Identification and analysis of mimicking anti-E autoantibodies and exploration of blood transfusion strategy
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摘要: 目的 对类自身抗体患者的不规则抗体进行鉴定分析，探讨类抗体的检测方法，为其制定输血策略，为临床合理用血提供借鉴和参考。方法 实验室接诊疑难交叉配血患者1例，采用试管法进行ABO血型、Rh血型鉴定、抗体筛查、抗体特异性鉴定、直接抗人球蛋白试验、吸收放散试验、抗体效价和交叉配血试验，采用毛细管超速离心法分离新旧红细胞，进行红细胞Rh系统血型抗原鉴定。结果 患者血型为B型，Rh血型为CcDEe，直接抗球蛋白试验、自身对照试验均阳性；盐水试管法进行血浆抗体筛查呈阴性，而间接抗人球蛋白试验呈阳性，红细胞(ccee)吸收后上清液与红细胞(ccee、CCEe)均呈阴性反应；放散液与红细胞(ccee)反应阴性，与红细胞(CCEe)呈弱阳性，自身红细胞吸收后血清抗体筛选试验结果为阴性；选择ee血型红细胞与其交叉配血显示相合。结论 患者血浆中存在类抗-E特异性自身抗体，此类患者输注ee血型红细胞，可提高输注效果。Abstract: Objective To identify and analyze irregular antibodies in autoantibody patients, explore the detection methods of antibody-like antibodies, and provide reference for formulating transfusion strategies and guiding clinical rational use of blood.Methods A patient with difficult cross-matching blood was admitted in our laboratory. The ABO and Rh blood type, antibody screening, antibody specificity identification, direct anti-human globulin test, absorption and diffusion test, antibody titer and cross-matching blood test were performed by test tube method. The new and old red blood cells were separated by capillary ultra-centrifugal method, and Rh blood type was identified.Results The patient's blood type was B and Rh blood type was CcDEe. Both direct antiglobulin test and self-controlled test were positive. Serum antibody screening by saline test tube was negative, but Liss-IAT test was positive, after absorption of red blood cell(ccee), the supernatant of red blood cell was negative with red blood cell(ccee, CCEe). The reaction between the diffusion solution and erythrocyte(ccee) was negative, the reaction with erythrocyte(CCEe) was weakly positive, after absorption of autoerythrocyte, the serum antibody screening test was negative. Cross matching test with Erythrocytes of ee blood type was negtive.Conclusion There were mimicking anti-E autoantibodies in the plasma of the patients. Infusion of red blood cell(ee) could improve the transfusions effect.
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Key words:
- antibody-like /
- cross matching blood /
- transfusion strategy
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表 1 患者ABO和Rh血型鉴定结果
反应条件 -A -B Ac Bc Oc D -C -c -E -e 自身细胞 IS 0 4+ 1+s 0 0 3+ 2+ 2+ 2+ 2+ 0 
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表 2 10月6日毛细管离心前后Rh因子鉴定
分离前 分离后 近心端 远心端 C c E e C c E e C c E e 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+
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表 3 10月8日毛细管离心前后Rh因子鉴定
分离前 分离后 近心端 远心端 C c E e C c E e C c E e 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 2+ 3+mf 3+mf 2+
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表 5 患者血清抗体鉴定结果
序号 Rh-Hr Rh-Hr Kell Duffy Kidd Lewis P MNS Lurher Xga 盐水 L-IAT C D E c e Cw f V K k Kpa Kpb Jsq Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub 1 R1WR1 + + 0 0 + + / / 0 + 0 + / + + 0 + 0 0 + 0 0 + 0 + 0 + + 0 0 2 R1R1 + + 0 0 + 0 / / + w + + 0 + 0 + + + 0 + + 0 + 0 + 0 + + 0 0 3 R2R2 0 + + + 0 0 / / 0 + 0 + / + + 0 + + 0 + 0 + 0 + 0 0 + + 0 + 4 R0 0 + 0 + + 0 / / 0 + 0 + / + 0 0 + 0 0 0 + 0 + 0 + 0 + + 0 0 5 r’r’ + 0 0 0 + 0 / / 0 + 0 + / + 0 + + + + 0 + + + 0 + 0 + + 0 0 6 r’’r’’ 0 0 + + 0 0 / / 0 + 0 + / + + 0 + 0 0 + + + 0 0 + 0 + + 0 + 7 rr 0 0 0 + + 0 / / + 0 0 + / + 0 + 0 + 0 + + 0 + 0 + 0 + 0 0 0 8 rr 0 0 0 + + 0 / / 0 + 0 + / + + + + + 0 + + 0 + + + 0 + + 0 0 9 rr 0 0 0 + + 0 / / + + 0 + / + + 0 + 0 0 + 0 + + + 0 0 + 0 0 0 10 rr 0 0 0 + + 0 / / 0 + 0 + / + + + 0 + 0 + + + + + + + 0 + 0 0 11 RzR1 + + + 0 + 0 / / 0 + 0 + / + + + + 0 + 0 0 0 + 0 + 0 + 0 0 + 12 RzR2 W + + + 0 0 / / 0 + + + / + 0 + + + + + + + + 0 + 0 + + 0 + 13 rr + 0 0 0 + 0 / / 0 + 0 + / + + 0 0 + + + + + 0 + 0 0 + + 0 0 14 r1wr + 0 0 + + + / / 0 + 0 + / + + + + + + + + + + + + 0 + 0 0 0 15 R2R2 + 0 0 + + 0 / / 0 + 0 + / + 0 + + + + 0 0 0 + + 0 0 + 0 0 0 16 R1R1 0 + + + 0 0 / / 0 + 0 + / + + 0 + 0 0 + + + + + + 0 + 0 0 + 自身 0 +
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[1] 张秋会, 孙文利, 胡兴斌, 等. AIHA患者血清中类同种特异性自身抗体的检出率及其分布情况探讨[J]. 中国输血杂志, 2016, 29(12): 1352-1355. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201612012.htm
[2] 王晓华, 骞田. Rh系统类抗体在临床输血中的鉴定及应用(附1例分析)[J]. 淮海医药, 2017, 35(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-HHYY201701013.htm
[3] Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia[J]. Blood, 2017, 129(22): 2971-2979. doi: 10.1182/blood-2016-11-693689
[4] Pecker LH, Timsar A, Pary PP, et al. Unusual serological findings associated with ceftriaxone-induced immune hemolytic anemia in a child with disseminated low-grade glioma[J]. Pediatr Blood Cancer, 2016, 63(10): 1852-1855. doi: 10.1002/pbc.26101
[5] Neuman G, Boodhan S, Wurman I. Ceftriaxone-induced immunehemolytic anemia[J]. Ann Pharmacother, 2014, 48(12): 1594-1604. doi: 10.1177/1060028014548310
[6] El Khoury C, Farhat H. Severe acute anemia attributable to concomitant occurrence of AIHA with PRCA induced by parvovirus B19 infection[J]. Blood, 2018, 131(12): 1388. doi: 10.1182/blood-2017-11-817908
[7] Minakawa K, Ohto H, Yasuda H, et al. Efficacy of D-red blood cell transfusion and rituximab therapy in autoimmune hemolytic anemia with anti-D and panreactive autoantibodies arising after hematopoietic stem cell transplant[J]. Transfusion, 2018, 58(7): 1606-1610. doi: 10.1111/trf.14634
[8] 中华人民共和国卫生部医政司. 全国临床检验操作规程[M]. 3版. 南京: 东南大学出版社, 2006: 246-266.
[9] Chiaroni J, Touinssi M, Mazet M, et al. Adsorption of autoantibodies in the presence of LISS to detect alloantibodies underlying warm autoantibodies[J]. Transfusion, 2003, 43(5): 651-655. doi: 10.1046/j.1537-2995.2003.00356.x
[10] Dwyre DM, Clapper A, Heintz M, et al. A red blood cell autoantibody with mimicking anti-E specificity[J]. Transfusion, 2004, 44(9): 1287-1292. doi: 10.1111/j.0041-1132.2004.04112.x
[11] 刘达庄. 免疫血液学[M]. 上海: 上海科学技术出版社, 2002: 58-68.
[12] 杨红梅, 虞茜, 邹昕, 等. 抗-E、抗-Lea合并抗-Jkb、抗-Cw致疑难配血及输血反应分析[J]. 临床血液学杂志, 2022, 35(12): 892-896. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2022.12.013
[13] 杨红梅, 邹昕, 马思飞, 等. 酸放散稀释法在类同种特异性自身抗体检测中的应用价值[J]. 检验医学与临床, 2023, 20(13): 1960-1962. doi: 10.3969/j.issn.1672-9455.2023.13.032
[14] 封彦楠, 马春娅, 杨鑫, 等. 类同种自身抗体患者血清学特点及抗体分布回顾性分析[J]. 中国实验血液学杂志, 2021, 29(4): 1301-1307. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202104047.htm
[15] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-SPAN201904001.htm
[16] 范亮峰, 刘曦, 沈伟, 等. 不规则抗体体内消减速率的研究[J]. 中国输血杂志, 2016, 29(11): 1229-1231. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201611008.htm
[17] 范亮峰, 叶珍, 刘曦, 等. 类抗-E自身抗体的分析与研究1例[J]. 中国输血杂志, 2017, 30(12): 1408-1410. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201712041.htm
[18] 万春晶, 王宝燕, 徐华, 等. 西安地区住院患者与健康人群Rh血型分布特征[J]. 中国输血杂志, 2017, 30(4): 395-398. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201704029.htm
[19] 肖艳丽, 赵一贺, 李代红. 直接Coombs试验阳性的AIHA患者的临床分析和输血治疗[J]. 中国输血杂志, 2018, 31(10): 1153-1156. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201810022.htm
[20] 刘达庄. 免疫血液学[M]. 上海: 上海科学技术出版社, 2002: 152.
[21] 丁琴丽, 陈宝龙, 邱芳. 产生类抗体的自身免疫性溶血性贫血患者的输血选择[J]. 中国实验血液学杂志, 2017, 25(4): 1208-1211. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY201704048.htm
[22] 田亚娟, 赵志弘, 刘敬闪, 等. 1例弱反应自身特异性抗体患者输血策略探讨[J]. 临床输血与检验, 2012, 14(4): 358-359. doi: 10.3969/j.issn.1671-2587.2012.04.031
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