2010—2016年延边地区输血前检测疑难问题分析
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摘要
目的分析输血前检测过程中出现的疑难问题,了解不规则抗体分布特点,完善本地区输血安全策略。方法回顾分析2010—2016年延边地区各临床医院送检的297例输血前检测疑难标本血型血清学检测结果,并对不规则抗体性质和分布特点进行数据统计。结果 297例输血前检测疑难标本中,ABO亚型9例(3.03%)、血浆蛋白异常42例(14.14%)、37℃下无反应性冷抗体32例(10.77%)、患者直抗阳性抗筛阴性22例(7.41%)、供血者直抗阳性12例(4.04%)、不规则抗体54例(18.18%)。不规则抗体54例中,同种特异性抗体43例、自身抗体11例,男性20例(37.04%)、女性34例(62.96%),有输血史的44例(81.48%)。同种特异性抗体43例中,抗-E 23例、抗-Ce 6例、抗-C 3例、抗-cE 2例、抗-D 2例、抗-DC 4例、抗-DE 1例、2例抗-M。结论本地区输血前检测疑难问题主要集中在不规则抗体阳性、血浆蛋白异常和冷抗体,其他依次为直抗阳性、ABO亚型。同种特异性抗体中以Rh血型抗体最多,临床输血应酌情选择Rh抗原相匹配的血液输注,保证输血安全有效。
Objective To analyze and evaluate the potential difficulties in pre-transfusion tests, assisting characterizing irregular antibody distribution and improving blood transfusion safety strategy in the region. Methods A retrospective analysis was performed on 297 blood samples with pre-transfusion serological tests, which were collected from numerous hospitals in Yanbian documented during January 2010 to December 2016. Statistical analysis was also conducted on irregular antibody properties and distribution characteristics. Results Of the 297 samples, 9 were ABO subtype(3.03%). 42 were considered abnormal plasma protein(14.14%); 32 were non-reactive below 37℃(10.77%); 22 were diagnosed as DAT negative(7.41%); 12 were DAT reactive(4.04%); 54 were irregular antibody cases(18.18%). In the 54 irregular antibody cases: 43 were allogeneic antibodies; 11 were autoantibodies; 20 were males(37.04%), 34 were females(62.96%). 44 possessed blood transfusion history(81.48%). Among the 43 specific antibodies: 23 anti-E, 6 anti-Ce, 3 anti-C, 2 anti-cE, 2 anti-D, 4 anti-DC, 1 anti-DE, and 2 anti-M. Conclusion The trouble-shooting suggests dominate difficulties in irregular antibodies, plasma protein abnormalities and low-temperature antibodies, followed by DAGT negativity, ABO subtype issues. Rh blood group antibodies ranked top in any given types of specific-antibodies. Clinical transfusion requires compatible Rh antigen to ensure safe and effective blood transfusion.
Objective To analyze and evaluate the potential difficulties in pre-transfusion tests, assisting characterizing irregular antibody distribution and improving blood transfusion safety strategy in the region. Methods A retrospective analysis was performed on 297 blood samples with pre-transfusion serological tests, which were collected from numerous hospitals in Yanbian documented during January 2010 to December 2016. Statistical analysis was also conducted on irregular antibody properties and distribution characteristics. Results Of the 297 samples, 9 were ABO subtype(3.03%). 42 were considered abnormal plasma protein(14.14%); 32 were non-reactive below 37℃(10.77%); 22 were diagnosed as DAT negative(7.41%); 12 were DAT reactive(4.04%); 54 were irregular antibody cases(18.18%). In the 54 irregular antibody cases: 43 were allogeneic antibodies; 11 were autoantibodies; 20 were males(37.04%), 34 were females(62.96%). 44 possessed blood transfusion history(81.48%). Among the 43 specific antibodies: 23 anti-E, 6 anti-Ce, 3 anti-C, 2 anti-cE, 2 anti-D, 4 anti-DC, 1 anti-DE, and 2 anti-M. Conclusion The trouble-shooting suggests dominate difficulties in irregular antibodies, plasma protein abnormalities and low-temperature antibodies, followed by DAGT negativity, ABO subtype issues. Rh blood group antibodies ranked top in any given types of specific-antibodies. Clinical transfusion requires compatible Rh antigen to ensure safe and effective blood transfusion.
引文
[1] 兰炯采,贠中桥,陈静娴.输血免疫血液学实验技术.北京:人民卫生出版社,2011:22-80,111-145.
[2] 池泉,郭永建,田兆高.红细胞血型抗体与输血安全.中国输血杂志,2008,21(8):649-653.
[3] 兰炯采.自身免疫性溶血性贫血患者的配血试验.中国输血杂志,2015,28(7):753-754.
[4] 谢敬文,严康峰,蓝文莉.番禺地区临床输血患者不规则抗体分析.中国输血杂志,2010,23(7):534.
[5] 马伟文,严康峰,谢敬文,等.745例患者疑难交叉配血检测结果分析.医学检验与临床,2014,25(6)20-21
[6] 夏卫,姜健.无锡地区疑难配血患者血型血清学特点分析.现代检验医学杂志,2012,27(3):156-158.
[7] Tormey CA,Fisk J,Stack G.Red blood cell alloantibody frequency,specificity and properties in a population of male military veterans.Transfusion,2008,48(10):2069-2076.
[8] 于天华,遇红梅,梁海英,等.5050名患者Rh分型及不规则抗体鉴定结果分析.中国输血杂志,2012,25(8):756-758.
[9] 刘开良,李宁,李碧娟,等.患者红细胞不规则抗体分析与临床意义探讨.中国输血杂志,2011,24(9):787-788.
[10] 向东,刘曦,王建莲,等.患者血型不规则抗体的分析.中国输血杂志,2005,18(1):22-23.
[11] 王晓华,樊晶.备血患者不规则抗体筛查及其结果分析.中国输血杂志,2015,28(12):1513-1514.
[2] 池泉,郭永建,田兆高.红细胞血型抗体与输血安全.中国输血杂志,2008,21(8):649-653.
[3] 兰炯采.自身免疫性溶血性贫血患者的配血试验.中国输血杂志,2015,28(7):753-754.
[4] 谢敬文,严康峰,蓝文莉.番禺地区临床输血患者不规则抗体分析.中国输血杂志,2010,23(7):534.
[5] 马伟文,严康峰,谢敬文,等.745例患者疑难交叉配血检测结果分析.医学检验与临床,2014,25(6)20-21
[6] 夏卫,姜健.无锡地区疑难配血患者血型血清学特点分析.现代检验医学杂志,2012,27(3):156-158.
[7] Tormey CA,Fisk J,Stack G.Red blood cell alloantibody frequency,specificity and properties in a population of male military veterans.Transfusion,2008,48(10):2069-2076.
[8] 于天华,遇红梅,梁海英,等.5050名患者Rh分型及不规则抗体鉴定结果分析.中国输血杂志,2012,25(8):756-758.
[9] 刘开良,李宁,李碧娟,等.患者红细胞不规则抗体分析与临床意义探讨.中国输血杂志,2011,24(9):787-788.
[10] 向东,刘曦,王建莲,等.患者血型不规则抗体的分析.中国输血杂志,2005,18(1):22-23.
[11] 王晓华,樊晶.备血患者不规则抗体筛查及其结果分析.中国输血杂志,2015,28(12):1513-1514.