ABO血型次侧不相合肝移植术后发生过客淋巴细胞综合征的研究(附2例报告)

目的 研究ABO血型次侧不相合肝移植后发生过客淋巴综合征(passenger lymphocyte syndrome,PLS)的机制及过客淋巴综合征血型血清学诊断标准和输血策略.方法 对2例ABO血型次侧不相合肝移植患者,进行ABO、RhD血型鉴定,直抗分型、抗体筛选和抗体鉴定试验,同时患者红细胞进行放散试验.结果 患者1:血型为AB型、RhD阳性,肝供者为O型、RhD阳性,患者血浆中存在抗-A、抗B,红细胞放散液中存在抗A、抗B;患者2:血型为A型、RhD阳性,肝供者为O型、RhD阳性,患者血浆中存在抗A,红细胞放散液中存在抗A.两位患者直抗均强阳性,抗体筛选阴性.结论 2例患者肝移植术后,均发生PLS.血红蛋白进行性下降,由于移植肝中的淋巴细胞产生了相应的ABO血型抗体,破坏受者的红细胞.患者与O型洗涤红细胞配血相合,输注后无不良输血反应,Hb上升.

Characteristics of ABO Reverse Blood Typing in Patients with Passenger Lymphocyte Syndrome after Minor ABO-Incompatible Liver Transplant

Objective The aim of this study was to reveal the strategy of blood transfusion and standard of serological ABO blood typing in patients with passenger lymphocyte syndrome after liver transplantation.Methods Serological ABO/RHD blood typing,direct agglutinin test,antibody screening,antibody identification,and elution test for antigens of red blood cells were conducted in two patients with minor ABO-incompatible liver transplant.Results The first patient had an AB+ blood type and the second had an A+ blood type and they both received an O+ donated liver.Both patients' specimens had strongly positive results on the direct agglutinin test but the antibody screening test had negative results.Conclusion These two patients developed passenger lymphocyte syndrome after liver transplant.Their hemoglobin levels continuously declined because lymphocytes from the donated liver produced antibodies against AB antigens that lysed the recipient's red blood cells.Washed red blood cells with compatible results on a cross-match test were given to the recipients and their hemoglobin level continuously increased without any notable transfusion reactions.