15例Rh血型鉴定假阳性结果分析

Rh血型系统是继ABO血型系统后的另一临床意义最大的血型系统之一,现临床已将Rh血型鉴定作为血型筛查的常规检验,对有效预防溶血性输血反应的发生,提高输血的安全性具有重要意义。关于Rh阴性患者因接受输血或妊娠产生D抗体,     

外科患者Rh(D)血型检测的临床应用

目的 探讨Rh(D)血型检测在外科患者临床输血中的重要作用.方法 玻片法检测该院2009～2010年手术备血患者Rh(D)血型.结果 3 516例手术备血患者中,1.2%(42/3 516)为Rh(D)阴性,98.8%(3 474/3 516)为Rh(D)阳性.结论 术前Rh(D)血型检测有利于及时发现Rh(D)阴性患者;对于Rh(D)阴性患者,有必要与医生和血液中心联系,制定合理的输血计划.     

储存式自体输血在Rh（D）阴性血型者择期手术中的应用

Rh（D）阴性血型在我国仅占0.14%,属稀有血型,由于Rh（D）阴性血液供应紧张,冰冻保存Rh（D）阴性红细胞价格昂贵,解冻冰冻红细胞需要一定时间,解冻后必须6h输注,所以,Rh（D）阴性手术患者的输血问题一直是临床输血中的难题.Rh（D）阴性手术患者常因输不上血而延误治疗.近年来自体输血逐渐应用于临床,尤其是当血源紧张或稀有血型的患者在等待手术而一时又难以找同型血源的情况下开展储存式自体输血更具有其临床意义.     

再论Rh阴性患者的科学安全输血

我们曾在本刊2008年第2期发表的一文中,阐述了Rh血型系统的免疫学特征,在临床输血中的意义,供/受者Rh血型不合时输血的原则[1].由于Rh阴性在汉族随机人群中仅为3‰,被视为"稀有血型"(竟有媒体将之热炒为"熊猫血"),当患者为Rh阴性,急诊抢救寻找同型血液困难时,便有了"向社会告急寻找Rh阴性献血者"的报道见诸各种大众媒体.     

输血患者Rh血型系统D、C、E抗原分布情况调查

目的 为患者提供血型抗原尽量相同的血液,保证输血安全.方法 用微柱凝胶法检测14,549名输血患者Rh血型系统D、C、E抗原.结果 Rh(D)抗原、Rh(C)抗原、Rh(E)抗原阳性率分别为99.50％、88.29％、52.91％.Rh(D)抗原阳性和Rh(D)抗原阴性组中C、E抗原分布存在明显差异.结论 将Rh血型系统D、C、E抗原的检测纳入输血前的常规检验,输血时尽量提供主要抗原同型输注,减少因输血引起的同种免疫反应,提高输血治疗的质量.     

Rh血型筛查及Rh阴性患者输血的分析

目的探讨在临床输血时对受血者进行Rh血型筛查的意义、必要性及Rh阴性患者的输血问题。方法用长春博德生物技术有限责任公司生产的RhD（IgM）血型定型试剂对本院6年来的备血者进行Rh血型筛查。结果共检测了28956例患者，Rh阴性的检出率为0．18％，已产生抗-D抗体1例。结论在输血前检测Rh血型能及时发现Rh阴性的受血者，有效地预防因Rh血型不合产生的同种免疫，预防输血时溶血性输血反应的发生，预防妊娠时母子Rh血型不合产生的新生儿溶血病、死胎或早产。     

滨州市RhD阴性献血者血型表现型分布情况

Rh血型是目前国际输血协会确认的23个红细胞血型系统中最复杂的血型系统,其临床的重要性仅次于ABO血型系统,Rh血型不合可引起严重的溶血反应和新生儿溶血病,为了进一步完善滨州市RhD阴性献血者资料库,笔者就本地区2003年9月至2010年4月共计534名RhD阴性献血者血型抗原进行了统计分析.现报告如下.     

3例无偿献血者Du型报道

Rh血型系统是ABO血型系统以外最具临床意义的血型系统，也是最复杂的血型系统之一，有40余种抗原，其中主要抗原有C、c、D、E、e5种。临床上，将D抗原缺乏者称为Rh阴性。在我国汉族人中，Rh阴性者只有0．2％-0．5％，Rh阴性患者的输血成为一个难题。很多血站采用全自动微板法检测Rh血型，以建立Rh阴性血型者档案库，保证临床用血需要。微板法所用试剂一般是盐水介质抗血清，当发现与抗D不凝集时，不应轻率地确定为Rh阴性，需进一步排除D^u型的可能。我站开展Rh血型鉴定以来，共筛选出Rh阴性者283人，经使用不同生产厂家的IgG试剂，进行抗人球蛋白试验，确定其中3例为D^u型，现报道如下。     

周口市Rh阴性献血者的表型及档案库管理

人类Rh血型系统是红细胞血型中仅次于ABO血型的重要系统,中国汉族人群中仅占0．2％～0．5％,属于稀有血型。随着输血事业的不断发展,Rh阴性血液l临床供给显得日趋重要。本站从1998—10对无偿献血者进行Rh阴性筛查,同时建立了周口市稀有血型库,并对Rh阴性献血者档案库进行了科学的管理,为此类患者临床用血提供了保障,现报道如下。     

Rh血型系统Del型研究进展

Rh血型系统是人类红细胞血型系统中最为复杂且最具多态性的系统,在临床的重要性仅次于ABO血型系统,而且其分子机理又非常复杂.到目前为止已发现至少49种抗原,其中与临床输血安全密切相关的Rh血型抗原主要有D、C、C、E、e这5种.Rh(D)还存在一些变异体——部分D、弱D和Del等.1984年日本学者Okubo在Rh(D)阴性献血者中首次发现1种非常弱的Rh(D)抗原表达型,命名为Del表型.其非常弱的Rh(D)抗原无法用敏感的间接抗球蛋白试验检出,而只能通过吸收放散试验才可检出.由于人们在Del型是否归于Rh阴性这点上并没有形成共识,故早期Del型献血者血液一直被当作Rh(D)阴性血液而应用于临床输血.     

Rh antibodies against the pretransplant red cells following Rh- incompatible bone marrow transplantation

A 22-year-old, blood group O, Rh-positive (R2r) man received bone marrow from his blood group A, Rh-negative (rr), HLA-identical sister for treatment of acute lymphocytic leukemia. The patient's pretransplantation serum contained anti-A in a low concentration; therefore, plasmapheresis was not done prior to transfusion of bone marrow. To prevent graft-versus-host disease, bone marrow was incubated with absorbed rabbit antithymocyte globulin prior to infusion, and the patient was treated with methotrexate in the posttransplantation period. After transplantation, the patient received 6 units of group O, Rh-negative (rr) packed red cells from random donors and 6 units of platelets from the marrow donor. Three months after transplantation, 0.5 percent of his red cells were still of the host's type (group O, Rh-positive), as detected by immunofluorescence technique in blood smears. Four months after transplantation, three different Rh antibodies--anti-D, -E, and -G--were detected. Since the patient received only Rh-negative red cell transfusions, it is concluded that he was immunized to his original red cells.     

Immunization to Rho(D) Observed in Pregnancy of a Woman with Type rhG(G)

A Negro woman was tested during her third pregnancy and found to have type rh^G(G). When the patient was re-tested during the sixth month of her fourth pregnancy, she was found to have a weak antibody of questionable identity. During the last two months of the pregnancy, the titer of the antibody rose sharply and it was established to be specific for Rh_o(D). The infant, delivered by cesarean section shortly before term, had evidence of mild hemolytic disease; it recovered without transfusion therapy. Since this indicates that isoimmunization to Rh_o can occur in a person of type rh^G, such persons should receive only Rh_o-negative blood for transfusion. They should be regarded as Rh-negative for prenatal purposes, but it might be considered preferable not to use them as blood donors for Rh-negative recipients.     

Studies on Rh Prophylaxis

The incidence of Rh immunization of Rh-negative volunteers given approximately 500 ml of Rh-positive blood is 18 out of 22. Complete Rh immune suppression was achieved in a treated group given a precalculated dose of Rh immune globulin. Rh immune prophylaxis is safe, effective and practical after transfusion accidents or massive fetomaternal hemorrhages where large volumes of Rh-positive blood enter the circulation of Rh-negative individuals.
The dose of RhoGAM,* Rho(D) Immune Globulin (Human) found to be effective in suppressing an immune response to the Rh factor was 20 μg/ml of red blood cells (not whole blood). Since each vial contains no less than 300 μg of anti-Rho(D), the potency for RhoGAM is 15 ml of red blood cells/vial.     

新生儿高胆红素血症换血治疗用血情况分析

目的通过调查单病种临床用血量,对我院新生儿高胆红素血症接受换血治疗的用血情况进行统计和分析,为临床合理用血提供有价值的依据。方法对我院2016年1月~2019年12月新生儿高胆红素血症接受换血治疗的389例患儿的临床资料进行回顾性分析,分别统计患儿的一般情况,并对换血治疗中用血量进行分析统计。结果389例患儿中男212例,女177例,性别差异无统计学意义(P>0.05);A型155例,B型128例,O型80例,AB型26例,患儿血型比较有统计学差异(P<0.001),高胆红素血症患者中O型血患儿换血最少,A型与B型无统计学差异(P>0.05);换血治疗多选用新鲜O型红细胞悬液和AB型新鲜冰冻血浆,O型红细胞用量共计1060 U,占红细胞总量86.14%,AB型血浆49050 mL,占血浆用量的75.81%,平均每例用血量为红细胞悬液3.13 U,新鲜冰冻血浆165 mL。结论通过对新生儿换血用血的分析,总结出用血经验,为优化用血方案提供依据,有效治疗的同时合理用血,节约用血。     

Analysis of saline-washed red cells for transfusion to neonatal patients

A protocol was developed under which washed red cells were used to provide small-volume transfusions for neonatal patients (under 4 months of age). Two pediatric units, each containing approximately 135 ml of red cells, were prepared from a freshly collected unit of group O Rh-negative whole blood. Units not more than 6 days old were washed with 1l of 0.9 percent NaCl in a blood cell processor. Aliquots of the washed red cells were drawn into labeled syringes for transfusion to neonatal patients. Data collected from 40 units of washed red cells prepared according to this protocol showed 83 percent red cell recovery, and satisfactory reduction in white cells, plasma proteins, extracellular potassium, red cell metabolic waste products, and anticoagulant. Over 5 years, a total of 2085 different neonatal patients received 7875 separate transfusions prepared from 1860 units of washed red cells. The clinical response was excellent, and no suspected reactions were reported.     

Lack of alloimmunization to D antigen in D-negative immunosuppressed liver transplant recipients

BACKGROUND: Orthotopic liver transplantation (OLT) sometimes requires large amounts of blood. An adequate supply of Rh-negative blood for Rh- negative patients is not always available. STUDY DESIGN AND METHODS: Seventeen Rh-negative patients, out of 327 receiving OLT in this hospital, received from 5 to 41 units of Rh-positive red cells during surgery. Each of the 17 patients was followed for 7 weeks to 70 months after OLT for detection of unexpected antibodies. Cyclosporin A and prednisone, azathioprine, and adjunctive rabbit antilymphocyte globulin or monoclonal OKT3 antibody were used to prevent graft rejection. RESULTS: Evidence of immunization, either to D or to antigens in the rest of the red cell antigen systems, did not appear in any patients. CONCLUSION: It is hypothesized that cyclosporin A affects the immune humoral response, inhibiting lymphocyte activation and the primary immune response; consequently, Rh-positive blood may be transfused to Rh-negative OLT recipients so treated with little or no risk of alloimmunization.     

Fatal hemolytic transfusion reaction resulting from ABO mistyping of a patient with acquired B antigen detectable only by some monoclonal anti- B reagents

BACKGROUND: Some monoclonal anti-B reagents are prepared exclusively from an anti-B clone, ES4, that is known to detect acquired B antigens that are not detectable by other anti-B clones or polyclonal anti-B reagents. CASE REPORT: A 92-year-old group A, Rh-negative man with diverticulitis was mistyped as group AB with the use of a monoclonal anti-B. The hospital did not detect anti-B in the patient's serum. After a negative antibody screen, blood was issued through an abbreviated crossmatch (i.e., immediate-spin crossmatch). The patient was given 3 units of group AB blood and 1 unit of group A blood, and no problems were reported. After the transfusion of a inverted question markfourth unit of AB blood the patient had a severe hemolytic transfusion reaction which resulted in kidney failure and death 10 days later. After the transfusion reaction, the patient's pretransfusion red cells were found to be group A with an acquired B antigen. The monoclonal anti-B used the hospital was formulated from the ES4 clone. A sample of the patient's serum taken before the transfusion was later found to contain a weak anti-B, detectable most obviously by the antiglobulin test, which was not performed at the crossmatch stage. The manufacturers of monoclonal anti-B reagents prepared from ES4 have since modified their reagents (i.e., lowered the pH) so that they now detect only the strongest examples of acquired B antigen. CONCLUSION: A fatal hemolytic transfusion reaction resulted because a monoclonal anti- B that detected acquired B antigen was used to type red cells from an elderly man whose serum had weak anti-B that was not detected by abbreviated compatibility testing.     

100例输血不良反应的相关因素及对策分析

目的探讨临床输血不良反应的相关影响因素,并分析其临床特点和预防控制措施。方法选择100例输血不良反应患者作为观察组,选择同期进行输血治疗且未发生输血不良反应的患者110例为对照组。观察输血不良反应的分布及相关影响因素。结果输血不良反应主要为非溶血性发热反应占46.00%(46/100),过敏反应占54.00%(54/100),溶血性输血反应及其他不良反应未发生;两组在输血类型比较,差异有统计学意义(P0.05);观察组中输血次数大于或等于3次及发血至开始输血时间间隔大于或等于0.5h,输血不良反应发生率分别为88.00%(88/100)和51.00%(51/100),均高于对照组,差异有统计学意义(P0.05)。结论临床输血存在一定风险,输血类型、输血次数和发血至开始输血时间等是患者输血不良反应的主要影响因素;合理选择血液成分,严格掌握输血适应证,加强各个输血环节的质量控制,严格临床输血操作,以降低患者不良反应的发生,提高患者输血安全性。     

Du confirmation

The need for repeat antiglobulin testing to detect the Du phenotype in donor blood already labeled as Rh-negative was challenged. The confirmatory testing by hospital transfusion services rejected only 47 units in 2.6 million tested. The confirmatory antiglobulin test for Du currently required of hospital transfusion services could be omitted.     

Autoimmune Hemolytic Anemia Associated with Anti-f: Report of a Case

An autoimmune hemolytic anemia occurring in a 60-year-old woman is described. The patient's blocd group is A, Rh-negative ( cde/cde ). Her serum was found to contain high titer anti-D and anti-C, which may have arisen as a result of isoimmunization by a pregnancy and a blood transfusion 17 years earlier. An eluate from the red cells contained an incomplete warm autoantibody of anti-f specificity.