Specificity analysis of irregular antibody in patients with difficult blood transfusion in Changzhou area
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摘要: 目的 分析常州地区疑难输血患者不规则抗体的检出情况。方法 对常州地区2019-2023年各医院送检的疑难配血患者标本,应用盐水法、聚凝胺法、抗球蛋白法[微柱凝集法和(或)试管法]检测不规则抗体。结果 共确认血型不规则抗体539例。其中同种特异性抗体436例(80.89%), 分别为: Rh 279例(51.76%),MNS 64例(11.87%),Lewis 31例(5.75%),Kidd 7例(1.30%),Duffy 3例(0.56%),P 6例(1.11%),Diego 3例(0.56%),Luther 1例(0.19%),Xg 1例(0.19%),混合抗体33例(6.12%),类同种自身抗体8例(1.48%);其他抗体103例(19.11%),分别为:自身抗体35例(6.49%),冷抗体16例(2.97%),药物抗体6例(1.11%), 抗-CD38抗体32例(5.94%),未知特异性抗体14例(2.60%)。结论 检出的不规则抗体与笔者先前报道有较大差异, 但Rh血型系统抗体仍然是临床疑难输血患者中最常见的不规则抗体,建议临床尽早实行Rh系统同型输注,以减少Rh系统抗体的产生,提高地区输血安全水平。Abstract: Objective The detection of irregular antibody in patients with difficult blood transfusion in Changzhou area was analyzed.Methods Saline method, polycoagulant method and antiglobulin method (microcolumn agglutination method and/or test tube method) were used to detect irregular antibodies in samples of patients with difficult blood matching sent to hospitals in Changzhou area from 2019 to 2023.Results A total of 539 cases of irregular blood group antibody were identified. There were 436 cases (80.89%) of homospecific antibodies, which were: Rh 279 cases (51.76%), MNS 64 cases (11.87%), Lewis 31 cases (5.75%), Kidd 7 cases (1.30%), Duffy 3 cases (0.56%) and P 6 cases (1.11%). There were 3 cases of Diego (0.56%), 1 case of Luthera (0.19%), 1 case of Xg (0.19%), 33 cases of mixed antibody (6.12%), and 8 cases of autoantibody (1.48%). There were 103 other antibodies (19.11%), including: autoantibody 35 cases (6.49%), cold antibody 16 cases (2.97%), drug antibody 6 cases (1.11%), anti-CD38 antibody 32 cases (5.94%) and unknown specific antibody 14 cases (2.60%).Conclusion The irregular antibodies detected were significantly different from those previously reported by the author, but Rh blood group system antibodies were still the most common irregular antibodies in patients with difficult clinical transfusion. It is recommended to implement Rh system isotype transfusion as early as possible to reduce the production of Rh system antibodies and improve the regional blood transfusion safety level.
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Key words:
- blood group /
- irregular antibody /
- frequency /
- blood transfusion safety
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表 1 539例不规则抗体特异性分布
血型系统 例数 百分比/% 血型系统 例数 百分比/% 同种抗体 436 80.89 抗-E+抗-Cw+抗-lea+抗-JKb 1 0.19 Rh 279 51.76 抗-cE+抗-Dia 1 0.19 抗-E 181 33.58 抗-cE+抗-JKa 2 0.37 抗-cE 63 11.69 抗-cE+抗-JKb 1 0.19 抗-C 1 0.19 抗-cE+抗-M 2 0.37 抗-c 1 0.19 抗-cE+抗-N 2 0.37 抗-e 3 0.56 抗-cE+抗-Cw+抗-Dia 1 0.19 抗-D 2 0.37 抗-cE+抗-JKb+抗-Wra 1 0.19 抗-Ce 27 5.01 抗-cE+抗-JKb+抗-Mur 1 0.19 抗-D+C 1 0.19 抗-C+抗-JKa 1 0.19 MNS 64 11.87 抗-Cw+抗-Dia 1 0.19 抗-M 57 10.58 抗-e+抗-JKb 1 0.19 抗-N 4 0.74 抗-Ce+抗-M 1 0.19 抗-S 3 0.56 抗-Ce+抗-Mur 1 0.19 Lewis 31 5.75 抗-Ce+抗-JKa 1 0.19 抗-lea 24 4.45 抗-Ce+抗-JKb 2 0.37 抗-leb 2 0.37 抗-Ce+抗-JKb+冷抗体 1 0.19 抗-lea+b 5 0.93 抗-Ce+抗-JKb+抗-Wra 2 0.19 Kidd 7 1.30 类Ce+抗-JKa 1 0.19 抗-JKa 3 0.56 类Ce+抗-JKb 1 0.19 抗-JKb 4 0.74 抗-S+抗-Wra 1 0.19 Duffy 抗-JKa+抗-M 2 0.37 抗-Fyb 3 0.56 抗-JKa+抗-N 1 0.19 P 抗-Fyb+抗-M 1 0.19 抗-P1 6 1.11 类同种自身抗体 8 1.48 Diego 类抗-Ce 6 1.11 抗-Dia 3 0.56 类抗-cE 1 0.19 Luther 类抗-C 1 0.19 抗-Lua 1 0.19 其他抗体 103 19.11 Xg 自身抗体 35 6.49 抗-Xga 1 0.19 冷抗体 16 2.97 混合抗体 33 6.12 药物抗体 6 1.11 抗-E+抗-JKa 1 0.19 抗-CD38抗体 32 5.94 抗-E+抗-JKb 1 0.19 未知特异性抗体 14 2.60 抗-E+抗-Dia 1 0.19 -
[1] van Gammeren AJ, van den Bos AG, Som N, et al. A national Transfusion Register of Irregular Antibodies and Cross(X)-match Problems: TRIX, a 10-year analysis[J]. Transfusion, 2019, 59(8): 2559-2566. doi: 10.1111/trf.15351
[2] 曲雪红, 王向岩. 输血前患者不规则抗体筛查及鉴定结果评价[J]. 临床检验杂志(电子版), 2018, 7(1): 146. https://www.cnki.com.cn/Article/CJFDTOTAL-LNJI201801095.htm
[3] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 4版. 北京: 人民卫生出版社, 2015.
[4] 闵志军, 张建伟, 曹伟春, 等. 常州地区疑难输血患者不规则抗体分析[J]. 临床血液学杂志, 2013, 26(10): 711-712. https://lcxy.whuhzzs.com/article/id/befff3fa-e4a3-44f1-af60-42da6132dd01
[5] 顾小文, 王玥, 尤建国. 大样本住院患者血型意外抗体检测结果的危险因素分析[J]. 中国输血杂志, 2023, 36(8): 701-705. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202308011.htm
[6] 许亚莉, 吴继博, 徐华, 等. 多中心联合筛查红细胞血型不规则抗体的大数据分析[J]. 中国输血杂志, 2018, 31(8): 823-825. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201808002.htm
[7] 王丽, 刘颖, 李文娟, 等. 8775例拟输血患者不规则抗体检出情况及危险因素分析[J]. 临床输血与检验, 2020, 22(5): 480-483. doi: 10.3969/j.issn.1671-2587.2020.05.009
[8] 洪毅, 李菲, 杨阳, 等. 56510例患者不规则抗体及特异性检测结果分析[J]. 海南医学, 2021, 32(2): 222-224. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN202102023.htm
[9] 钟昌瑞, 阙庆和, 黄巧莉, 等. 住院患者不规则抗体阳性率及特异性分析[J]. 临床血液学杂志, 2023, 36(4): 255-259. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.04.007
[10] 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
[11] 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. doi: 10.3969/j.issn.1671-2587.2022.01.003
[12] 谢惠益, 周载鑫, 杨玥, 等. 抗-M抗体影响血型鉴定及对临床输血的影响及解决策略[J]. 临床输血与检验, 2022, 24(6): 716-720.
[13] 潘宗岱, 刘超, 薛静, 等. 筛选细胞剂量效应造成抗-M抗体漏检引起的思考[J]. 临床血液学杂志, 2023, 36(2): 109-112. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2023.02.007
[14] 孙长杰, 王晓宁, 卢伟伟, 等. 红细胞Kidd血型抗原研究现状及进展[J]. 中国实验诊断学, 2020, 24(2): 340-343. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD202002047.htm
[15] 杨琳, 赵静雅, 杨世明, 等. IgG抗c、IgG抗E抗体联合IgG抗Jka抗体的检测分析[J]. 细胞与分子免疫学杂志, 2020, 36(11): 1032-1035. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM202110011.htm
[16] 毛娟, 褚晓月, 左琴琴, 等. IgG-Jk. a联合IgG-cE、IgG-Fy. b抗体鉴定及输血策略分析[J]. 中国输血杂志, 2019, 5(8): 811-813. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201908027.htm
[17] 刘丽丽. 抗体筛查漏检抗-Mur致交叉配血不合两例报告[J]. 北京医学, 2022, 44(4): 358-362. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202204017.htm
[18] 陈瑜, 邱芳, 朱颖, 等. Duffy血型系统抗体分布和临床意义分析[J]. 临床血液学杂志, 2021, 34(4): 255-258. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2021.04.008
[19] 杰夫·丹尼尔主编, 朱自严主译. 人类血型[M]. 北京: 科学出版社, 2007: 448.
[20] 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
[21] 糜坚青, 蔡晓红, 王少元, 等. CD38单克隆抗体对输血相容性检测干扰及其应对方案的专家共识[J]. 中国输血杂志, 2021, 34(4): 327-334. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202104002.htm
[22] 龙馨妍, 王雷萍, 张印则, 等. 药物诱导的免疫溶血性贫血研究进展[J]. 中国输血杂志, 2023, 36(6): 553-556. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202306022.htm
[23] Sharma A, Chamberlain S, Mannuru D, et al. An uncommon incidence of drug-induced immune hemolytic Anemia secondary to ceftriaxone[J]. Cureus, 2021, 13(12): e20682.
[24] 杨璐, 陈麟凤, 于洋, 等. 不规则抗体特异性不明确患者的输血疗效及安全性评估[J]. 国际检验医学杂志, 2015, 36(18): 2630-2632. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201518006.htm
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