直接Coombs试验阳性的AIHA患者的临床分析和输血治疗
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摘要
目的探讨直接Coombs试验(DAT)阳性的AIHA患者的临床特征和输血前试验,回顾性研究输血后综合疗效,寻找有效的输血策略。方法对本院88例DAT阳性的AIHA患者查阅病例,进行临床统计分析;对温抗体型AIHA病例进行DAT阳性凝集强度和溶血严重程度比较;按照输注不同血液制品种类,以实验室指标和临床症状改善为评价指标进行综合评价;按照不同配血方式,以输血不良反应发生情况进行安全性评估。结果 88例AIHA中有88. 6%(78/88)为温反应性自身抗体。血液系统疾病,风湿类疾病和感染类疾病成为继发性AIHA的主要原因。DAT的凝集强度在2+及以上和2+以下和溶血的严重程度之间的差异有统计学意义(P<0. 05)。输注ABO同型悬浮红细胞和洗涤红细胞,2组患者输血前后,红细胞(RBC)计数和血红蛋白(HB)水平显著提高(P<0. 05),网织红细胞百分比(Ret)和总胆红素(TBIL)水平显著降低(P<0. 05)。2组患者临床症状缓解情况的差异没有统计学意义(P>0. 05)。交叉配血相合组和最小不相容组的总不良反应发生率的差异无统计学意义(P> 0. 05)。结论输血治疗AIHA能显著改善病人的贫血症状,但需要掌握严格的输血适应征,选择合适血制品输注,减少输血不良反应发生。
Objective To discuss the clinical characteristics of AIHA patients and routine pre-transfusion compatibility testing,evaluating the transfusion therapeutic efficacy and proposing effective transfusion strategies. Methods 88 AIHA cases were studied. The DAT strength with warm-reactive autoantibodies and the severity of hemolysis were compared. The laboratory indexes and clinical symptom improvement status were comprehensively evaluated according to different types of blood products. The incidence of adverse reactions in two different groups were used for safety assessment. Results Warm-reactive autoantibodies accounted for 88. 6% of the 88 patients. Hematologic disease,autoimmune disorder and infectious disease were the main reason for secondary AIHA. The relationship between severity of hemolysis and DAT strength was statistically significant by χ2 analysis( χ2= 52. 365,P<0. 05). Compared to the pre-transfusion condition,the red blood cell count and hemoglobin level significantly increased in both groups( P<0. 05). The Ret and TBIL significantly decreased in both groups( P<0. 05).There was no statistically significant difference between the washed RBCs and the suspended RBCs in clinical symptoms. It showed no significantly difference( P> 0. 05) in the incidence of adverse reaction of blood transfusion between the unmatched group and the cross-matched group. Conclusion Blood transfusion can improve the symptoms of anemia in AIHA patients significantly. However,it is necessary to master strict blood transfusion indications with proper blood products to reduce potential adverse reactions in transfusion.
Objective To discuss the clinical characteristics of AIHA patients and routine pre-transfusion compatibility testing,evaluating the transfusion therapeutic efficacy and proposing effective transfusion strategies. Methods 88 AIHA cases were studied. The DAT strength with warm-reactive autoantibodies and the severity of hemolysis were compared. The laboratory indexes and clinical symptom improvement status were comprehensively evaluated according to different types of blood products. The incidence of adverse reactions in two different groups were used for safety assessment. Results Warm-reactive autoantibodies accounted for 88. 6% of the 88 patients. Hematologic disease,autoimmune disorder and infectious disease were the main reason for secondary AIHA. The relationship between severity of hemolysis and DAT strength was statistically significant by χ2 analysis( χ2= 52. 365,P<0. 05). Compared to the pre-transfusion condition,the red blood cell count and hemoglobin level significantly increased in both groups( P<0. 05). The Ret and TBIL significantly decreased in both groups( P<0. 05).There was no statistically significant difference between the washed RBCs and the suspended RBCs in clinical symptoms. It showed no significantly difference( P> 0. 05) in the incidence of adverse reaction of blood transfusion between the unmatched group and the cross-matched group. Conclusion Blood transfusion can improve the symptoms of anemia in AIHA patients significantly. However,it is necessary to master strict blood transfusion indications with proper blood products to reduce potential adverse reactions in transfusion.
引文
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[9] Kor DJ,Kashyap R,Weiskopf RB,et al. Fresh red blood cell transfusion and short-term pulmonary,immunologic,and coagulation status:a randomized clinical trial. Am J Respir Crit Care Med,2012,185(8):842-850.
[10]王立新,陈春霞,魏曾珍,等.自身免疫性溶血性贫血患者输血治疗的回顾性分析.中国输血杂志,2017,30(1):45-47.
[11] Chaudhary RK,Das SS. Autoimmune hemolytic anemia:From lab to bedside.Asian Journal of Transfusion Science,2014,8(1):5-12.
[12] Ziman A,Cohn C,Carey PM,et al.Warm-reactive(immunoglobulin G)autoantibodies and laboratory testing practices:review of the literature and survey of current practice. Transfusion,2017,57(2):463-477.
[2] Liebman HA,Weitz IC. Autoimmune Hemolytic Anemia. The Medical clinics of North America,2017,101(2):351-359.
[3] Packman CH. Hemolytic anemia due to warm autoantibodies. Blood reviews,2008,22(1):17-31.
[4] Rattarittamrong E,Eiamprapai P,Tantiworawit A,et al. Clinical characteristics and long-term outcomes of warm-type autoimmune hemolytic anemia. Hematology,2016,21(6):368-374.
[5] Manual ZJ,Yazer MH. The role of the Coombs test in eval luating hemolysis in adults. CMAJ,2006,174(3):305-307.
[6] Packman CH. The clinical pictures of autoimmune hemolytic anemia. Transfusion Medicine and Hemotherapy,2015,42(5):317-324.
[7]汪传喜,田兆嵩.AIHA病人的输血前检查和成分输血.中国输血杂志,2000,13(1):61-63.
[8]戴晓波,任燕歇,曾朱军,等.直接抗人球蛋白试验阳性非自身免疫性溶血性贫血受血者的临床特征和输血对策.中国输血杂志,2013,26(6):555-557.
[9] Kor DJ,Kashyap R,Weiskopf RB,et al. Fresh red blood cell transfusion and short-term pulmonary,immunologic,and coagulation status:a randomized clinical trial. Am J Respir Crit Care Med,2012,185(8):842-850.
[10]王立新,陈春霞,魏曾珍,等.自身免疫性溶血性贫血患者输血治疗的回顾性分析.中国输血杂志,2017,30(1):45-47.
[11] Chaudhary RK,Das SS. Autoimmune hemolytic anemia:From lab to bedside.Asian Journal of Transfusion Science,2014,8(1):5-12.
[12] Ziman A,Cohn C,Carey PM,et al.Warm-reactive(immunoglobulin G)autoantibodies and laboratory testing practices:review of the literature and survey of current practice. Transfusion,2017,57(2):463-477.