湖南省临床血型学EQARh弱(D)抗原检测结果分析与探讨
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摘要
目的 :评估湖南省临床血型学室间质量评价(EQA)参评实验室对Rh弱(D)抗原血型检测能力。方法 :湖南省临床检验中心(简称中心)工作人员现场检测和调查采用间接抗人球蛋白试验(抗D为IgG))、微柱凝胶卡法和试管法检测某批号红细胞Rh弱(D);EQA参评实验室按照《临床实验室室间质评要求》(GB/20032301-T-361)和PT评价方案检测某批号红细胞Rh弱(D)。结果 :现场检测和调查:抗人球蛋白试验(抗D为IgG)检测弱D阳性符合率明显高于微柱凝胶卡法和试管法(抗D为IgM);调查部分EQA回报阴性实验室90%未做阴性确认实验,10%实验室阴性确认实验方法和试剂选择错误。EQA参评实验室:全省参评实验室407家,回报阳性实验室12家,阳性符合率仅2.7%;采供血机构和妇幼机构现场参评实验室60家,回报阳性实验室2家,阳性符合率仅3.3%;EQA参评实验室三种方法检测弱D阳性符合率都低,无统计学意义。结论 :全省EQA参评实验室对某批号Rh弱(D)检测能力较低,常规血清学检测Rh(D)阴性后建议采用间接抗人球蛋白(抗D为IgG)试验做阴性确认实验,尤其在妇幼机构和采供血机构的实验室中必须做阴性确认实验。
Objective To evaluate the detectability of Rh weak(D) blood group antigen in External Quality Assessment(EQA) of Evaluatiaon Laboratory in Hunan province. Methods The indirect anti-human globulin tests anti-D(IgD) are field tested and surveyed by the stuff in Hunan Center For Clinical Laboratory(abbreviate Center), and The red blood cells of Rh weak(D) are tested by each laboratory in a way of microcolumn gel card method and tube method; The red blood cells of Rh weak(D) are tested by EQA Evaluatiaon Laboratory according to the report Clinical Laboratory Quality Assessment Requirements(GB/20032301-T-361) and PT Evaluation Protocols. Results Field testing and survey: The accordance rate of positive weak(D) in anti-human globulin card+anti-D(IgD) in field test and survey are obviously higher than the microcolumn gel card method and tube method((anti(IgM)); 90% of EQA laboratories did not take Rh(D) negative test confirmation again, while 10% of EQA laboratories chose wrong methods and reagents during this process. EQA Evaluatiaon Laboratory: There are 407 laboratories, among of which 12 take Rh(D) positive test confirmation experiment, with only 2.7% in positive accordance rate; there are 60 blood transfusion management and maternal and child care institutions, among of which 2 take Rh(D) positive test confirmation experiment, with only 3.3% in positive accordance rate. The weak D positive accordance rate are lower than the standard with those three methods in EQA Evaluatiaon Laboratory, without any sense in statistics. Conclusion The EQA Evaluatiaon Laboratory has low level in the testing ability of Rh weak(D) blood type. Anti-human globulin test anti-D(IgD) is regarded as Rh(D) negative test confirmation after conventional serologic detection of Rh(D), especially in maternal and child health care institutions and blood transfusion management the confirmation experiments must be putted into effect.
Objective To evaluate the detectability of Rh weak(D) blood group antigen in External Quality Assessment(EQA) of Evaluatiaon Laboratory in Hunan province. Methods The indirect anti-human globulin tests anti-D(IgD) are field tested and surveyed by the stuff in Hunan Center For Clinical Laboratory(abbreviate Center), and The red blood cells of Rh weak(D) are tested by each laboratory in a way of microcolumn gel card method and tube method; The red blood cells of Rh weak(D) are tested by EQA Evaluatiaon Laboratory according to the report Clinical Laboratory Quality Assessment Requirements(GB/20032301-T-361) and PT Evaluation Protocols. Results Field testing and survey: The accordance rate of positive weak(D) in anti-human globulin card+anti-D(IgD) in field test and survey are obviously higher than the microcolumn gel card method and tube method((anti(IgM)); 90% of EQA laboratories did not take Rh(D) negative test confirmation again, while 10% of EQA laboratories chose wrong methods and reagents during this process. EQA Evaluatiaon Laboratory: There are 407 laboratories, among of which 12 take Rh(D) positive test confirmation experiment, with only 2.7% in positive accordance rate; there are 60 blood transfusion management and maternal and child care institutions, among of which 2 take Rh(D) positive test confirmation experiment, with only 3.3% in positive accordance rate. The weak D positive accordance rate are lower than the standard with those three methods in EQA Evaluatiaon Laboratory, without any sense in statistics. Conclusion The EQA Evaluatiaon Laboratory has low level in the testing ability of Rh weak(D) blood type. Anti-human globulin test anti-D(IgD) is regarded as Rh(D) negative test confirmation after conventional serologic detection of Rh(D), especially in maternal and child health care institutions and blood transfusion management the confirmation experiments must be putted into effect.
引文
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[14]Yasuda H,Ohto H,Sakuma S,et al.Secondary anti-D immunization by Del red blood cells[J].Transfusion,2005,45(10):1581-1584.
[15]Kim KH,Kim KE,Woo KS,et a1.Primary anti-D immunization by DEL red blood cells[J].Korean J Lab Med,2009,29(4):361—365.
[16]Wagner FF,Gassner C,Muller TH,et a1.Molecular basis of weak D phenotypes[J].Blood,1999,93(1):385-393.
[17]杨珊,孔庆芳,谭庆芬.弱D、Del的检测及临床意义探讨[J].海南医学,2010,21(16):106-107
[18]舒群峰.十堰市Rh弱D和/或部分D变异型血型血清学检测结果分析[J].检验医学,2015,30(10):1004-1007.
[19]赵米春.输血前A2/A2B亚型和Rh弱D血型检测的意义[J].临床合理用药,2014,7(8A):121-122.
[20]任本春,张爱.弱D和部分D研究进展[J].临床血液学杂志,2012,25(8):542-545.
[21]金辉,张一兵,佟青,等.Rh血型弱D和DEL表型的基因突变分析[J].基础医学与临床,2012,32(4):447-450.
[22]胡应明,何子毅,陈金凤,等.东莞市无偿献血者ABO亚型和弱D型分布调查[J].临床血液学杂志,2014,27(6):475-477.
[2]兰炯采输血免疫血液学实验技术[M].北京:人民卫生出版社,2011.1,54,57,96.
[3]红尚.全国临床检验操作规程(第四版)[M].北京:人民卫生出版社,2014.124-129.
[4]Flegel WA.Molecular genetics of RH and its clinical application[J].Transfus Clin Biol,2006,13(1-2):4-12.
[5]Daniels G.Human Blood Groups[M].2nd ed.Oxford,UK:Blackwell Science Press,2002:165.
[6]孙国栋,段现民,尹志柱,等.华北地区汉族人群Rh(D)抗原弱表现型个体的分子遗传机制研究[J].中国输血杂志,2007,20(2):108-113.
[7]Yan L,Wu J,Zhu F,et a1.Molecular basis of D variants in Chinese persons[J].Transfusion,2007,47(3):471-477.
[8]刘达庄.免疫血液学[M].上海:上海科技出版社,2002.65-68,194-231.
[9]卢涛,曾毅,孙忠敏.Rh D血型变异及相关临床问题[J].长江大学学报(自科版),2014,11(30):87-90.
[10]王同显,冯智慧.血清学弱D表型患者RHD基因分型的必要性[J].中国输血杂志,2015,28(11):1297-1299.
[11]Daniels G.Variants of Rh D-current testing and clinical consequences[J].Br J Haematol,2013,161(4):461-470.
[12]Avent ND,Raid ME.The Rh blood group system:a review[J].Bood,2000,95(2):375-387.
[13]李丹,邵超鹏,张悦,等.部分D表型同种抗-D1例及其基因型分析[J].中国输血杂志,2008,21(9):680-683.
[14]Yasuda H,Ohto H,Sakuma S,et al.Secondary anti-D immunization by Del red blood cells[J].Transfusion,2005,45(10):1581-1584.
[15]Kim KH,Kim KE,Woo KS,et a1.Primary anti-D immunization by DEL red blood cells[J].Korean J Lab Med,2009,29(4):361—365.
[16]Wagner FF,Gassner C,Muller TH,et a1.Molecular basis of weak D phenotypes[J].Blood,1999,93(1):385-393.
[17]杨珊,孔庆芳,谭庆芬.弱D、Del的检测及临床意义探讨[J].海南医学,2010,21(16):106-107
[18]舒群峰.十堰市Rh弱D和/或部分D变异型血型血清学检测结果分析[J].检验医学,2015,30(10):1004-1007.
[19]赵米春.输血前A2/A2B亚型和Rh弱D血型检测的意义[J].临床合理用药,2014,7(8A):121-122.
[20]任本春,张爱.弱D和部分D研究进展[J].临床血液学杂志,2012,25(8):542-545.
[21]金辉,张一兵,佟青,等.Rh血型弱D和DEL表型的基因突变分析[J].基础医学与临床,2012,32(4):447-450.
[22]胡应明,何子毅,陈金凤,等.东莞市无偿献血者ABO亚型和弱D型分布调查[J].临床血液学杂志,2014,27(6):475-477.