Detection and analysis of ABO blood group forward and reverse typing inconsistency caused by ABO blood group antibody deficiency
-
摘要: 目的 分析ABO血型反定型抗体缺失样本的血型血清学及基因检测结果，探讨ABO血型抗体缺失的原因和输血策略。方法 采用Ortho AutoVue全自动血型系统对该院2019年11月至2023年10月33 296例患者进行常规ABO血型检测，选择ABO血型正反定型不符疑为抗体缺失者，采用盐水试管法复核并增加ABO亚型检测、吸收放散试验检测红细胞上的A或B抗原，对ABO基因第6和第7外显子进行测序分析。结果 95例ABO血型正反定型不符样本中，7例疑为血型抗体缺失，其中4例确认为ABO血型抗原减弱，3例确认为ABO血型抗体缺失，本地区ABO血型抗体缺失检出率0.09‰，经过基因测序分析，确定血型抗体缺失者基因型分别为 B.01/O.01.02、O.01.13/O.01.13、B.01/O.01.01 。结论 疑似ABO血型抗体缺失者需要从正定型和反定型分别进行检测分析，ABO基因检测可明确具体ABO基因型，提高ABO血型鉴定的准确性并可明确ABO血型抗体缺失现象。对于疑似或确定为ABO血型抗体缺失者的输血，可采用相容性输血的方式。Abstract: Objective To analyze the serological and genetic test results of samples with ABO reverse typing antibody deficiency, and to explore the causes of ABO reverse typing antibody deficiency and transfusion strategy.Methods The Ortho AutoVue automatic blood group system was used to perform routine ABO blood group testing for 33 296 patients in the hospital from November 2019 to October 2023. Those who were suspected of antibody deficiency due to the inconsistency of ABO blood group forward and reverse typing were selected. ABO subgroup detection, A or B antigen detection on red blood cells, and exon 6 and 7 of ABO gene sequencing were performed.Results Among the 95 cases of ABO blood group positive and reverse typing discrepancies, 7 cases were suspected to be ABO blood group antibody deficiency, of which 4 cases were confirmed to be ABO blood group antigen weakening and 3 cases were confirmed to be ABO blood group antibody deficiency. The detection rate of ABO blood group antibody deficiency in this region was 0.09‰. After gene sequencing analysis, the genotypes were B.01/O.01.02、O.01.13/O.01.13、B.01/O.01.01 .Conclusion Suspected ABO blood group antibody deficiency needs to be detected and analyzed from forward typing and reverse typing respectively. ABO gene testing can clarify the specific ABO genotype, improve the accuracy of ABO blood group identification and identify the phenomenon of ABO blood group antibody deficiency. Compatible transfusion can be used for patients who were suspected or confirmed ABO blood group antibody deficiency.
-
-
表 1 3例ABO血型抗体缺失样本的盐水试管法检测结果
编号 ABO正定型 ABO反定型 患者红细胞吸收放散 抗-A 抗-B 抗-A1 抗-AB 抗-H A1c Bc Oc 自身对照 A1c Bc 1 0 4+ 0 4+ 2+ 0 0 0 0 0 / 2 0 0 0 0 4+ 0 0 0 0 0 + 3 0 4+ 0 4+ 2+ 0 0 0 0 0 / 注：“/”为未检测。 
下载: 导出CSV
表 2 ABO反定型盐水试管法增强检测结果
编号 4℃ 10 min 血浆加倍 离心2次 A1c Bc A1c Bc A1c Bc 1 0 0 0 0 0 0 2 0 0 0 0 0 0 3 0 0 0 0 0 0
下载: 导出CSV
表 3 3例样本的ABO基因第6、7外显子测序结果
样本 碱基突变位点* 氨基酸替换 基因型 1 c.297A>G；c.526C>G；c.657C>T；c.703G>A；c.796C>A；c.803G>C；c.930G>A c.106G>T；c.188G>A；c.189C>T；c.220C>T；c.261delG；c.297A>G；c.646T>A；c.681G>A；c.771C>T；c.829G>A p.Arg176Gly；p.Gly235Ser；p.Leu266Met；.Gly268Ala；p.Val36Phe；p.Arg63His；p.Pro74Ser；p.Thr88Profs*31 B.01/O.01.02 2 c.261delG；c.297A>G；c.646T>A；c.681G>A；c.771C>T；c.829G>A c.261delG；c.297A>G；c.646T>A；c.681G>A；c.771C>T；c.829G>A p.Thr88Profs*31 p.Thr88Profs*31 O.01.13/O.01.13 3 c.297A>G；c.526C>G；c.657C>T；c.703G>A；c.796C>A；c.803G>C；c.930G>A c.261delG p.Arg176Gly；p.Gly235Ser；p.Leu266Met；p.Gly268Ala；p.Thr88Profs*31 B.01/O.01.01 注：*与 A1.01 标准序列相比较。
下载: 导出CSV
表 4 其他检验结果
相关检验结果 ALB (40~ 55 g/L) GLB (20~ 40 g/L) 清蛋白(46.6%~ 62.2%) α1球蛋白(1.7%~ 4.1%) α2球蛋白(5.9%~ 13.5%) β球蛋白(10.9%~ 18.9%) γ球蛋白(11.6%~ 22.4%) WBC (3.5×109/L~ 9.5×109/L) 淋巴细胞数(1.1×109/L~ 3.2×109/L) 1 46.80 27.20 / / / / / 6.85 2.23 2 42.30 32.10 57.00 2.40 6.88 9.20 24.52 9.15 2.90 3 35.50 22.10 56.00 5.08 9.76 12.38 16 8.02 1.81 注：“/”为未检测。
下载: 导出CSV
-
[1] 许桂平, 康琼华, 李晶晶, 等. 120例ABO血型正反定型不符影响因素分析及对策浅析[J]. 中国输血杂志, 2018, 31(1): 61-63. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO201801022.htm
[2] 潘英芳, 邵静茹, 周娜, 等. 围产期孕妇检出罕见CisAB血型及其备血策略探讨[J]. 临床血液学杂志, 2023, 36(4): 283-287. doi: 10.13201/j.issn.1004-2806.2023.04.013
[3] 向东. 人红细胞输血相关免疫学概述[J]. 中华微生物学和免疫学杂志, 2023, 43(9): 677-682. doi: 10.3760/cma.j.cn112309-20230906-00067
[4] 秦洪伟, 刘玉锋, 张树超. 青岛市某三级医院就诊患者ABO血型正反定型不符原因分析[J]. 临床血液学杂志, 2023, 36(12): 896-901. doi: 10.13201/j.issn.1004-2806.2023.12.012
[5] 国家卫生健康委员会. 输血医学术语: WS 203—2020[S]. 北京: 中国标准出版社, 2020.
[6] Youk HJ, Ryu HY, Seo SW, et al. A New Trial to Measure ABO Antibodies Using Complement-Dependent Cytotoxicity[J]. Medicina(Kaunas), 2022, 58(6): 830.
[7] 韩婷, 唐代玉. 141例母婴血型不合患儿新生儿溶血病检测结果分析[J]. 临床血液学杂志, 2023, 36(6): 402-405. doi: 10.13201/j.issn.1004-2806.2023.06.004
[8] Zorn E. ABO antibody development, a new look at a very old question[J]. Transplantation, 2023, 107(11): 2311-2312. doi: 10.1097/TP.0000000000004659
[9] Springer GF, Horton RE, Forbes M. Origin of anti-human blood group B agglutinins in white Leghorn chicks[J]. J Exp Med, 1959, 110(2): 221-244. doi: 10.1084/jem.110.2.221
[10] Yamamoto S. The occurrence of materials cross-reacting with anti-a and-b agglutinins in fruit or seed extracts of higher plants[J]. Int J Immunogenetics, 1977, 4(5): 325-330. doi: 10.1111/j.1744-313X.1977.tb00915.x
[11] 李志强, 吕先萍, 刘铁梅, 等. 1周岁内婴幼儿月龄与ABO血型抗体凝集强度消长的多中心前瞻性研究[J]. 临床输血与检验, 2021, 23(4): 450-454. doi: 10.3969/j.issn.1671-2587.2021.04.009
[12] 岳晓红, 汪群英, 李建英. 低蛋白血症引起罕见血型抗体缺乏1例[J]. 中原医刊, 2004, (21): 53. https://www.cnki.com.cn/Article/CJFDTOTAL-MEDI200421058.htm
[13] 覃小矿, 马曙轩, 侯云生, 等. X-连锁无丙种球蛋白血症患儿ABO血型一例[J]. 海南医学, 2017, 28(10): 1705-1706. doi: 10.3969/j.issn.1003-6350.2017.10.054
[14] 聂益军. 恶性疾病导致ABO血型抗原或抗体减弱的讨论[J]. 检验医学与临床, 2014, 11(1): 66-68. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201401029.htm
[15] 张循善, 卫玉芝, 李燕萍, 等. 多发性骨髓瘤引起ABO血型的抗原减弱及抗体丢失2例[J]. 中国输血杂志, 2001, 14(1): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO200101029.htm
[16] 李小飞, 马春娅, 侯瑞琴. ABO血型不合异基因造血干细胞移植受者血型检测与血液成分输注专家共识[J]. 中国输血杂志, 2023, 36(11): 971-977. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202311001.htm
[17] 陈亮, 吕翼. 外周免疫耐受机制的研究进展及其应用[J]. 生物学教学, 2023, 48(6): 4-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SWJX202306002.htm
[18] Kakkar B, Mallhi RS, Philip J. Type Ⅰ ABO discrepancy due to missing antibody attributable to anti-snake venom in two patients: a rare presentation[J]. Transfus Apher Sci, 2022, 61(5): 103437.
[19] 张印则, 徐华, 周华友. 红细胞血型原理与检测策略[M]. 3版. 北京: 人民卫生出版社, 2023: 350-352.
[20] 秦洪伟, 李守蕾, 薛杰, 等. 疑似B3亚型标本的ABO基因检测与输血策略分析[J]. 临床血液学杂志, 2022, 35(4): 294-296. doi: 10.13201/j.issn.1004-2806.2022.04.015
[21] 冯晨晨, 肖建宇, 史丽莉, 等. 误判O型的疑难血型鉴定及安全输血策略的研究[J]. 中国实验血液学杂志, 2021, 29(3): 910-916. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202103045.htm
[22] 蒋玉林, 毛伟, 刘不尽, 等. 抗体缺失致血型鉴定困难1例[J]. 检验医学与临床, 2021, 18(24): 3645-3647. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202124043.htm
[23] Rehman GU, Shi H, Khan M, et al. Molecular genetic analysis reveals a novel B variant allele at the ABO locus[J]. Transpl Immunol, 2022, 75: 101684.
[24] 韩斌, 葛东梅, 刘培燕, 等. ABO抗体缺失致血型鉴定困难1例[J]. 临床输血与检验, 2017, 19(2): 201-202. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY201702036.htm
[25] 夏世梅, 袁梅, 冯星星, 等. 11例X连锁无丙种球蛋白血症患儿的临床分析[J]. 中国现代医生, 2023, 61(25): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202325001.htm
-
图(1)
表(4)
计量
- 文章访问数: 788
- PDF下载数: 925
- 施引文献: 0