低频(IgG+IgM)抗-Mur联合IgG抗-E致疑难配血
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摘要
目的:准确对抗-Mur,抗-E进行抗体类型和特异性鉴定,为患者选择合适的供血者,保证临床输血的安全。方法:采用微柱凝胶法对患者红细胞进行Rh分型和直接抗人球蛋白试验测定,采用盐水试管法和微柱凝胶法检测患者血清与谱细胞的反应格局来确定抗体的类型及特异性,同时进行抗体效价的测定,运用荧光PCR法对患者MNS血型系统进行基因分型。结果:患者红细胞Rh分型为DCCee,直接抗人球蛋白试验为阴性,血清中存在(IgG+IgM)型抗-Mur和IgG型抗-E抗体,IgG型抗-Mur效价为4,IgM型抗-Mur效价为2,IgG型抗-E效价为32,MNS血型系统基因分型结果为M(-)N(+)S(-)s(+)Mur(-)。结论:抗-E和抗-Mur均可以引起严重免疫性输血反应及新生儿溶血病,在实际工作中,我们要学会综合运用在不同介质中,不同实验条件下,以及正确选用抗体筛查和抗体特异性鉴定细胞,帮助我们检出有临床意义的抗体,尤其避免低频抗体的漏检,从而保证输血的安全性。
Objective:Accurate antibody type and specificity identification of anti-Mur and anti-E,for patients to choose the appropriate donor,so as to ensure the safety of clinical blood transfusion.Method:The microcolumn gel method was used to determine the Rh type and direct anti human globulin test of the erythrocytes of the patients.The type and specificity of the antibody were determined by detecting the response pattern of patients' serum and spectral cells in the saline test tube method and the microcolumn gel method.At the same time,the antibody titer was measured and the genotyping of MNS blood group system was performed by fluorescence PCR.Result:The erythrocyte Rh type was DCCee,and the direct anti human globulin test was negative.There were(IgG+IgM)antiMur and IgG anti-E antibodies in the serum.The IgG anti-Mur titer was 4,the IgM anti-Mur titer of 2,and the IgG anti-E titer of 32.The genotyping of MNS blood group system was M(-)N(+)S(-)s(+)Mur(-).Conclusion:Both anti-E and anti-Mur can cause severe immune transfusion reaction and hemolytic disease of the newborn.In practical work,we should learn to use it in different media,under different experimental conditions,and select antibody screening and antibody specific identification cells to help us detect antibodies with clinical significance,especially to avoid leakage detection of low frequency antibody,so as to ensure the safety of blood transfusion.
Objective:Accurate antibody type and specificity identification of anti-Mur and anti-E,for patients to choose the appropriate donor,so as to ensure the safety of clinical blood transfusion.Method:The microcolumn gel method was used to determine the Rh type and direct anti human globulin test of the erythrocytes of the patients.The type and specificity of the antibody were determined by detecting the response pattern of patients' serum and spectral cells in the saline test tube method and the microcolumn gel method.At the same time,the antibody titer was measured and the genotyping of MNS blood group system was performed by fluorescence PCR.Result:The erythrocyte Rh type was DCCee,and the direct anti human globulin test was negative.There were(IgG+IgM)antiMur and IgG anti-E antibodies in the serum.The IgG anti-Mur titer was 4,the IgM anti-Mur titer of 2,and the IgG anti-E titer of 32.The genotyping of MNS blood group system was M(-)N(+)S(-)s(+)Mur(-).Conclusion:Both anti-E and anti-Mur can cause severe immune transfusion reaction and hemolytic disease of the newborn.In practical work,we should learn to use it in different media,under different experimental conditions,and select antibody screening and antibody specific identification cells to help us detect antibodies with clinical significance,especially to avoid leakage detection of low frequency antibody,so as to ensure the safety of blood transfusion.
引文
[1] Daniels G.Human blood groups[M].2nd ed.Oxford:Blackwell Science.2002:125-140.
[2] Reid ME.MNS blood group system[J].Immunohematology,2009,25(3):95-101.
[3] Palaeajomsuk P.Molecular basis of MNS blood group variants[J].Immunohematology,2006,22:171-182.
[4]郭长义,宋雪冬,宋任浩.献血人群不规则抗体检出率及影响因素分析[J].浙江临床医学,2014(9):1457-1458.
[5]黄秀琼,陈丽琼,钮荣祥,等.云南怒族稀有血型MNSs系统(Mur)抗原抽样调查分析[J].大理学院学报,2004,3(1):39-40.
[6]陈瑞明,顾晓菁,熊立凡,等.上海市无偿献血者Miltenberger抗体频率的调查[J].中国输血杂志,2000,13(4):267-268.
[7]孙爱农,黄丽雅,许惠棍,等.自动化微量板法检测红细胞不规则抗体的研究[J].现代检验医学杂志,2007,22(6):9-12.
[8]闰文强,周金安,剐慧芳.抗Mur 3例及抗S 1例[J].临床血液学杂志,2011,24(2):122-123.
[9]吴远军,吴勇,陈宝婵.Rh血型抗体的检测及结果分析[J].细胞与分子免疫学杂志,2008,24(6):604-606.
[10]魏玲,姬艳丽,莫春妍,等.广州地区无偿献血者抗Mur筛查及Mur抗原基因型检测[J].南方医科大学学报,2012,32(12):1833-1835.
[11]蓝欲晓,孙革.低频率抗Mur抗体引起溶血性输血反应的调查研究[J].江西医学检验,2005,23(3):203-204.
[2] Reid ME.MNS blood group system[J].Immunohematology,2009,25(3):95-101.
[3] Palaeajomsuk P.Molecular basis of MNS blood group variants[J].Immunohematology,2006,22:171-182.
[4]郭长义,宋雪冬,宋任浩.献血人群不规则抗体检出率及影响因素分析[J].浙江临床医学,2014(9):1457-1458.
[5]黄秀琼,陈丽琼,钮荣祥,等.云南怒族稀有血型MNSs系统(Mur)抗原抽样调查分析[J].大理学院学报,2004,3(1):39-40.
[6]陈瑞明,顾晓菁,熊立凡,等.上海市无偿献血者Miltenberger抗体频率的调查[J].中国输血杂志,2000,13(4):267-268.
[7]孙爱农,黄丽雅,许惠棍,等.自动化微量板法检测红细胞不规则抗体的研究[J].现代检验医学杂志,2007,22(6):9-12.
[8]闰文强,周金安,剐慧芳.抗Mur 3例及抗S 1例[J].临床血液学杂志,2011,24(2):122-123.
[9]吴远军,吴勇,陈宝婵.Rh血型抗体的检测及结果分析[J].细胞与分子免疫学杂志,2008,24(6):604-606.
[10]魏玲,姬艳丽,莫春妍,等.广州地区无偿献血者抗Mur筛查及Mur抗原基因型检测[J].南方医科大学学报,2012,32(12):1833-1835.
[11]蓝欲晓,孙革.低频率抗Mur抗体引起溶血性输血反应的调查研究[J].江西医学检验,2005,23(3):203-204.