不规则抗体筛查在输血安全中的临床应用
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摘要
目的:通过对临床输血患者红细胞血型不规则抗体的检测结果和分布特点,保障临床输血安全。方法:采用微柱凝胶法对2018-01—2018-07收治的21例临床输血患者进行不规则抗体筛查,对抗体筛查阳性标本采用盐水法、凝聚胺法、抗球蛋白法进行抗体特异性鉴定。结果:21例临床患者不规则抗体阳性者,其中男8例,女13例;女性患者不规则抗体检出率显著高于男性。21例不规则抗体阳性患者中,自身抗体1例,同种抗体+自身抗体1例,同种抗体19例。检出的同种抗体中抗-DC 1例,抗-E 2例,抗-Ec 6例,抗-c 1例,抗-Ce 1例,抗-M2例,抗-P11例,抗-Lea2例,抗-JKa1例,未确定特异性抗体2例。有妊娠史/输血史者≥3次的检出率明显高于无妊娠史和输血史者。结论:对有多次妊娠史和反复输血的临床患者在输血前应进行不规则抗体筛选,及时发现有临床意义的抗体,可有效避免临床患者免疫性溶血反应的发生,提高临床患者输血的安全性、有效性。
Objective:To analyze the irregular RBC antibody detection results and distribution characteristics in the clinical patients,in order to ensure the safety of blood transfusion.Method:Micro-column gel tests were performed for irregular antibody screening on 21 cases of clinical patients form January to July 2018.Positive samples were processed by the brine method,the amine condensation method and the anti-globulin method to identify the antibody specificity.Result:21 patients had positive irregular antibodies,including 8 males and 13 females,and the frequency of irregular antibodies of female patients was higher than that of male.In these 21 patients,1 case was autoantibodies,1 case was isotype antibodies and autoantibodies,and 19 cases were alloantibodies.The 19 cases of alloantibodies included 1 case of anti-DC,2 cases of anti-E,6 cases of anti-Ec,1 case of anti-c,1 case of anti-Ce,2 cases of anti-M,1 case of anti-P1,2 cases of anti-Lea,1 case of anti-JKa,and 2 cases of uncertain regarding antibody specificity.The positive rate of patients with pregnancy or transfusion history was higher than that of people without pregnancy or transfusion history.Conclusion:The screening of irregular antibodies in the patients with multiple pregnancies and repeated blood transfusions should be taken before blood transfusions.Timely detection of irregular antibodies can save the time during crossmatch,avoid the occurrence of immunological hemolysis reaction,and improve the safety and effectiveness of blood transfusion.
Objective:To analyze the irregular RBC antibody detection results and distribution characteristics in the clinical patients,in order to ensure the safety of blood transfusion.Method:Micro-column gel tests were performed for irregular antibody screening on 21 cases of clinical patients form January to July 2018.Positive samples were processed by the brine method,the amine condensation method and the anti-globulin method to identify the antibody specificity.Result:21 patients had positive irregular antibodies,including 8 males and 13 females,and the frequency of irregular antibodies of female patients was higher than that of male.In these 21 patients,1 case was autoantibodies,1 case was isotype antibodies and autoantibodies,and 19 cases were alloantibodies.The 19 cases of alloantibodies included 1 case of anti-DC,2 cases of anti-E,6 cases of anti-Ec,1 case of anti-c,1 case of anti-Ce,2 cases of anti-M,1 case of anti-P1,2 cases of anti-Lea,1 case of anti-JKa,and 2 cases of uncertain regarding antibody specificity.The positive rate of patients with pregnancy or transfusion history was higher than that of people without pregnancy or transfusion history.Conclusion:The screening of irregular antibodies in the patients with multiple pregnancies and repeated blood transfusions should be taken before blood transfusions.Timely detection of irregular antibodies can save the time during crossmatch,avoid the occurrence of immunological hemolysis reaction,and improve the safety and effectiveness of blood transfusion.
引文
[1] Chen C,Tan J,Wang L,et al.Unexpected red blood cell antibody distri butions in Chinese people by a systematic literature review[J].Transfusion,2016,56:975-979.
[2]尚红,王毓三,申子喻,等.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:118-143.
[3]孙晓琳,于洋,关晓珍,等.“剂量效应”现象对意外抗体鉴定的影响[J].中国实验血液学杂志,2015,23(1):222-227.
[4] Verduin EP,Brand A,Schonewille H.Is female sex a risk factor for red blood cell alloimmunization after transfusion?A systematic review[J].Transfus Med Rev,2012,26:342-353.
[2]尚红,王毓三,申子喻,等.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:118-143.
[3]孙晓琳,于洋,关晓珍,等.“剂量效应”现象对意外抗体鉴定的影响[J].中国实验血液学杂志,2015,23(1):222-227.
[4] Verduin EP,Brand A,Schonewille H.Is female sex a risk factor for red blood cell alloimmunization after transfusion?A systematic review[J].Transfus Med Rev,2012,26:342-353.