Clinical significance of Rh phenotype detection and antibody screening in blood transfusion safety
-
摘要: 为了分析本地区献血者Rh表型分布频率和患者抗体筛选结果，探讨对献血者和受血者常规Rh抗原表型检测在疑难配血及临床输血安全中的意义，选择7 939例RhD阳性献血者进行常规Rh抗原表型检测，对904例不规则抗体筛查阳性患者进行抗体鉴定分析。在7 939例RhD阳性献血者的Rh抗原中，共检测出8种表型；在904例抗体鉴定结果中，单一抗体809例(89.49%)，混合抗体67例(7.41%)，自身抗体20例(2.21%)，类同种特异性自身抗体8例(0.88%)；Rh血型系统抗体共531例(58.74%)，67例混合抗体中，64例为Rh系统合并其他血型系统抗体共同存在，占比高达95.52%。因此，对献血者和受血者常规Rh抗原分型检测，建立Rh表型库，为患者选择表型相合的红细胞输注，可减少Rh抗体的产生，保障输血安全。Abstract: To analyze the clinical significance of Rh antigen typing detection and irregular antibody for the incompatibility in blood cross matching to ensure the safety of blood transfusion, a total of 7 939 blood donors' samples were detected by Rh blood group antigen test card to establish Rh phenotype database. A total of 876 irregular antibody screening positive patients were tested to identify antibody specificity. As a result, in these 7 939 samples with RhD positive blood group, eight kinds of Rh blood group phenotypes were detected. In the 904 patients with irregular antibody screening positive, 531 cases (58.74%) were in Rh system. 809 samples(89.49%) were single antibody and 67 cases(7.41%) were mixed antibody, 20 cases(2.21%) were autoantibodies and 8 cases (0.89%) were mimicking antibodies. Of 67 mixed antibodies, 64 cases were in Rh system combined with other blood group system antibodies, accounting for up to 95.52%. Consequently, establishment of Rh phenotype database of patients and blood donors and blood transfusion with the same phenotype may reduce the production of Rh antibodies, increase the rate of compatibility and promote the safety of blood transfusion.
-
-
表 1 7 939例RhD阳性献血者Rh表型分布
例 血型 A B O AB 合计 比例/% CCee 880 1 001 1 024 378 3 283 41.35 CcEe 751 885 859 287 2 782 35.04 Ccee 222 294 187 72 775 9.76 ccEE 192 214 213 53 672 8.46 ccEe 98 102 95 35 330 4.16 CCEe 13 8 14 3 38 0.48 CcEE 11 6 9 8 34 0.43 ccee 5 9 10 1 25 0.31 CCEE 0 0 0 0 0 0 合计 2 172 2 519 2 411 837 7 939 100.00 
下载: 导出CSV
表 2 809例患者不规则抗体鉴定结果
例 不规则抗体 Rh-hr Kidd MNSs Duffy Lewis Diego P 合计 D C E c e Jka Jkb M S Mur Fya Fyb Lea Leb Wra P1 例数 49 14 357 15 24 3 2 168 12 54 2 16 77 9 3 4 809
下载: 导出CSV
表 3 67例混合不规则抗体鉴定结果
例 混合不规则抗体 抗-C合并
抗-e抗-E合并
抗-c抗-E合并
抗-M抗-C合并
抗-JKb抗-E合并
抗-Cw抗-D合并
抗-C抗-E合并
抗-Jka抗-S合并
抗-Wra合计 例数 18 39 1 1 2 3 1 2 67
下载: 导出CSV
-
[1] 杨东, 陈青. 红细胞血型系统研究新进展[J]. 临床输血与检验, 2022, 24(2): 137-141, 146. doi: 10.3969/j.issn.1671-2587.2022.02.001
[2] 范佳鸣, 曾艳, 张建军. Rh血型系统遗传分子学研究进展[J]. 中国优生与遗传杂志, 2020, 28(2): 267-269, 131.
[3] 孙亚纯, 黎海澜, 郭仲辉, 等. Rh血型系统分型与相容性输血研究[J]. 中国输血杂志, 2022, 35(3): 272-274.
[4] 赵桐茂. Rh基因型匹配输血研究进展[J]. 精准医学杂志, 2019, 34(4): 283-286, 301.
[5] 周赟, 代静, 蔡兰, 等. 无偿献血人群RhD阴性血型分布研究[J]. 临床血液学杂志, 2023, 36(8): 545-547. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.08.003
[6] 赵震, 张冬霞, 王晓宁, 等. 9684例输血患者Rh血型系统抗原频率及不规则抗体检测临床价值分析[J]. 中国实验诊断学, 2020, 24(1): 139-141. doi: 10.3969/j.issn.1007-4287.2020.01.046
[7] Thornton NM, Grimsley SP. Clinical significance of antibodies to antigens in the ABO, MNS, P1PK, Rh, Lutheran, Kell, Lewis, Duffy, Kidd, Diego, Yt, and Xg blood group systems[J]. Immunohematology, 2019, 35(3): 95-101. doi: 10.21307/immunohematology-2020-021
[8] 童廉箕, 陆琼, 沈伟. 抗-DC抗体引起的双胎新生儿溶血病1例报道[J]. 临床血液学杂志, 2023, 36(8): 600-602. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.08.015
[9] Winter DP, Hulzebos C, Van'O RM, et al. History and current standard of postnatal management in hemolytic disease of the fetus and newborn[J]. Eur J Pediatr, 2023, 182(2): 489-500.
[10] 张良子, 左琴琴, 张泳, 等. 1779例疑难配血患者意外抗体分布特征及输血策略分析[J]. 中国输血杂志, 2022, 35(9): 963-966.
[11] 崔颖, 张勇萍, 杨世明, 等. 不规则抗体筛选与特异性鉴定的影响因素及其对策分析[J]. 细胞与分子免疫学杂志, 2022, 38(2): 165-170.
[12] Flores-Bello A, Mas-Ponte D, Rosu ME, et al. Sequence diversity of the Rh blood group system in Basques[J]. Eur J Hum Genet, 2018, 26(12): 1859-1866.
[13] 孙波, 孙小媛, 邵长峰, 等. 青岛市部分患者与献血者人群Rh表型及单体型频率分布特征分析[J]. 中国输血杂志, 2021, 34(3): 205-207.
[14] 韩斌, 朱于莉, 冯智慧. 孕妇产前红细胞血型不规则抗体筛查及鉴定分析[J]. 国际输血及血液学杂志, 2020, 43(1): 67-70.
[15] 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
[16] 秦华, 程菲, 朱梅, 等. 拟输血患者不规则抗体筛查结果分析[J]. 中国输血杂志, 2019, 32(6): 560-564.
[17] 陈智玮, 张宁洁, 王勇军. 多次输血产生抗-Jkb抗体合并抗-cE抗体1例[J]. 临床输血与检验, 2020, 22(1): 32-36.
[18] 陈敏洁, 曹锁春, 许飞, 等. 抗-Ec合并抗-M抗体致疑难配血实验分析[J]. 检验医学与临床, 2020, 17(3): 430-432.
[19] 张利, 杨洪军, 彭涛, 等. Rh抗原配型输血的临床应用分析[J]. 临床血液学杂志, 2022, 35(10): 695-699. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.10.001
[20] 曲执, 郭美玲. 产妇Rh血型系统抗体的检出特点分析其与新生儿溶血病之间的关系并制定临床输血应对对策分析[J]. 中国医药指南, 2022, 20(21): 85-87.
[21] 阳志勇, 陈芝喜. Rh抗原分型检测对反复输血患者的临床意义[J]. 中国免疫学杂志, 2018, 34(2): 267-269.
-