价[J]. 临床血液学杂志, 2022, 35(6): 402-403, 409. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.06.003
[5] 郭伟洁, 刘泽雅, 张凡, 等. 中国献血人群意外抗体阳性率的Meta分析[J]. 临床输血与检验, 2021, 23(2): 202-212. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202102016.htm
[6] 林军, 戚小艳, 王源. 输血患者及献血者红细胞血型同种不规则抗体发生频率的回顾性分析[J]. 中国输血杂志, 2016, 29(10): 1156-1158. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201610030.htm
[7] 宋奥微, 马婷, 杨江存. 31858例住院患者不规则抗体筛查及抗体鉴定结果分析[J]. 细胞与分子免疫学杂志, 2019, 35(2): 169-173.
[8] 李慧, 徐焕铭, 张毅, 等. 输血前患者不规则抗体筛查及鉴定结果分析[J]. 中国实验血液学杂志, 2015, 23(3): 861-865. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY201503055.htm
[9] 郭长义, 宋雪冬, 宋任浩. 5种不规则抗体筛查方法的检测阈值比较[J]. 临床血液学杂志, 2014, 27(12): 1042-1044. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201412018.htm
[10] 何屹, 文韬, 袁红. 剂量效应对输血相容性检测影响研究[J]. 中国免疫学杂志, 2021, 37(19): 2381-2384. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXZ202119014.htm
[11] 熊玉琪, 邹昕, 虞茜, 等. 剂量效应在不规则抗体鉴定的应用分析——附1例报告[J]. 临床血液学杂志, 2022, 35(8): 592-594. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.08.013
[12] 李志静. 红细胞输注无效的原因与安全输血[J]. 中国输血杂志, 2017, 30(4): 381-383. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201704023.htm
[13] 李海云. 筛选细胞检测低效价不规则抗体漏检原因探讨[J]. 中国输血杂志, 2018, 31(11): 1303-1305. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201811033.htm
[14] 王鹤, 章旭. 红细胞血型基因分型技术在疑难配血中的应用[J]. 临床输血与检验, 2018, 20(2): 189-190. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY201802029.htm
[15] Arslan O. Electronic crossmatching[J]. Transfus Med Rev, 2006, 20(1): 75-79.
[16] 朱霞蔚, 卢根杰, 陈科达, 等. 精准电子交叉配血技术临床应用价值探讨[J]. 中国卫生检验杂志, 2019, 29(12): 1453-1455. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201912013.htm
-