抗-I抗体导致的配血困难1例及输血策略

张瑞宁; 李艳; 张瑜; 吴继博; 万春晶; 王宝燕

doi:10.13201/j.issn.1004-2806.2023.06.014

抗-I抗体导致的配血困难1例及输血策略

- 西安交通大学第一附属医院输血科(西安，710061)
基金项目:
西安交通大学第一附属医院科研发展基金(No：2020ZYTS-23)

详细信息

通讯作者: 王宝燕，E-mail：18991232219@189.com

中图分类号: R457.1

收稿日期: 2022-10-25

修回日期: 2023-01-15

刊出日期: 2023-06-01

One case of difficulty in matching blood and transfusion strategy caused by anti-I antibody

- Department of Blood Transfusion, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China

More Information

Corresponding author: WANG Baoyan, E-mail: 18991232219@189.com

Received Date: 25 October 2022

Revised Date: 15 January 2023

Publish Date: 01 June 2023

摘要

摘要: 目的对1例抗I抗体引起的血型正反定型不符及交叉配血困难的患者进行回顾性分析。方法采用免疫血清学方法对患者样本进行血型鉴定，同步进行不规则抗体筛查、交叉配血及效价检测，并进一步采用新生儿细胞检测血型反定型，不规则抗体鉴定。结果患者血清中存在抗IgM-I抗体，效价为16，导致血型正反定型不一致及交叉配血困难。结论在对患者血标本进行输血相容性检测时，如出现意外凝集，应对标本做进一步不规则抗体筛选及特异性鉴定，确定抗体类型，评估患者后选择最佳的输血策略。
- 抗-I抗体 /
- 血型鉴定 /
- 交叉配血
Abstract: Objective To retrospectively analyze a patient with anti-I antibody causing mismatch between positive and negative blood type and difficulty in cross-matching blood group.Methods Blood group identification was carried out by immunoserology, irregular antibody screening, cross matching and titer detection were carried out simultaneously, and blood group reverse typing and irregular antibody identification were further carried out by neonatal cells.Results The anti IgM-I antibody was found in the serum of the patients, and the titer was 16.Conclusion In the case of accidental agglutination, irregular antibody screening and specificity identification should be performed to determine the type of antibody, and the optimal transfusion strategy should be selected after evaluation of the patient.
- anti-I antibody /
- blood group identification /
- cross matching

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表 1 ABO血型鉴定及Rh血型鉴定结果

分类	正定型			反定型						Rh系统分型
分类	标准红细胞			标准红细胞			新生儿细胞			Rh系统分型
ABO及Rh血型	Ac	Bc	Oc	Ac	Bc	Oc	Ac	Bc	Oc	C	c	E	e
凝集强度	4+	3+s	4+	4+	4+	4+	-	-	-	4+	-	4+	4+

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表 2 抗体筛选红细胞试剂盒抗原格局及抗体筛查结果

序号	D	C	E	c	e	Jk^a	Jk^b	M	N	S	s	Fy^a	Fy^b	Le^a	Le^b	P₁	盐水法	抗球蛋白法
1	+	0	+	+	0	+	+	+	+	+	+	+	0	+	+	0	4+	1+
2	+	+	+	0	+	0	+	+	+	0	+	+	0	0	+	+	4+	2+
3	+	+	0	+	+	0	+	0	+	0	+	+	+	0	+	+	4+	2+

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表 3 患者血清抗体鉴定结果

序号	C	D	E	c	e	C^w	f	V	K	k	Kp^a	Kp^b	Js^a	Js^b	Fy^a	Fy^b	Jk^a	Jk^b	Le^a	Le^b	P₁	M	N	S	s	Lu^a	Lu^b	Xg^a	盐水法	抗球蛋白法
1	+	+	0	0	+	+	/	/	0	+	0	+	/	+	+	W	0	+	0	+	+	0	+	+	+	0	+	+	4+	2+
2	+	+	0	0	+	0	/	/	+	w	+	+	0	+	0	+	+	+	0	+	+	0	+	0	+	0	+	+	4+	2+
3	0	+	+	+	0	0	/	/	0	+	0	+	/	+	+	0	+	+	0	+	0	+	0	+	0	0	+	+	4+	3+
4	0	+	0	+	+	0	/	/	0	+	0	+	/	+	0	0	+	0	0	0	+	0	+	0	+	0	+	+	4+	2+
5	+	0	0	0	+	0	/	/	0	+	0	+	/	+	0	+	+	+	+	0	+	+	+	0	+	0	+	+	4+	2+
6	0	0	+	+	0	0	/	/	0	+	0	+	/	+	+	0	+	0	0	+	+	+	0	0	+	0	+	+	4+	3+
7	0	0	0	+	+	0	/	/	+	0	0	+	/	+	0	+	0	+	0	+	+	0	+	0	+	0	+	0	4+	3+
8	0	0	0	+	+	0	/	/	0	+	0	+	/	+	0	+	+	0	0	+	0	+	0	+	+	+	+	+	4+	2+
9	0	0	0	+	+	0	/	/	+	+	0	+	/	+	0	W	+	0	0	+	+	0	+	+	0	0	W	+	4+	3+
10	0	0	0	+	+	0	/	/	0	+	0	+	/	+	+	+	0	+	0	+	+	+	+	+	+	+	0	+	4+	3+
11	+	+	+	0	+	0	/	/	0	+	0	+	/	+	+	+	+	0	+	0	0	0	+	0	+	0	+	0	4+	2+
12	w	+	+	+	0	0	/	/	0	+	0	+	/	+	0	+	+	+	+	0	+	+	+	0	+	0	+	+	4+	3+
13	+	+	0	0	+	0	/	/	0	+	0	+	/	+	+	0	0	+	+	0	+	+	0	+	0	0	+	+	4+	2+
14	+	0	0	+	+	+	/	/	0	+	0	+	/	+	+	+	+	+	+	0	+	+	+	+	+	0	+	0	4+	2+
15	0	+	+	+	0	0	/	/	+	+	0	+	/	+	0	+	+	0	+	0	+	+	+	+	+	0	+	+	4+	3+
16	0	+	+	+	0	0	/	/	0	+	0	+	/	+	+	0	+	0	0	+	+	+	+	+	+	0	+	0	4+	2+

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表 4 交叉配血结果

血样	主侧		次侧
血样	盐水介质	抗球蛋白介质	盐水介质	抗球蛋白介质
同型献血员	+	+	-	-
新生儿同型血样	-	-	-	-

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