DEL型血诱导Rh(D)阴性患者产生抗-D并致配血不合

许进明; 张敏; 李莺; 孙小红; 周小玉

doi:10.13201/j.issn.1004-2806.2024.02.013

DEL型血诱导Rh(D)阴性患者产生抗-D并致配血不合

- 南京医科大学第一附属医院输血科(南京，210029)
基金项目:
江苏省卫生健康委科研项目(No：ZDB2020015)

详细信息

通讯作者: 周小玉，E-mail：deerzxy@163.com

中图分类号: R457.1

收稿日期: 2023-04-12

修回日期: 2023-12-21

刊出日期: 2024-02-01

Anti-D production induced by DEL type blood in Rh (D) negative patients and blood matching incompatibility

- Department of Blood Transfusion, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

More Information

Corresponding author: ZHOU Xiaoyu, E-mail: deerzxy@163.com

Received Date: 12 April 2023

Revised Date: 21 December 2023

Publish Date: 01 February 2024

摘要

摘要: 分析1例Rh(D)阴性患者输注DEL型血后产生高效价抗-D致交叉配血不合的原因，为Rh(D)阴性患者安全输血提供策略建议。采用盐水试管法和微柱凝胶抗人球蛋白法进行不规则抗体筛查和性质鉴定，采用微柱凝胶抗人球蛋白法对不规则抗体进行特异性鉴定和效价测定；将配血不合红细胞与患者血清在37℃温吸收后在56℃热放散，对所得放散液采用微柱凝胶抗人球蛋白法进行抗体特异性鉴定，同时采用吸收放散法对献血员红细胞进行DEL型检测。患者血清中不规则抗体筛查结果为阳性，抗体性质为IgG型，抗体特异性为抗-D，效价为2 048，配血不合红细胞吸收放散液抗体特异性鉴定为抗-D，经吸收放散检测该献血员为DEL型(回顾调查该患者在17 d前输注的一袋红细胞也为DEL型)。Rh(D)阴性患者接受DEL型血输注，具有产生抗-D的潜在风险，所产生的抗-D可再次结合DEL型红细胞致配血不合。对于有输血史、妊娠史、有生育要求的女性以及输血依赖等群体输注应持谨慎态度。对已经产生抗-D患者，在非紧急情况不应输注，避免溶血性输血不良反应的发生，提高输血的安全性和有效性。
- DEL型 /
- 抗-D /
- 吸收放散 /
- Rh血型 /
- 交叉配血
Abstract: To analyze the cause of cross matching incompatibility caused by high titer antibody D after infusion of DEL type blood in a Rh(D) negative patient, and provide strategic recommendations for safe blood transfusion in Rh(D) negative patients. The irregular antibodies were screened and identified by brine test tube method and microcolumn gel anti human globulin method, and the irregular antibodies were specifically identified and titer determined by microcolumn gel anti human globulin method. The mismatched red blood cells and the patient's serum were absorbed at 37℃ and then dissipated at 56℃. The obtained diffusion solution was identified by microcolumn gel anti human globulin method for antibody specificity. At the same time, the blood donors' red blood cells were detected for DEL type by absorption and diffusion method. The screening result for irregular antibodies in the patient's serum was positive, and the nature of the antibody was IgG type. The specificity of the antibody was anti-D, with a titer of 2 048. The specificity of the red blood cell absorption and release solution antibody was identified as anti-D. After absorption and release testing, the donor was classified as DEL type(a retrospective investigation showed that the red blood cells transfused by this patient 17 days ago were also DEL type). The infusion of DEL type blood into Rh(D) negative patients carried a potential risk of inducing the production of anti-D, which could be combined with DEL type red blood cells again to cause incompatibility. For women with a history of blood transfusion, pregnancy or fertility requirements and patients with blood transfusion dependence, transfusion should be cautious. As for those who have already developed anti-D, transfusion should only be performed in emergency situations to avoid the occurrence of hemolytic transfusion adverse reactions, and improve the safety and effectiveness of blood transfusion.
- DEL type /
- anti-D /
- absorption and dissipation test /
- Rh blood type /
- cross matching

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表 1 患者就诊期间配发血情况表

日期	献血员	血型	血量/U	配血结果	抗筛结查	抗体鉴定
2月19日	献血员1	A型，Rh阴性	2	相合	阴性
2月21日	献血员2	A型，Rh阴性	2	相合
3月7日	献血员3	A型，Rh阴性	1	相合	阳性	抗-D
3月7日	献血员4	A型，Rh阴性	2	相合	阳性	抗-D
3月8日(择期手术备血)	献血员5	A型，Rh阴性	2	不合	阳性	抗-D
	献血员6	A型，Rh阴性	2	相合
	献血员7	A型，Rh阴性	1	相合
	献血员8	A型，Rh阴性	2	相合

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表 2 患者血清不规则抗体筛查格局

编号	Rh						Kidd		MNs				Duffy
编号	D	C	E	c	e	C^w	Jk^a	Jk^b	M	N	S	s	Fy^a	Fy^b
Ⅰ	+	+	-	-	+	-	+	-	-	+	-	+	-	+
Ⅱ	+	-	+	+	-	-	-	+	+	-	+	+	+	-
Ⅲ	+	+	+	+	+	-	+	+	+	-	+	+	+	+

编号	RhKell				Lewis		P	Xg	Lutheran		Diego		结果
编号	K	k	Kp^a	Kp^b	Le^a	Le^b	P₁	Xg^a	Lu^a	Lu_b	Di^a		NS	IAT
Ⅰ	-	+	-	+	+	-	-	+	-	+	-		0	4+
Ⅱ	+	+	-	+	-	+	-	-	-	+	-		0	4+
Ⅲ	+	+	-	+	-	+	+	+	-	+	-		0	4+

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表 3 患者血清(或献血员细胞放散液)抗体特异性鉴定格局表

编号	RH							Lewis			MNSsMur						Kidd
编号	D	C	c	E	e	C^w		le^a	le^b		M	N	S		s	Mur	Jk^a	Jk^b
1	+	+	0	+	+	0		0	+		0	+	0		+	0	0	+
2	+	+	0	0	+	+		0	+		+	0	0		+	0	+	+
3	+	0	+	+	0	0		0	+		+	0	+		+	0	+	+
4	+	0	+	0	+	0		0	0		+	+	0		+	0	+	+
5	0	+	+	0	+	0		0	+		+	+	0		+	0	0	+
6	0	0	+	+	+	0		+	0		+	+	+		+	0	+	0
7	0	0	+	0	+	0		+	0		0	+	0		+	0	0	+
8	0	0	+	0	+	0		0	+		+	0	0		+	0	+	0
9	+	+	+	0	+	0		+	W		+	+	0		+	+	+	0
10	+	+	0	0	+	0		+	0		0	+	+		0	0	+	0
11	+	W	+	+	0	0		0	+		+	0	0		+	0	+	+
12	0	0	+	0	+	0		+	0		+	+	0		+	0	0	+
13	0	0	+	0	+	0		0	+		+	+	+		+	0	+	0
14	0	0	+	0	+	0		0	0		+	+	0		+	0	0	+
15	0	0	+	0	+	0		0	+		+	0	+		0	0	0	+
16	+	+	+	+	+	0		0	+		+	+	0		+	+	0	+

编号	Duffy		P1		Xg		Dia		Kell						Lutherar		抗体鉴定结果
编号	Fy^a	Fy^b	P1		Xg^a		Di^a		K	k	Kp^a	Kp^b	Js^a	Js^b	Lu^a	Lu^b	患者血清	献血员细胞放散液
1	0	+	+		+		0		0	+	0	+	0	+	0	+	2+	2+
2	+	0	0		+		0		0	+	0	+	0	+	0	+	2+	2+
3	0	+	0		+		0		0	+	0	+	0	+	0	+	2+	2+
4	0	0	+		0		0		0	+	0	+	0	+	0	+	2+	2+
5	0	+	+		+		0		0	+	0	+	0	+	0	+	0	0
6	+	+	0		+		0		0	+	0	+	0	+	0	+	0	0
7	0	+	+		+		0		+	+	0	+	0	+	0	+	0	0
8	+	0	+		+		0		0	+	0	+	0	+	0	+	0	0
9	+	0	+		0		0		0	+	0	+	0	+	0	+	2+	2+
10	0	+	+		+		0		+	+	0	+	0	+	0	+	2+	2+
11	+	0	+		+		+		0	+	0	+	0	+	0	+	2+	2+
12	+	+	+		+		0		+	+	0	+	0	+	+	0	0	0
13	+	0	0		+		0		0	+	0	+	0	+	0	+	0	0
14	0	+	0		+		0		0	+	0	+	0	+	0	+	0	0
15	0	+	+		+		0		0	+	0	+	0	+	0	+	0	0
16	+	0	0		+		0		0	+	0	+	0	+	0	+	2+	2+
自身对照																	0

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表 4 献血员5和献血员6 DEL型检测格局表

人员		放散液(IAT)			洗涤液(IAT)
人员	O1细胞	O2细胞	O3细胞	O1细胞	O2细胞	O3细胞
献血员5(配血不合)	+	+	+	0	0	0
献血员6(配血相合)	0	0	0	0	0	0

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