Analysis on the forward and reverse blood typing inconsistency caused by irregular antibodies after patients' first blood transfusion in the short term
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摘要: 目的 分析患者首次输血后短期内产生不规则抗体对血型正反定型的影响，正确鉴定患者血型和不规则抗体特异性，保证临床输血安全。方法 采用试管法、凝聚胺法、微柱凝胶卡式法进行不规则抗体筛选、抗体鉴定试验、Rh分型及直接抗人球蛋白试验分析不规则抗体特异性；2-巯基乙醇(2-ME)处理标本后鉴定血型。结果 患者血型为B型Rh阳性，Rh分型为ccDEE，血清中检出IgM、IgG抗-C。结论 患者首次输血后即可产生具有临床意义的特异性不规则抗体，建议对献血者和患者进行Rh血型系统抗原(CcEe)分型，可以快速匹配抗原相合血液，避免因抗体筛查阳性引起交叉配血困难而延误患者的输血治疗，减少不规则抗体引起的溶血性输血反应的发生。Abstract: Objective To analyze the impact of irregular antibodies produced by patients on forward and reverse typing among short term after their first blood transfusion, and accurately identify the patient's blood type and the specificity of irregular antibodies, as well as ensure clinical blood transfusion safety.Methods Test-tube, polyamine and microcolumn-gel-card methods were applied for irregular antibody screening, antibody identification, Rh typing and direct-anti-human-globulin test, to analyze the specificity of irregular antibodies; blood type was identified after 2-ME treatment.Results The patient's blood type was B type Rh positive, Rh subtype was ccDEE, and IgM and IgG anti C were detected in the serum.Conclusion After the first blood transfusion, specific irregular antibodies with clinically significance were produced by patients. It was recommended to perform group system antigen(CcEe) typing on Rh blood for blood-donors and patients, that could make quick blood matching with common antigen, avoid transfusion treatment delay due to difficulty from cross matching caused by positive antibody screening, and reduce the occurrence of hemolytic transfusion reactions caused by irregular antibodies.
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Key words:
- irregular antibody /
- anti-C /
- IgG /
- IgM
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表 1 ABO血型血清学试验
方法 抗-A 抗-B Ac Bc Oc 自身c 微柱凝胶卡法 0 4+ 4+ 4+ 3+ 0 试管法(盐水法) 0 3+ 3+ 3+ 2+ 0 2-ME处理后微柱凝胶卡法 0 4+ 3+ 0 0 0 
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表 2 患者谱细胞反应格局表
序号 Rh-rh Kidd MNS Duff Dieg Kell Lewi P DO Yt IS IAT D C E c e JKa JKb M N S s Mur Fya Fyb Dia Dib K k Lea Leb P1 DOa DOb Yta Ytb 1 + 0 + + + + 0 + 0 0 + 0 + 0 0 / 0 + + + 0 / / / / 0 0 2 + + 0 0 + + 0 0 + 0 + 0 + 0 0 / 0 + 0 + +w / / / / 4+ 4+ 3 + + + + + + 0 0 + 0 + 0 + + + / 0 + + + + / / / / 4+ 4+ 4 + 0 + + 0 + + 0 + 0 + 0 + 0 0 / 0 + 0 + 0 / / / / 0 0 5 + 0 + + + 0 + + + 0 + 0 + 0 0 + 0 + 0 + + 0 + + 0 0 0 6 + + 0 0 + + 0 + + + + 0 + 0 0 / 0 + 0 + + / / / / 3+ 4+ 7 0 + 0 + + + + + + 0 + 0 + 0 0 / 0 + 0 + + / / / / 3+ 3+ 8 + + + + + + + + 0 0 + 0 + 0 0 / 0 + + + 0 / / / / 3+ 3+ 9 0 0 0 + + + + 0 + 0 + 0 + 0 0 + 0 + + 0 0 0 + + 0 0 0 10 + + + + + + + + + 0 + + + 0 + / 0 + 0 + + / / / / 3+ 3+
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表 3 抗-C抗体效价测定
时间 IgM+IgG IgM IgG 凝聚胺法 抗人球蛋白微柱凝胶卡 试管法 微柱凝胶卡法 凝聚胺法 抗人球蛋白微柱凝胶卡 输血后14 d 1∶128 1∶512 1∶16 1∶64 1∶32 1∶256 输血后21 d 1∶256 1∶1024 1∶8 1∶32 1∶64 1∶512
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[1] 任伟, 姚洁, 林泽宇. 反复输血患者体内产生不规则抗体的临床分析及解决策略[J]. 中国输血杂志, 2016, 29(12): 1350-1352. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201612011.htm
[2] Mbalibulha Y, Muwanguzi E, Mugyenyi G. Rhesus blood group haplotype frequencies among blood donors in southwestern Uganda[J]. J Blood Med, 2018, 9: 91-94. doi: 10.2147/JBM.S151017
[3] 李育, 贝娜. 受血者与献血者Rh表型检测的临床意义[J]. 浙江医学, 2015, 37(10): 827-828, 857. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201510011.htm
[4] 李海云, 程从远. 南阳市RhD/C/c/E/e血型分型库建立的意义及应用[J]. 中国实验血液学杂志, 2016, 24(5): 1583-1587. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY201605057.htm
[5] 胡丽华. 临床输血学检验技术[M]. 北京: 人民卫生出版社, 2015: 18-21.
[6] 向东, 范亮峰, 刘曦, 等. 免疫性溶血性输血反应100例分析[J]. 临床输血与检验, 2022, 24(1): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202201003.htm
[7] 郝欣欣, 王秋实. 溶血性输血反应病例分析及国内文献回顾[J]. 中国输血杂志, 2023, 36(4): 316-320. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202304010.htm
[8] Panch SR, Montemayor-Garcia C, Klein HG. Hemolytic transfusion reactions[J]. N Engl J Med, 2019, 381(2): 150-162. doi: 10.1056/NEJMra1802338
[9] 戚央聪, 马幼丽, 陆贤吉. 9910例患者和献血员Rh表型检测与临床意义[J]. 中国卫生检验杂志, 2018, 28(1): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201801023.htm
[10] 孙丽芳. 在抗体筛选阳性患者快速配血中应用Rh抗原分型的效果分析[J]. 中国输血杂志, 2020, 33(5): 481-483. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202005023.htm
[11] 王磊, 吴学忠. 受血者与供血者Rh(D、C、c、E、e)抗原相容情况的回顾性分析[J]. 临床输血与检验, 2021, 23(2): 181-185. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202102011.htm
[12] 王彬, 金丽琴. 患者和献血员Rh血型表型的检测与临床输血[J]. 中国卫生检验杂志, 2015, 25(9): 1380-1381. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWJZ201509030.htm
[13] 刘英, 王峻, 葛艳玲. 疑难交叉配血成因与交叉配血策略的分析[J]. 中国输血杂志, 2020, 33(2): 152-154. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202002022.htm
[14] 皮兰敢, 何章勇. 抗-C伴随自身类抗-e的鉴定[J]. 中国输血杂志, 2017, 30(7): 693-695. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201707016.htm
[15] 吕运来, 王欢欢, 马红丽, 等. 临床红细胞输注不良反应及其对输注效果的影响[J]. 中国输血杂志, 2008, 21(1): 8-9. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO200801007.htm
[16] 刘金莲, 李丽兰, 刘学军, 等. 南宁地区疑难输血患者红细胞不规则抗体的分析[J]. 中国输血杂志, 2020, 33(1): 60-63. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202001023.htm
[17] Sahin I, Reagan JL, Niroula R, et al. Refractoriness to red blood cell transfusion therapy due to hypersplenism[J]. Transfusion, 2018, 58(11): 2513-2516.
[18] Fung MK, Eder AF, Spitalnik SL, et al. Technical Manual[M]. 19nd ed. Bethesda, MD: AABB, 2017: 233-235.
[19] 陈爱霞. 血清不规则抗体筛查及Rh抗原检测对临床输血安全的影响[J]. 基层医学论坛, 2022, 26(13): 86-88, 91. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT202213028.htm
[20] 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. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYA202002047.htm
[21] 马彩虹, 安翠红. Rh血型D、C、E抗原的分布及其在临床输血中的应用和检验准确率[J]. 临床医学研究与实践, 2019, 4(7): 94-96. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201907040.htm
[22] 胡梅京, 车丽敏, 张艳宾, 等. 探讨ABO、RhD血型调查与建立Rh表型库在安全输血中的临床意义[J]. 河北医科大学学报, 2020, 41(6): 704-708. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202006019.htm
[23] 刘太香, 薛敏, 许进明, 等. 变异型D产生抗-D合并抗-C及抗-Jkb抗体1例[J]. 临床血液学杂志, 2023, 36(2): 137-139. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.02.014
[24] 董树岭, 宋婕, 王书亚, 等. 104 588名住院患者红细胞同种抗体检测结果分析[J]. 中国输血杂志, 2023, 36(3): 245-248. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202303013.htm
[25] 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
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