99例输血反应原因及其治疗与预防初探

目的对99例输血反应患者进行免疫血液学实验室检查,治疗免疫性输血反应,并探讨其预防措施。方法对大连地区9家医院99例输血反应患者进行检查,应用改良Polybrene、简易致敏红细胞血小板血清学试验（SEPSA）等新技术,进行同种特异性抗体的筛选、鉴定及交叉配型试验,并对其治疗。结果检出引起免疫性输血反应的共38例,其中抗-D引起的6例,抗-E引起的13例;引起过敏反应15例,其中有血浆蛋白抗体的7例;发热反应46例,其中14例有白细胞抗体,1例有血小板抗体。结论在输血前或出现输血反应时全面开展免疫血液学实验室检查,能有效诊断、预防和治疗免疫性输血反应,提高输血的安全性和有效性。     

红细胞输血同种免疫发生率的研究

红细胞同种免疫通常由输血或妊娠刺激产生。为探讨由输血引起的红细胞同种免疫 ,笔者对上海地区 1 9345例输注含红细胞成分血单位的患者的输血后血样进行检查 ,共检出 1 3例同种抗体 ,通过分析初步得出了上海地区红细胞输血的同种免疫发生率。同时 ,由于上海地区各医院输血水平参差不齐 ,故将患者按其样本是否使用增强技术 (抗人球法、Polybrene法、酶法、凝胶技术等 )进行输血前免疫血液学检查分为两组 ,比较这两组患者的同种免疫发生率 ,探讨免疫血液学增强技术在输血前的应用与红细胞免疫性输血反应的相关性 ,现将结果报告如下。材料与…     

临床溶血性输血反应的诊断与分析

目的 探讨临床溶血性输血反应病例发生的原因和不规则抗体导致的输血反应.方法 2种谱细胞鉴定不规则抗体筛查阳性的5 816名患者的红细胞抗体特异性.直接抗球蛋白试验、间接抗球蛋白试验和红细胞抗体吸收释放试验诊断临床溶血性输血反应患者125例(其中5例为速发性输血反应).盐水介质法、凝聚胺法、抗-IgG+ C3d凝胶柱卡式法和间接抗球蛋白试验试管法做输血前相容性配血试验用于分析临床输血反应的实验室原因.结果 120例迟发性输血反应中,由患者抗-E与供者E抗原阳性红细胞相容性配血假阴性导致输血反应的病例占94.4％,其次为抗-C和抗-e引起.患者红细胞同种免疫性不规则抗体特异性以抗-E为主,占68％,明显多于其他特异性抗体(P＜0.05).用多种方法做输血配血相容性试验发现:在患者抗-E血清与供者E/e抗原配血反应中,单一方法均存在不符合与不确定性.结论 抗-E是输血患者产生不规则抗体的主要因素.相当数量的E抗原和抗-E反应强度不一致的个体,显示存在E抗原变异体的多样性,也降低了交叉配血的准确性,是导致溶血性输血反应的主要原因.     

血小板输注的同种免疫作用及其对策

血小板输注的同种免疫反应是血小板输注无效的主要原因。笔者对 2 1 71例血小板输注患者进行输血反应调查 ,结果发现 1 791例随机输注血小板的患者中发生输血反应的有 5 1例 (2 .8% ) ;而免疫性因素引起的有 3 6例 (2 .0 % )。在 3 80例采用简易致敏红细胞血清学技术 (SEPSA) [1 ] 进行配合性输注血小板的患者中 ,输血反应率为 0 .8%。说明血小板 SEPSA技术对预防免疫性输血反应意义重大。材料与方法1　研究对象　 2 1 71例临床输注单采血小板患者来自上海市 1 3家医院。2　试剂　 SEPSA 试剂盒 (批号 :1 9991 1 0 2和2 0 0 0 0 5 1 0…     

石家庄地区疑难配血患者血型抗体特异性分析及解决对策

由于红细胞血型抗原的复杂性和多态性,目前红细胞输血主要考虑ABO同型及RhD抗原相合,并通过一些配血试验来预防免疫性输血反应的发生.对于多次输血或有妊娠史的患者有可能产生同种免疫性抗体,ABO血型系统以外的不规则抗体是引起严重的新生儿溶血病、输血不良反应、疑难血型鉴定及疑难配血的主要原因之一.血型同种免疫性抗体的产生受多种因素影响.其中,抗原的免疫原性和个体差异可能是最主要的.我们对2007年以来石家庄地区各医院送检的疑难配血标本的抗体特异性进行了分析,报告如下.     

44例患者不规则抗体分析

目的回顾性总结分析番禺地区临床输血患者中不规则抗体检出情况,为预防和治疗免疫性输血反应提供依据。方法对2006年至2008年番禺各医院送检的免疫血液学标本247例,应用盐水、抗球蛋白法、聚凝胺法检测不规则抗体。结果共鉴定确认血型不规则抗体44例。其中自身抗体13例,药物抗体2例,确定同种特异性抗体29例,分别为：抗-E 15例、抗-Mur 5例、抗-cE 4例、抗-M 2例、抗-C 1例、抗-P11例、抗-Jkb1例。结论本地区的同种特异性抗体以Rh血型系统抗体为主（占68.9%）,抗-Mur次之（占17.2%）,建议有条件的医院开展Rh系统E抗原同型输血。     

输血患者及献血者红细胞血型同种不规则抗体发生频率的回顾性分析

目的探讨患者及献血者人群中红细胞血型不规则抗体的发生频率及分布特点。方法收集本院临床红细胞标本32 496(人)份及献血者标本30 592(人)份,应用盐水法、试管抗球蛋白法、微柱凝胶法和各种血型定型试剂检定红细胞不规则抗体的特异性;调查红细胞不规则抗体患者的性别比例、有无输血史及妊娠史。结果本组红细胞血型不规则抗体筛选阳性率0.36%(230/63 080),其中同种抗体占93.04%(214/230),同种抗体+自身抗体0.43%(1/230),自身抗体占1.73%(4/230)例,未确定特异性的同种抗体占4.78%(11/230)。特异性抗体中,89.50%(196/219)来源于患者、发生频率0.31%(196/63 080),10.50%(23/219)来自献血者、发生频率0.04%(23/63 080)。结论患者不规则抗体发生频率明显高于献血者;为了避免患者免疫性输血反应的发生,减少献血者不规则抗体的输入,输血前全面开展红细胞同种免疫抗体筛检,对献血者血浆做次侧交叉配血,提高临床输血的安全性和有效性。     

血小板抗原与抗体的研究及其应用

血小板抗原与抗体的研究,在各类免疫性血小板减少症的诊断和治疗中具有重要作用.与红细胞血型遗传和免疫血液学技术相比,血小板抗原、抗体的基础研究和免疫检测技术相对落后,尤其是国内,在新的种族特异性血小板抗原的发现、血小板抗体特异性鉴定、血小板输注同种免疫问题等方面,亟需加大研究力度,以推动我国血小板免疫学研究和临床应用的发展.     

一例检出抗-E孕妇围产期输血策略及其不同血型双胎新生儿免疫血液学检测结果比较

妊娠可引起红细胞同种免疫,产生红细胞同种抗体,具有临床意义的红细胞同种抗体可引起免疫溶血性输血反应(immune hemolytic transfusion reaction,IHTR)和胎儿及新生儿免疫溶血性疾病(hemolytic disease of fetus and newborn,HDFN)。筛查孕妇不规则抗体,鉴定抗体特异性,有利于及时发现具有临床意义的红细胞同种抗体[1]。因此,欧美地区的孕期健康检查普遍包括不规则抗体筛查,英国血液学标准委员会(british committee for standards in haematology,BCSH)建议,对所有孕妇均应在妊娠早期(首次产前健康检查)和妊娠28周时进行不规则抗体筛选,以确定是否存在特异性同种抗体[2]。     

37例溶血性输血反应分析

目的通过对免疫性溶血性输血反应实验室资料的回顾性分析与总结,探讨免疫性输血反应发生的原因及如何确保输血的免疫性安全。方法对医院实验室近10年共37例免疫性溶血性输血反应血型血清学检查检测结果进行回顾性统计分析和评价,比较3种血型血清学方法的输血前检测在保证免疫性输血安全的作用。结果 37例免疫性溶血性输血反应样本中因管理方面造成有6例,由于专业技术水平和方法学的原因共31例,辖区内全面推广输血前D抗原及不规则抗体筛查血型血清学试验前后仅4例。1999～2004、2004～2009年这两个5年中,因不规则血型抗体导致溶血性输血反应分别为27例(8.7%)和4例(12.9%)。结论加强输血前血型血清学的检测与管理是保障临床输血免疫性安全和输血有效性的重要保障。     

Comparison of a manual hexadimethrine bromide-antiglobulin test with saline- and albumin-antiglobulin tests for pretransfusion testing

A prospective double-blind study compared a manual hexadimethrine bromide (Polybrene) antiglobulin antibody detection test (P-AHG) and crossmatch with the albumin-antiglobulin antibody detection test and saline-antiglobulin crossmatch routinely used in our laboratory. A total of 10,084 pretransfusion blood samples from approximately 6000 patients were tested. The P-AHG method detected 153 of 157 alloantibodies for which antigen-negative, crossmatch-compatible blood is routinely provided. All four antibodies not detected were anti-K. The routine techniques detected 147 of the 157 alloantibodies. The P-AHG method detected only 36 percent of the alloantibodies for which crossmatch-compatible blood is routinely provided without determination of the antigen status of the donor unit's red cells (e.g., anti-Lea), whereas the routine method detected 91 percent of such antibodies. Eighty-six percent of the 189 alloantibodies detected by the Polybrene technique were found before the addition of antiglobulin. The manual Polybrene test is a rapid and sensitive technique; it may be used without an antiglobulin phase as a routine crossmatch procedure when accompanied by a sensitive antibody detection test that includes antiglobulin and an additional test to ensure ABO compatibility.     

单采血小板配型与聚酯纤维滤过输注在急症处理中的疗效观察

目的:探讨单采血小板输注方法,提高血小板输注疗效。方法:观察急诊外科手术和血液病患者,对血小板随机同型输注无效者采用简易致敏红细胞血小板血清学(SEPSA)配型和淋巴细胞清除后输注。结果:18例手术患者既往无血小板输注史,血小板输注24h后平均由58.3×109/L上升到104×109/L(P0.05);32例血液病随机血小板输注8～10次后产生了血小板和HLA抗体,当再次血小板输注后,其中26例患者平均上升3.4×109/L,6例平均上升2.9×109/L(P0.05);改用SEPSA配型和聚脂纤维膜滤过输注,26例平均由输前的12×109/L上升到38.6×109/L(P0.05),6例平均由9.5×109/L上升到34.9×109/L,并无输血反应。结论:配型和聚脂纤维滤过输注能显著提高患者血小板数目,有效降低输血反应发生率。     

The German Haemovigilance System–reports of serious adverse transfusion reactions between 1997 and 2007

Data of the German Haemovigilance System were collected from 1997 to 2007 and assessed on the basis of pre‐defined safety standards. Suspected cases of serious adverse reactions following transfusions reported to the Paul‐Ehrlich‐Institut were evaluated on the basis of national criteria, and the definitions of International Society of Blood Transfusion (ISBT) in compliance with defined causality criteria. The suspected cases were rated as confirmed and unconfirmed transfusion reactions. Assessment of causality took into consideration the clinical course of the adverse reaction and, if necessary, information about donation and manufacturing. Of the 5128 suspected serious adverse reactions, 1603 could be confirmed. Referring to the absolute figures, acute transfusion reactions (e.g. allergic reactions, hypotension and dyspnoea) were recorded most frequently, followed by transfusion‐related acute lung injury (TRALI), haemolytic reactions, transfusion‐related bacterial infections and virus infections. The majority of the 52 transfusion‐related fatalities (14 each) were due to TRALI and acute transfusion reactions (mostly severe allergic reactions). Referred to the blood products administered, immune TRALI cases and TRALI‐related fatal courses were most frequently reported after administration of fresh frozen plasma (FFP) (15/10⁶ and 3.5/10⁶ units, respectively), transfusion‐related bacterial infections after administration of platelet concentrates (7/10⁶ units), acute haemolytic transfusion reactions after administration of red blood cell concentrates (2.3/10⁶units) and acute transfusion reactions after administration of red blood cell or platelet concentrates (7.8/10⁶ and 13/10⁶ units, respectively). Despite the high safety standard required for blood products in Germany, there is still room for reducing the frequency of isolated cases of transfusion reactions by targeted action.     

Two cases of "hrB-like" autoantibodies appearing as alloantibodies

Two cases are described in which autoantibodies mimicked alloantibodies. The direct antiglobulin test (DAT) on the red cells (RBCs) from both patients was negative when routine manual hexadimethrine bromide (Polybrene) and enzyme-linked antiglobulin techniques were used. The RBCs also did not react on direct bromelin and direct Polybrene tests. However, an "hrB-like" antibody was eluted from the RBCs of both patients. The sera from these patients reacted with all e+ hrB+ RBCs but not with e+ hrB-, e-, or their own RBCs. The antibody in the serum of one patient was not adsorbed by R2R2 RBCs. Serologic tests initially suggested (by direct testing and adsorption studies) that the serum antibodies were alloantibodies rather than autoantibodies. RBCs taken from one patient, 8 months after her sample was first referred to our laboratory, reacted with a serum sample from her first admission. An RBC sample taken from the other patient, initially typed e+ and hrB- but 1 month later typed e+ and hrB+ by using the same anti-hrB sera, was used to test the earlier samples.     

Post-transfusion purpura and delayed haemolytic transfusion reaction

Summary. Two women with post-transfusion purpura (PTP) are presented, one with anti-HPA1a and the other with anti-HPA3a antibodies. Platelet-specific antibodies were identified using the platelet immunofluorescence test (PIFT) and the monoclonal antibody immobilization of platelet antigens (MAIPA) assay. Lymphocytotoxic and red cell antibodies were also detected in both patients, the latter being responsible for a delayed haemolytic transfusion reaction (DHTR). In the patient with anti-HPA1a antibody, red cell anti-c alloantibody was found in the serum and in the eluate from red cells; it was active in the monocyte monolayer assay (MMA). The patient with anti-HPA3a antibody had the red cell alloantibodies anti-D, -M and -S detected in the serum, the last being responsible for DHTR.     

某三甲医院131例次输血不良反应回顾性分析

目的分析该院近4年输血不良反应的发生情况和患者的输注效果,为临床输血安全性和有效性管理提供依据。方法回顾该院2015-2018年《输血不良反应反馈单》及相关记录,分析输血不良反应的分布情况和特点,收集相关数据分析发生输血不良反应患者的输注效果。结果2015-2018年共输血35363例次,发生输血不良反应131例次,总发生率为0.37%,输血不良反应发生率呈逐年下降趋势。各年龄段人群均有输血不良反应发生,随年龄增长呈先上升后下降趋势;女性患者输血不良反应发生率明显高于男性(P<0.05)。输血不良反应主要为发热反应和过敏反应,分别占57.25%和38.17%。不同血液成分输血不良反应发生率以血小板最高,为0.78%,悬浮红细胞次之,为0.41%。悬浮红细胞输血不良反应发生例次随自体血回输增多而逐年递减。输注同样剂量悬浮红细胞和血小板,病例组输注效果均明显差于对照组(P<0.05)。结论该院输血不良反应发生率逐年降低,自体血回输对减少悬浮红细胞输血不良反应有一定作用。临床工作中应严格把握血液成分输注指征,持续开展并扩大自体输血覆盖面,保障临床科学、合理、安全用血。     

HPA配型在免疫性血小板输注无效中的应用研究

目的探讨以HPA配型解决免疫性血小板输注无效的方案。方法 1)建立PCR-SSP方法检测HPA-1～5基因型检测方法,建立机采血小板供者库;2)采用微柱凝胶法和Capture-P法对32名血小板输血无效患者作血小板同种抗体筛查,并对2种方法比较;3)对血小板同种抗体筛查阳性患者采用已知HPA基因型的标准谱血小板作抗体鉴定并采取HPA基因型同型输注的原则寻找供者。结果 1)采用PCR-SSP方法成功检测出HPA-1～5基因型,并对1 000名血小板供者的HPA-1～5基因型定型;2)32例血小板输注无效病例中,微柱凝胶法检测血小板同种抗体阳性率为50%,Capture-P法血小板抗体阳性检出率为40%;3)32例血小板输血无效病例中2种方法同时血小板抗体阳性13例,其中2例鉴定为抗-HPA,分别为抗-HPA-5b(P=1/84)、抗-HPA-1a(P=1/55)。结论对抗-HPA引起的血小板输注无效患者采用HPA基因型相合的方法寻找供者是有效的。     

血液病患者机采血小板无效输注与血小板抗体相关性的研究

目的探讨血液病患者机采血小板无效输注（platelet transfusion resistance，PTR）与血小板抗体相关性。方法以计算血小板计数纠正增加指数（corrected count increment，CCI）作为PTR的量化的判断依据，观察207例的血液病患者进行机采血小板输注效果，并采用简易致敏红细胞血小板血清学技术（SEPSA）检测血小板抗体，计算PTR发生率及血小板抗体阳性率；将研究对象分为血小板抗体阳性组及血小板抗体阴性组，比较两组血小板输注效果及1hCCI、24hCCI值。结果PTR发生率为43．0％，血小板抗体阳性率为37．2％；血小板抗体阳性组与阴性组的PTR发生率差异具有统计学意义，（P〈0．01）；血小板抗体阳性组1hCCI及24hCCI明显低于血小板抗体阴性组，差异具有统计学意义，（P〈0．01）。结论血液病患者输注机采血小板前需进行血小板抗体的检测，对血小板抗体阳性患者进行血小板配型，有效地预防免疫性血小板无效输注的发生。     

A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions

It is generally assumed that febrile nonhemolytic transfusion reactions are an immunologically mediated reaction involving the recipient's plasma and the white cells in the donor unit. This has led to the use of white cell reduction and pretransfusion medication, to try to minimize these reactions. To better understand febrile transfusion reactions, a prospective study was performed in which all patients receiving platelet and red cell transfusions in a tertiary-care medical center were interviewed before and after transfusion to obtain information about the typical presentation of the syndrome. It was found that transfusion reactions were much more frequently associated with platelet transfusion (30.8%) than with red cell transfusion (6.8%, p < 0.0005). The routine use of antipyretics prevented most episodes of fever but did not prevent the occurrence of other symptoms such as chills, cold, and discomfort. The application of logistic regression analysis revealed that the dominant factor determining the risk of a reaction was not white cell contamination, but the age of the component (p < 0.005). The significant relationship between reaction and the increasing age of the component suggests that cytokines released in the component during storage may be responsible for many reactions to blood components.     

A proposal for compatibility testing incorporating the manual hexadimethrine bromide (Polybrene) test

In November 1984, the Standards Committee of the American Association of Blood Banks changed the requirements for pretransfusion testing by making the performance of an antiglobulin crossmatch optional when the antibody screening test is negative. The crossmatch would be necessary only to confirm ABO compatibility. Many will welcome this change; others will persist in their current methods. This article presents data supporting the use of the manual hexadimethrine bromide (Polybrene) test, a 1-minute room temperature procedure, as a crossmatch technique when the antibody screening test is negative. The manual Polybrene test (MPT) is an effective method for detecting ABO incompatibility. Forty-seven randomly selected serums gave expected results with A1, A2, and B red cells. Only 66 percent of 84 group B sera were serologically incompatible with A2B red cells by MPT, but the same results (69% positive) were observed using a 5-minute low-ionic-strength solution (LISS) room temperature technique. As only 37 percent of these crossmatches were incompatible using a LISS immediate spin (IS) method, the reliability of an IS method is questioned. An MPT crossmatch provides added security in that most unexpected blood group antibodies are demonstrable by this method. Of 106 serums tested which contained antibodies, 83 reacted. We believe that the MPT provides a rapid and sensitive test that, accompanied by a carefully performed antibody screening test, meets the requirements of Standards and will provide for safe red cell transfusion without the need for an antiglobulin crossmatch.