Retrospective analysis of reasons for ABO grouping discrepancies among patients from a tertiary hospital in Qingdao
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摘要: 目的 回顾性分析青岛市某三级医院住院和门诊就诊患者中，ABO血型正反定型不符的检出率和常见原因。方法 采用Ortho AutoVue全自动血型及配血系统对该院2019年11月—2023年2月门诊及住院患者进行常规ABO血型检测，方法为全自动血型系统微柱玻璃珠法，排除人为实验误差，对ABO正反定型不符的样本进行分类、进一步检测并登记，综合分析确定引起ABO正反定型不符的原因，汇总分析该院引起ABO血型正反定型不符的常见原因及处理措施。结果 微柱玻璃珠法检测26 065例患者，ABO血型正反定型不符68例，检出率0.26%。68例正反定型不符标本中，弱/无红细胞反应类型4例，占5.88%；额外的红细胞反应类型8例，占11.76%；混合红细胞反应类型9例，占13.24%；弱/无血清反应类型12例，占17.65%；额外的血清反应类型35例，占51.47%。意外抗体中检出最多的为抗-M抗体。ABO基因第6、7外显子直接测序22例，检出ABO亚型等位基因11例，全部为B亚型等位基因，B(A)亚型为主，未检出A亚型等位基因，检出O亚型等位基因4种，并检出1例新的等位基因突变c.272T>C。结论 青岛市某三级医院ABO血型正反定型不符的主要影响因素为意外抗体、ABO亚型、血浆抗体减弱或缺失、血液系统疾病。通过排除人为操作失误、采用盐水试管法复核、结合意外抗体筛查结果、临床病史，对疑似亚型采用基因检测手段分析其影响机制，可解决多数正反定型不符的问题，对保障输血安全具有重要意义。Abstract: Objective To retrospectively analyze the detection rate and common causes of inconsistent positive and negative ABO blood type among inpatients and outpatients in a tertiary hospital in Qingdao.Methods Ortho AutoVue automatic blood group and blood matching system was used to perform routine ABO blood group detection on outpatients and inpatients in our hospital from November 2019 to February 2023. Automatic blood group system microcolumn glass bead method was used to exclude human experimental errors. The samples with inconsistent ABO positive and negative stereotyping were classified, further tested and registered, and the causes of the inconsistent ABO positive and negative stereotyping were determined by comprehensive analysis, and the common causes and treatment measures of the inconsistent ABO blood group positive and negative stereotyping were summarized and analyzed.Results The difference between positive and negative ABO blood type was detected in 68 cases with the detection rate of 0.26%. Among the 68 cases, 4 cases(5.88%) had weak or no erythrocyte reaction type. There were 8 cases with additional red blood cell reaction type, accounting for 11.76%. Mixed red blood cell reaction type in 9 cases, accounting for 13.24%. There were 12 cases(17.65%) of weak/no serum reaction type. There were 35 additional types of serum reaction, accounting for 51.47%. Most of the accidental antibodies were anti-M antibodies. In 22 cases of ABO gene exon 6 and 7, 11 ABO subtype alleles were detected by direct sequencing, all of which were B subtype alleles, mainly B(A) subtype, no A subtype alleles were detected, 4 alleles of O subtype were detected, and 1 new alleles mutation C. 272T>C was detected.Conclusion The main influencing factors of the inconsistency of positive and negative ABO blood type in a tertiary hospital in Qingdao were accidental antibodies, ABO subtypes, weakened or absent plasma antibodies, and hematological diseases. By eliminating human error, using saltwater test tube method for review, combined with accidental antibody screening results and clinical history, genetic detection methods were used to analyze the influence mechanism of suspected subtypes, which could solve most of the problems of inconsistent positive and negative typing, and was of great significance for ensuring the safety of blood transfusion.
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Key words:
- ABO blood groups /
- ABO typing discrepancies /
- microcolumn glass bead method /
- ABO gene
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表 1 微柱玻璃珠法ABO血型正反定型不符分类及处理措施
分类 例数 占比/% 分析处理措施 弱/无红细胞反应 4 5.88 盐水试管法复核；增加抗-A1、抗-H、抗-AB检测；4℃增强试验；吸收放散试验；临床资料(年龄、性别、临床诊断、输血史、妊娠史)；ABO基因检测 额外的红细胞反应混合红细胞反应 89 11.7613.24 盐水试管法复核；增加抗-A1、抗-H、抗-AB检测；临床资料(年龄、性别、临床诊断、输血史、妊娠史)；ABO基因检测 弱/无血清反应 12 17.65 盐水试管法复核；反定型血浆加倍；临床资料(年龄、性别、临床诊断、输血史、妊娠史)；正定表现为O型时加做吸收放散试验；ABO基因检测 额外的血清反应 35 51.47 盐水试管法复核；意外抗体筛查和鉴定；直抗试验和自身对照试验；37℃温育后检测；盐水稀释和替换；血浆高速离心去除纤维蛋白；ZZAP处理红细胞并吸收自身抗体 
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表 2 微柱玻璃珠法ABO血型正反不符具体原因
影响因素 例数 占比/% 意外抗体 29 42.65 ABO亚型 11 16.18 血浆抗体减弱或缺失 9 13.24 血液系统疾病 7 10.29 生理或疾病状态 5 7.35 自身抗体 3 4.41 冷抗体 2 2.94 蛋白凝集 1 1.47 纤维蛋白 1 1.47
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表 3 11例ABO亚型血型血清学及基因检测结果
序号 血型血清学检测结果 吸收放散 表型 基因测序结果 抗-A 抗-B 对照 A1c Bc 抗-A1 抗-AB 抗-H Ac Bc 1 4+ 3+ 0 0 0 4+ 4+ 1+ / / ABw A1.02/BA.04 2 3+ 4+ 0 2+ 0 0 4+ 4+ + / B(A) BA.04/O.01.01 3 0 0 0 4+ 0.5+ 0 0 4+ + - B亚型 Bw-new/O.01.02 4 0 0 0 3+ 0.5+ 0 0 4+ - + B亚型 Bw.03/O.01.01 5 1+ 4+ 0 2+ 0 4+ 4+ 4+ + / B(A) BA.04/O.01.01 6 3+ 4+ 0 3+ 0 0 4+ 4+ + / B(A) BA.04/O.01.01 7 2+ 4+ 0 2+ 0 0 4+ 4+ + / B(A) BA.04/O.01.02 8 mf 4+ 0 4+ 0 0 4+ 4+ + / B(A) BA.04/O01.02 9 3+ 4+ 0 4+ 0 0 4+ 4+ + / B(A) BA.04/O01.02 10 2+ 4+ 0 4+ 0 0 4+ 4+ + / B(A) BA.04/O01.02 11 2+ 4+ 0 3+ 0 0 4+ 4+ + / B(A) BA.04/O01.31 注：mf为混合凝集，/为未检测。
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