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摘要: 目的 掌握血液中IgM型抗-Cw抗体的鉴定方法以及患者的输血原则。方法 直接抗人球蛋白试验检测红细胞致敏情况，抗筛细胞筛查血清中不规则抗体，对于血清中不规则抗体采用微柱凝集抗人球蛋白法和盐水法进行鉴定，微柱凝集抗人球蛋白法和盐水法交叉配血试验筛选所需悬浮红细胞。结果 结合抗筛细胞的格局和抗体鉴定谱细胞的格局，患者血清中检出IgM型抗-Cw联合IgG型抗-Wra，直接抗球蛋白试验阴性，自身对照阴性，红细胞Cw抗原阴性，红细胞C抗原阳性和Wra抗原阴性。结论 盐水法结合微柱凝集抗人球蛋白法可以鉴定血清中IgM型抗-Cw抗体；筛选Cw抗原阴性、Wra抗原阴性的悬浮红细胞、盐水法和微柱凝集抗人球蛋白法交叉配血均相合的红细胞悬液为患者输注。Abstract: Objective To master the method of identification of IgM anti-Cw antibody in blood and the principles of patient transfusion.Methods Direct anti-human globulin test was used to detect erythrocyte sensitization, and anti-sieve cells were used to screen irregular antibodies in serum. Column agglutination anti-human globulin method and saline method were used to identify irregular antibodies in serum, and column agglutination anti-human globulin method and saline method were used to cross-match blood test to screen suspended erythrocytes.Results Combined with the pattern of anti-screening cells and the pattern of antibody identification cells, IgM anti-Cw and IgG anti-Wra were detected in the serum of the patients, but the direct anti-globulin test was negative, the self control was negative, and the red blood cell Cw antigen was negative, red blood cell C antigen was positive and Wra antigen was negative.Conclusion The serum IgM type anti-Cw irregular antibody can be identified by the saltwine-binding column agglutination anti-human globulin method. Red blood cell suspension with Cw antigen negative and Wra antigen negative and red blood cell suspension with cross matching of saline method and column agglutination anti-human globulin method were selected for infusion.
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Key words:
- identification of irregular antibodies /
- IgM /
- anti-Cw /
- IgG /
- anti-Wra
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表 1 不规则抗体筛查结果
试验方法(试剂厂家) Ⅰ号 Ⅱ号 Ⅲ号 微柱凝集IAT(BIO-RAD抗筛细胞) 0 0 0 微柱凝集IAT(Sanquin抗筛细胞) 1+ 0 0 盐水法(Sanquin抗筛细胞) 1+ 0 0 酶法(Sanquin抗筛细胞) 4+ 0 0 
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表 2 IgM抗体和IgG型不规则抗体鉴别结果
试验方法(SanquinⅠ号抗筛细胞) 2-Me处理血浆 患者原血浆 自身对照 盐水法4 ℃10 min 0 2+ / 盐水法室温10 min 0 1+ / 酶法 0 3+ 0 IAT 0 +/- /
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表 3 抗体鉴定结果
序号 Rh-Hr Kell Duffy Kidd Lewis P MNS Luther Xg 患者样本 C D E c e Cw f v K k Kpa Kpb Jsa Jsb Fya Fyb Jka Jkb Lea Leb P1 M N S s Lua Lub Xga 酶法 IS IAT 1 + + 0 0 + + / / 0 + 0 + / + + 0 0 + 0 + + + 0 + + 0 + 0 3+ w 0 2 + + 0 0 + 0 / / + 0 0 + 0 + + 0 + 0 0 + 0 0 + 0 + 0 + 0 0 0 0 3 0 + + + 0 0 0 0 0 + 0 + 0 + 0 + + + + 0 + + + + 0 0 + + 0 0 0 4 0 + 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 0 6 0 0 + + 0 0 / / 0 + 0 + / + + + + 0 0 0 + + 0 + + 0 + + 0 0 0 7 0 0 0 + + 0 / / 0 + 0 + / + 0 + + 0 + 0 + + 0 + + 0 + 0 0 0 0 8 0 0 0 + + 0 / / + 0 0 + / + 0 + 0 + 0 + + 0 + 0 + 0 + 0 0 0 0 9 0 0 0 + + 0 / / + + 0 + / + + 0 + + 0 0 + + + + 0 0 + 0 0 0 0 10 0 0 0 + + 0 / / 0 + 0 + / + + + + 0 0 0 + 0 + 0 + + + + 0 0 0 11 + + + 0 + 0 / / 0 + 0 + / + 0 + 0 + + 0 + + 0 + + 0 + + 0 0 0 12 w + + + 0 0 / / 0 + 0 + / + + + + + 0 + + + + + + 0 + + 0 0 0 13 + 0 0 + + + / / 0 + 0 + / + + + + 0 + 0 + + + + + 0 + 0 3+ w 0 14 0 + + + 0 0 / / 0 + 0 + / + 0 + + 0 0 + 0 0 + 0 + 0 + + 0 0 0 15 + + 0 0 + 0 / / 0 + + + + + + 0 + + 0 + + 0 + 0 0 + + 0 0 0 16 0 0 0 + + 0 / / 0 + 0 + / + + 0 0 + + 0 + + + 0 + 0 + + 3+ 0 2+ 注：IS：盐水介质离心；患者自身对照阴性，DAT阴性。
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表 4 交叉配血结果及Digeo血型结果
供者 微柱凝集法 盐水法 酶法 Digeo血型 主侧 次侧 主侧 次侧 主侧 次侧 1 0 0 0 0 0 0 Wra- 2 0 0 0 0 0 0 Wra- 3 0 0 0 0 0 0 Wra-
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