H抗原缺失患者抗H抗体血型血清学检测及结果分析
摘要
目的分析H抗原缺失患者抗H抗体血型血清学检测结果及其对输血相容性检测的影响。方法采用血型血清学方法对出现正反定型不符及交叉配血不合的3例患者血标本,进行抗体筛选及特异性鉴定,唾液血型物质测定,对患者红细胞进行H抗原检测及直接抗人球蛋白试验。结果患者中A型1例, AB型2例, RhD为阳性。输血相容性检测在4℃、 22℃及37℃出现4+～±的凝集反应,引起ABO血型正反定型不符或交叉配血不合,患者红细胞H抗原及直接抗人球蛋白试验阴性。经血型血清学鉴定为抗H抗体,抗体类型为IgM型,抗体效价4℃为1∶64～1∶128, 22℃为1∶4～1∶32, 37℃为1∶1～1∶2。抗体效价及凝集强度随温度上升而降低。结论 22℃有反应活性的抗H抗体,可干扰输血相容性检测结果, 37℃有反应活性的抗H抗体可能引起输血反应。含有抗H抗体的患者应输同型血,如紧急抢救无同型血而需输O型红细胞时,应用输注盐水法和抗人球蛋白法交叉配血均相合的血液。
引文
[1] Scharberg E A, Olsen C, Bugert P. The H blood group system[J]. Immunohematology, 2016, 32(3): 112-118.
[2] 林晨蓓, 林甲进. H抗原阴性者血型血清学特点和基因测序结果研究[J]. 临床血液学杂志, 2017, 30(12): 981-982. Lin C, Lin J. Study on blood group serological characteristics and gene sequencing of H antigen negative patients[J]. Lin Chuang Xue Ye Xue Za Zhi, 2017, 30(12): 981-982.
[3] Mak K H, Lubhnko A, Greenwell P, et al. Serologic characteristics of H-deficient phenotypes among Chinese in Hong Kong[J]. Transfusion, 1996, 36(11/12): 994-999.
[4] Barbara D W, Mauermann W J, Neal J R, et al. Cold agglutiniins in patients undergoing cardiac surgery requiring cardiopulmonary bypass[J].J Thorac Cardiovasc Surg, 2013, 146(3): 668-680.
[5] 吴毅, 肖瑞卿, 林武存. 抗-H冷抗体引起血型鉴定困难1例[J]. 中国输血杂志, 1998, 11(4): 209. Wu Y, Xiao R, Lin W. Anti-H cold antibody caused difficulty in blood type identification in 1 case[J]. Zhongguo Shu Xue Za Zhi, 1998, 11(4): 209.
[6] 耿玉敏. 全凝集抗-H抗体一例[J]. 临床检验杂志, 1997, 15(3): 180. Geng Y. A case of total agglutination anti-H antibody[J]. Lin Chuang Jian Yan Za Zhi, 1997, 15(3): 180.
[7] Lin-Chu M, Broadberry R E. Blood transfusion in the para-Bombay phenotype[J]. Br J Haematol, 1990, 75(4): 568-572.
[8] Kelly R J, Ernst L K, Larsen R D, et al. Molecular basis for H blood group deficiency in Bombay(Oh) and para-Bombay individuals[J]. Proc Natl Acad Sci U S A, 1994, 91(13): 5843-5847.
[9] Dipta T F, Hossain A Z. The Bombay blood group: are we out of risk?[J]. Mymensingh Med J, 2011, 20(3): 536-540.
[10] 何子毅, 邹文涛, 胡应明, 等. 红细胞H抗原缺陷型鉴定及其理化功能研究[J]. 中国输血杂志, 2013, 26(1): 45-48. He Z, Zou W, Hu Y, et al. Identification and physicochemical function of H antigen deficiency type of erythrocytes[J]. Zhongguo Shu Xue Za Zhi, 2013, 26(1): 45-48.
[11] Mallick S, Kotasthane D S, Chowdhury P S, et al. Bombay blood group: Is prevalence decreasing with urbanization and the decreasing rate of consanguineous marriage[J]. Asian J Transfus Sci, 2015, 9(2): 129-132.
[12] 唐聪海, 林小晶, 胡晓明, 等. 4例类孟买型血型血清学特点研究[J]. 临床血液学杂志, 2015, 28(6): 525-527. Tang C, Lin X, Hu X, et al. Serological characteristics of para-bombay blood group[J]. Lin Chuang Xue Ye Xue Za Zhi, 2015, 28(6): 525-527.
[13] 孙福军, 焦淑贤, 韩平, 等. 寒冷性抗-H一例报告[J]. 中国输血杂志, 1993, 6(2): 97-98. Sun F, Jiao S, Han P, et al. A case report of cold-induced anti-H[J]. Zhongguo Shu Xue Za Zhi, 1993, 6(2): 97-98.
[14] Arend P. ABO phenotype-protected reproduction based on human specific α1, 2 L-fucosylation as explained by the Bombay type formation[J]. Immunobiology, 2018, 223(11): 684-693.
[15] 赵素珍, 张春燕, 颜廷宇, 等. 成人i型产生高效价抗-I 1例[J]. 中国输血杂志, 2015, 28(6): 730-731. Zhao S, Zhang C, Yan T, et al. Adult type I produced 1 case of high potency valence antibody -I[J]. Zhongguo Shu Xue Za Zhi, 2015, 28(6): 730-731.
[16] 谢进荣, 吴维华, 金月林, 等. 二例类孟买型血型的血清学鉴定及输血实践[J]. 中国输血杂志, 2017, 30(9): 1065-1067. Xie J , Wu W, Jin Y, et al. Serological identification of para-bombay type blood group and blood transfusion practice in two cases[J]. Zhongguo Shu Xue Za Zhi, 2017, 30(9): 1065-1067.
[17] Geng W, Gao H H, Zhang L W. Serological characteristics and family survey of 3 cases of H-deficient blood group [J]. Zhongguo Shi Yan Xue Ye Xue Za Zhi, 2016, 24(3): 913-717.
[18] 杜娟, 张勇萍, 杨世明, 等. 抗I抗体引起ABO血型正反定型不符及原因分析[J]. 细胞与分子免疫学杂志, 2018, 34(7): 637-639. Du J, Zhang Y, Yang S, et al. Analysis of reasons for ABO blood group inconsistency caused by anti-I antibody[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2018, 34(7): 637-639.
[19] Luo G, Wei L, Wang Z, et al. The summary of FUT1 and FUT2 genotyping analysis in Chinese para-Bombay individuals including additional nine probands from Guangzhou in China[J]. Transfusion, 2013, 53(12): 3224-3229.
[20] 杨世明, 张勇萍, 潘晓莉. 冷凝集素综合征的血清学特性及检测方法探讨[J]. 细胞与分子免疫学杂志, 2006, 22(4): 135-137. Yang S, Zhang Y, Pan X. Study on serological characteristics and detection methods of condensed agglutinin syndrome[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2006, 22(4): 135-137.
[21] 张勇萍, 安宁, 杨世明, 等. 血型不规则抗体的筛查和抗体特异性分析[J]. 细胞与分子免疫学杂志, 2014, 30(9): 980-982. Zhang Y, An N, Yang S, et al. Screening of antibodies with irregular blood types and analysis of antibody specificity[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2014, 30(9): 980-982.
[22] Zhang A, Chi Q, Ren B. Genomic analysis of para-Bombay individuals in south-eastern China: the possibility of linkage and disequilibrium between FUT1 and FUT2[J]. Blood Transfus, 2015, 13(3): 472-477.
[23] 刘秋菊, 朱碎永, 林甲进. 类孟买型血清学特点及后续输血策略的研究[J]. 中国卫生检验杂志, 2017, 27(9): 1276-1278. Liu Q, Zhu S, Lin J. Study on serological characteristics of para-bombay type and its subsequent blood transfusion strategy[J]. Zhongguo Wei Sheng Jian Yan Za Zhi, 2017, 27(9): 1276-1278.
[24] 夏和凤, 马荣国, 刘桂芳. 抗H抗体致正反定型不符1例[J]. 临床血液学杂志, 2010, 23(2): 126-127. Xia H, Ma R, Liu G. Positive and negative stereotypes caused by anti-H antibody were inconsistent in 1 case[J]. Lin Chuang Xue Ye Xue Za Zhi, 2010, 23(2): 126-127.
[25] 张勇萍, 杨琳, 杨世明, 等. 56例不规则抗体引起ABO血型正反定型不相符的分析[J]. 细胞与分子免疫学杂志, 2016, 32(2): 250-252. Zhang Y, Yang L, Yang S, et al. Analysis of inconsistency of ABO blood group positive and negative stereotypes caused by irregular antibodies in 56 cases[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2016, 32(2): 250-252.
[2] 林晨蓓, 林甲进. H抗原阴性者血型血清学特点和基因测序结果研究[J]. 临床血液学杂志, 2017, 30(12): 981-982. Lin C, Lin J. Study on blood group serological characteristics and gene sequencing of H antigen negative patients[J]. Lin Chuang Xue Ye Xue Za Zhi, 2017, 30(12): 981-982.
[3] Mak K H, Lubhnko A, Greenwell P, et al. Serologic characteristics of H-deficient phenotypes among Chinese in Hong Kong[J]. Transfusion, 1996, 36(11/12): 994-999.
[4] Barbara D W, Mauermann W J, Neal J R, et al. Cold agglutiniins in patients undergoing cardiac surgery requiring cardiopulmonary bypass[J].J Thorac Cardiovasc Surg, 2013, 146(3): 668-680.
[5] 吴毅, 肖瑞卿, 林武存. 抗-H冷抗体引起血型鉴定困难1例[J]. 中国输血杂志, 1998, 11(4): 209. Wu Y, Xiao R, Lin W. Anti-H cold antibody caused difficulty in blood type identification in 1 case[J]. Zhongguo Shu Xue Za Zhi, 1998, 11(4): 209.
[6] 耿玉敏. 全凝集抗-H抗体一例[J]. 临床检验杂志, 1997, 15(3): 180. Geng Y. A case of total agglutination anti-H antibody[J]. Lin Chuang Jian Yan Za Zhi, 1997, 15(3): 180.
[7] Lin-Chu M, Broadberry R E. Blood transfusion in the para-Bombay phenotype[J]. Br J Haematol, 1990, 75(4): 568-572.
[8] Kelly R J, Ernst L K, Larsen R D, et al. Molecular basis for H blood group deficiency in Bombay(Oh) and para-Bombay individuals[J]. Proc Natl Acad Sci U S A, 1994, 91(13): 5843-5847.
[9] Dipta T F, Hossain A Z. The Bombay blood group: are we out of risk?[J]. Mymensingh Med J, 2011, 20(3): 536-540.
[10] 何子毅, 邹文涛, 胡应明, 等. 红细胞H抗原缺陷型鉴定及其理化功能研究[J]. 中国输血杂志, 2013, 26(1): 45-48. He Z, Zou W, Hu Y, et al. Identification and physicochemical function of H antigen deficiency type of erythrocytes[J]. Zhongguo Shu Xue Za Zhi, 2013, 26(1): 45-48.
[11] Mallick S, Kotasthane D S, Chowdhury P S, et al. Bombay blood group: Is prevalence decreasing with urbanization and the decreasing rate of consanguineous marriage[J]. Asian J Transfus Sci, 2015, 9(2): 129-132.
[12] 唐聪海, 林小晶, 胡晓明, 等. 4例类孟买型血型血清学特点研究[J]. 临床血液学杂志, 2015, 28(6): 525-527. Tang C, Lin X, Hu X, et al. Serological characteristics of para-bombay blood group[J]. Lin Chuang Xue Ye Xue Za Zhi, 2015, 28(6): 525-527.
[13] 孙福军, 焦淑贤, 韩平, 等. 寒冷性抗-H一例报告[J]. 中国输血杂志, 1993, 6(2): 97-98. Sun F, Jiao S, Han P, et al. A case report of cold-induced anti-H[J]. Zhongguo Shu Xue Za Zhi, 1993, 6(2): 97-98.
[14] Arend P. ABO phenotype-protected reproduction based on human specific α1, 2 L-fucosylation as explained by the Bombay type formation[J]. Immunobiology, 2018, 223(11): 684-693.
[15] 赵素珍, 张春燕, 颜廷宇, 等. 成人i型产生高效价抗-I 1例[J]. 中国输血杂志, 2015, 28(6): 730-731. Zhao S, Zhang C, Yan T, et al. Adult type I produced 1 case of high potency valence antibody -I[J]. Zhongguo Shu Xue Za Zhi, 2015, 28(6): 730-731.
[16] 谢进荣, 吴维华, 金月林, 等. 二例类孟买型血型的血清学鉴定及输血实践[J]. 中国输血杂志, 2017, 30(9): 1065-1067. Xie J , Wu W, Jin Y, et al. Serological identification of para-bombay type blood group and blood transfusion practice in two cases[J]. Zhongguo Shu Xue Za Zhi, 2017, 30(9): 1065-1067.
[17] Geng W, Gao H H, Zhang L W. Serological characteristics and family survey of 3 cases of H-deficient blood group [J]. Zhongguo Shi Yan Xue Ye Xue Za Zhi, 2016, 24(3): 913-717.
[18] 杜娟, 张勇萍, 杨世明, 等. 抗I抗体引起ABO血型正反定型不符及原因分析[J]. 细胞与分子免疫学杂志, 2018, 34(7): 637-639. Du J, Zhang Y, Yang S, et al. Analysis of reasons for ABO blood group inconsistency caused by anti-I antibody[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2018, 34(7): 637-639.
[19] Luo G, Wei L, Wang Z, et al. The summary of FUT1 and FUT2 genotyping analysis in Chinese para-Bombay individuals including additional nine probands from Guangzhou in China[J]. Transfusion, 2013, 53(12): 3224-3229.
[20] 杨世明, 张勇萍, 潘晓莉. 冷凝集素综合征的血清学特性及检测方法探讨[J]. 细胞与分子免疫学杂志, 2006, 22(4): 135-137. Yang S, Zhang Y, Pan X. Study on serological characteristics and detection methods of condensed agglutinin syndrome[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2006, 22(4): 135-137.
[21] 张勇萍, 安宁, 杨世明, 等. 血型不规则抗体的筛查和抗体特异性分析[J]. 细胞与分子免疫学杂志, 2014, 30(9): 980-982. Zhang Y, An N, Yang S, et al. Screening of antibodies with irregular blood types and analysis of antibody specificity[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2014, 30(9): 980-982.
[22] Zhang A, Chi Q, Ren B. Genomic analysis of para-Bombay individuals in south-eastern China: the possibility of linkage and disequilibrium between FUT1 and FUT2[J]. Blood Transfus, 2015, 13(3): 472-477.
[23] 刘秋菊, 朱碎永, 林甲进. 类孟买型血清学特点及后续输血策略的研究[J]. 中国卫生检验杂志, 2017, 27(9): 1276-1278. Liu Q, Zhu S, Lin J. Study on serological characteristics of para-bombay type and its subsequent blood transfusion strategy[J]. Zhongguo Wei Sheng Jian Yan Za Zhi, 2017, 27(9): 1276-1278.
[24] 夏和凤, 马荣国, 刘桂芳. 抗H抗体致正反定型不符1例[J]. 临床血液学杂志, 2010, 23(2): 126-127. Xia H, Ma R, Liu G. Positive and negative stereotypes caused by anti-H antibody were inconsistent in 1 case[J]. Lin Chuang Xue Ye Xue Za Zhi, 2010, 23(2): 126-127.
[25] 张勇萍, 杨琳, 杨世明, 等. 56例不规则抗体引起ABO血型正反定型不相符的分析[J]. 细胞与分子免疫学杂志, 2016, 32(2): 250-252. Zhang Y, Yang L, Yang S, et al. Analysis of inconsistency of ABO blood group positive and negative stereotypes caused by irregular antibodies in 56 cases[J]. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi, 2016, 32(2): 250-252.