Analysis of positive rate and specificity of irregular antibodies in hospitalized patients
-
摘要: 目的 对住院患者进行不规则抗体筛查和抗体鉴定，并对结果及阳性率进行分析，探讨其特异性和临床意义，为临床安全输血提供帮助。方法 通过医院信息系统(HIS)和检验系统(LIS)收集患者基本信息、输血史、妊娠史、抗体的数量和特异性。收集了52 265例住院患者的临床资料，不规则抗体鉴定阳性195例，其中男61例，女134例；有输血史58例，无输血史137例；有妊娠史126例，无妊娠史8例。结果 住院患者不规则抗体阳性率为0.37%，Rh血型系统抗体、MNS血型系统抗体、Lewis血型系统抗体最为常见，其中抗E阳性45例(23.08%)，抗Ec阳性12例(6.15%)，抗D阳性7例(3.59%)，抗M阳性47例(24.10%)，抗Lea 23例(11.79%)，混合抗体5例(2.56%)，未确定特异性抗体41例(21.03%)。在女性患者中，Rh血型系统抗体占40.30%，高于对照组(P < 0.05)；在有输血史中，Rh血型系统抗体56.90%，高于对照组(P < 0.05)，无输血史中，MNS血型系统抗体31.39%、Lewis血型系统抗体17.52%，高于对照组(P < 0.05)；在有妊娠史中，Rh血型系统抗体41.27%，MNS血型系统抗体21.43%，Lewis血型系统抗体11.90%，略高于对照组，但差异无统计学意义(P>0.05)。结论 对输血患者进行抗体筛查并对阳性的进一步鉴定，结合本区域抗体的特点改变实验流程和选择合适的试剂等，可以提高抗体检测水平、减少不良反应的发生，提高输血安全。同时可以避免对有生育潜力女性的致敏作用，达到优生优育目的。Abstract: Objective To investigate the specificity and clinical significance of irregular antibody screening and antibody identification in hospitalized patients, and analyze the results and positive rate, so as to provide help for clinical safe blood transfusion.Methods The basic information of patients, transfusion history, pregnancy history, antibody quantity and specificity were collected through hospital information system(HIS) and laboratory information system(LIS). The clinical data of 52 265 inpatients were collected. 195 cases were positive for irregular antibody, including 61 males and 134 females. 58 cases had transfusion history, 137 cases had no transfusion history. There were 126 cases with pregnancy history and 8 cases without pregnancy history.Results The positive rate of irregular antibody was 0.37%. Rh blood group system antibody, MNS blood group system antibody and Lewis blood group system antibody were the most common. Among them, 45 cases(23.08%) were anti-E positive, 12 cases(6.15%) were anti-Ec positive, 7 cases(3.59%) were anti-D positive, 47 cases(24.10%) were anti-M positive, 23 cases(11.79%) were anti-Lea positive, 5 cases(2.56%) were mixed antibody and 41 cases(21.03%) were undetermined specific antibody. In female patients, Rh blood group system antibodies accounted for 40.30%, which was higher than that of the control group(P < 0.05). In the patients with transfusion history, Rh blood group system antibody was 56.90% higher than that of the control group(P < 0.05). In the patients without transfusion history, MNS blood group system antibody was 31.39% and Lewis blood group system antibody was 17.52% higher than that of the control group(P < 0.05). In the pregnant group, Rh blood group antibody(41.27%), MNS blood group antibody(21.43%) and Lewis blood group antibody(11.90%) were higher than those in the control group, but there was no statistical significance(P>0.05).Conclusion Antibody screening for transfusion patients and further identification of positive results, changing the experimental process and selecting appropriate reagents according to the characteristics of antibodies in the region could improve the antibody detection level, reduce the occurrence of adverse reactions and improve blood transfusion safety. Meanwhile, the sensitization effect on females with fertility potential could be avoided, and the aim of eugenics and better rearing could achieved.
-
Key words:
- irregular antibody /
- antibody identification /
- positive rate /
- specificity
-
-
表 1 不规则抗体的频率、特异性及在性别、输血史、妊娠史中的分布关系
例(%) 抗体系统 抗体特异性 总数(n=195) 男(n=61) 女(n=134) 输血史 妊娠史 有输血史(n=58) 无输血史(n=137) 有妊娠史(n=126) 无妊娠史(n=8) RH 抗-C 1(0.51) 0 1(0.75) 0 1(0.73) 1(0.79) 0 抗-Ce 2(1.03) 0 2(1.49) 1(1.72) 1(0.73) 1(0.79) 1(12.5) 抗-D 7(3.59) 0 7(5.22) 0 7(5.11) 7(5.56) 0 抗-E 45(23.08) 9(14.75) 36(26.87) 23(39.66) 22(16.06) 36(28.57) 0 抗-Ec 12(6.15) 4(6.56) 8(5.97) 9(15.52) 3(2.19) 7(5.56) 1(12.5) MNS 抗-M 47(24.10) 20(32.79) 27(20.15) 4(6.90) 43(31.39) 26(20.63) 1(12.5) 抗-Mur 1(0.51) 0 1(0.75) 1(1.72) 0 1(0.79) 0 Lewis 抗-Lea 23(11.79) 9(14.75) 14(10.45) 0 23(16.79) 14(11.11) 0 抗-Leb 2(1.03) 1(1.64) 1(0.75) 1(1.72) 1(0.73) 1(0.79) 0 Kidd 抗-JKa 2(1.03) 1(1.64) 1(0.75) 2(3.45) 0 1(0.79) 0 抗-JKb 2(1.03) 1(1.64) 1(0.75) 2(3.45) 0 1(0.79) 0 P 抗-P1 2(1.03) 1(1.64) 1(0.75) 0 2(1.46) 1(0.79) 0 Diego 抗-Dia 1(0.51) 1(1.64) 0 1(1.72) 0 0 0 Duffy 抗-Fyb 1(0.51) 0 1(0.75) 1(1.72) 0 1(0.79) 0 抗-LWa 1(0.51) 0 1(0.75) 0 1(0.73) 1(0.79) 0 混合抗体 抗-Ec+抗-Mur 2(1.03 0 2(1.49) 2(3.45) 0 2(1.59) 0 抗-Ec+抗-Mur+抗-Jka 1(0.51) 0 1(0.75) 2(3.45) 0 1(0.79) 0 抗-E+抗-Mur 2(1.03) 1(1.64) 1(0.75) 1(1.72) 0 1(0.79) 0 其他 未确定特异性 41(21.03) 13(21.31) 28(20.90) 8(13.79) 33(24.09) 23(18.25) 5(62.5) 
下载: 导出CSV
表 2 本科室往年文章不规则抗体数据
例(%) 抗体系统 抗体特异性 2012年1月-2013年12月(n=84) 2013年1月-2014年12月(n=73) 2016年1月-2019年9月(n=516) RH 抗-C 11(11.90) 1(1.37) 2(0.39) 抗-Ce 0 0 7(1.36) 抗-c 0 0 5(0.97) 抗-D 6(7.14) 13(17.81) 40(7.75) 抗-E 25(29.76) 31(42.47) 148(28.68) 抗-Ec 0 0 54(10.47) 抗-e 4(4.76) 0 3(0.58) MNS 抗-M 13(15.48) 11(15.07) 50(9.69) 抗-Mur 1(1.19) 2(0.39) 抗-S 0 0 1(0.19) LWIS 抗-Lea 9(10.71) 7(9.59) 44(8.53) 抗-Leb 0 0 3(0.58) Kidd 抗-Jka 1(1.19) 2(2.74) 2(0.39) 抗-Jkb 0 0 2(0.39) Duffy 抗-Fyb 1(1.19) 0 3(0.58) 抗-P1 0 0 1(0.19) Diego 抗-Dia 0 0 1(0.19) 混合抗体 抗-Ec+Mur 0 0 17(3.29) 未确定特异性 23(27.38) 8(10.96) 131(25.39)
下载: 导出CSV
-
[1] 张趁利, 庞桂芝, 娄白敏, 等. 不规则抗体筛查在输血安全中的临床应用[J]. 临床血液学杂志, 2019, 32(2): 99-102. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201902005.htm
[2] Noiret L, Slater A, Higgins JM. Determinants of red blood cell alloantibody detection duration: analysis of multiply alloimmunized patients supports peritransfusion factors[J]. Transfusion, 2017, 57(8): 1930-1937. doi: 10.1111/trf.14157
[3] Makarovska-Bojadzieva T, Velkova E, Blagoevska M. The impact of extended typing on red blood cell alloimmunization in transfused patients[J]. Open Access Maced J Med Sci, 2017, 5(2): 107-111. doi: 10.3889/oamjms.2017.054
[4] 邱启东, 邱小兰, 李玉闽. 血型不规则抗体筛查53614例结果分析[J]. 基层医学论坛, 2014, 18(31): 4270-4271. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT201431069.htm
[5] 钟昌瑞, 阙庆和, 邱启东, 等. 57415例住院患者的血型鉴定、抗体筛查分析及意义[J]. 齐齐哈尔医学院学报, 2015, 36(12): 1765-1766. https://www.cnki.com.cn/Article/CJFDTOTAL-QQHB201512029.htm
[6] 阙庆和, 钟珍珍, 陈晓慧. 血型不规则抗体阳性分析及输血对策[J]. 实验与检验医学, 2021, 39(5): 1302-1304. doi: 10.3969/j.issn.1674-1129.2021.05.075
[7] Stack G, Tormey CA. Estimating the immunogenicity of blood group antigens: a modified calculation that corrects for transfusion exposures[J]. Br J Haematol, 2016, 175(1): 154-160. doi: 10.1111/bjh.14175
[8] Schonewille H, van de Watering LMG, Brand A. Additional red blood cell alloantibodies after blood transfusions in a nonhematologic alloimmunized patient cohort: is it time to take precautionary measures?[J]. Transfusion, 2006, 46(4): 630-635. doi: 10.1111/j.1537-2995.2006.00764.x
[9] Hauser RG, Esserman D, Karafin MS, et al. The evanescence and persistence of RBC alloantibodies in blood donors[J]. Transfusion, 2020, 60(4): 831-839. doi: 10.1111/trf.15718
[10] 吴继博, 马峰, 岳彦伟, 等. 不规则抗体筛查阳性患者输血策略的探讨[J]. 中国输血杂志, 2018, 31(8): 831-833. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201808005.htm
[11] 詹廷西, 王静, 徐丹丹, 等. 输血前患者不规则抗体筛查及鉴定的临床意义探讨[J]. 中国免疫学杂志, 2021, 37(3): 335-338, 345. doi: 10.3969/j.issn.1000-484X.2021.03.014
[12] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM201902015.htm
[13] 金方思, 张瑛, 施顺秋, 等. Rh抗原表型检测和不规则抗体筛查对孕产妇的临床意义[J]. 临床血液学杂志, 2022, 35(2): 100-102, 107. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.02.004
[14] 李娜, 杨世明, 穆士杰. 住院患者86672例红细胞不规则抗体筛查结果及特异性抗体分布特点[J]. 空军军医大学学报, 2022, 43(8): 875-878. https://www.cnki.com.cn/Article/CJFDTOTAL-DSJY202208019.htm
[15] 董雅静, 苏瑞蕊, 张霁云, 等. 抗-M抗体致噬血细胞综合征患者迟发性溶血性输血反应1例[J]. 临床血液学杂志, 2021, 34(8): 600-602. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202108018.htm
[16] 林土连, 李嘉骅, 吕俊健, 等. 新生儿MN血型不合溶血病致重度水肿一例[J]. 中华新生儿科杂志(中英文), 2021(4): 62-63.
[17] Verduin EP, Brand A, Schonewille H. Is female sex a risk factor for red blood cell alloimmunization after transfusion? A systematic review[J]. Transfus Med Rev, 2012, 26(4): 342-353, 353. e1-353. e5.
[18] 陈蕊, 和润泞, 刘昌盛, 等. 云南省地中海贫血儿童意外抗体筛查及输血对策的探讨[J]. 中国输血杂志, 2022, 35(6): 636-639. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202206011.htm
[19] Dorothea, Evers, MD, et al. Red-blood-cell alloimmunisation in relation to antigens' exposure and their immunogenicity: a cohort study[J]. Lancet Haematol, 2016, 3(6): e284-e292.
[20] 崔颖, 陈扬, 魏华, 等. 妊娠妇女ABO/RhD血型和不规则抗体特征及临床意义[J]. 中国妇幼保健, 2018, 33(16): 3632-3635. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201816010.htm
[21] 龚淞颂, 沈伟, 王钰箐, 等. 中国部分人群Mur血型抗原分布及分子基础的研究[J]. 中国输血杂志, 2015, 28(8): 997-1000. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201508059.htm
-