疑难交叉配血分析和对策

目的分析交叉配血不合的原因,探讨处理方法,寻求使患者有效、安全输血治疗的对策。方法采用凝疑胺介质和微柱凝胶抗人球蛋白方法交叉配血,选用多种抗体筛选细胞和谱细胞,进行抗体特异性鉴定,以吸收放散试验和2-巯基乙醇试验,鉴别自身抗体和同种特异性抗体。结果共收集231例交叉配血不合案例。其中交叉配血不合由不拱则抗体引起的102例、未捡出不规则抗体的59例、同时存在不规则抗体和自身抗体的70例。结论对于A、B、O、RhD同型输血引起的交叉配血不合,根据引起交叉配血不合的不同因素,采用合理的交叉配血流程与方法,可明显提输血疗效,减少输血不良反应。     

交叉配血不合常见原因循证分析

目的探讨交叉配血不合的原因及处理方法 ,以指导临床安全使用血液。方法检索2001～2004年国内公开发行的主要医学期刊上的有关交叉配血不合的案例报告,总结引起交叉配血不合的各种原因及其相应的表现和处理方法。结果共收集39例交叉配血不合案例,主要表现为以下4大类原因引起交叉配血不合:红细胞除ABO以外的其他血型系统引起的交叉配血不合24例,患者均有输血史或妊娠史,配血多表现为主侧凝集,次侧无凝集;由自身抗体引起的交叉配血不合9例,患者多为身身免疫性疾病,配血表现为主、次侧均有凝集;由血清蛋白紊乱及清球蛋白比例倒置引起的假凝集4例和由药物引起的交叉配血不合2例,主要表现为配血次侧凝集。结论提倡自身输血及成分输血,尽量避免或减少异体输血,是减少配血不合及输血反应的主要手段。     

临床用血前交叉配血不合104例原因分析

目的分析总结临床输血中遇到的疑难交叉配血病例,探讨输血前交叉配血不合的原因,使临床输血更加的科学、安全、有效。方法回顾性分析合肥市不同医院送到本站进行用血前疑难交叉配血病例104例,疑难交叉配血采用盐水法、MP法和抗人球蛋白法等方法检测。结果 104例疑难交叉配血标本中,ABO血型正、反定型不符1例,受血者不规则抗体阳性28例,冷凝集素凝集5例,红细胞直接抗人球蛋白试验阳性43例。104例疑难交叉配血结果为,盐水法交叉配血主/次出现凝集13例,聚凝胺法交叉配血主/次侧出现凝集34例,抗人球蛋白法交叉配血主/次侧出现凝集44例。结论交叉配血不合的原因主要有：缗钱状假凝集,冷凝集素所致非特异性凝集,红细胞被致敏引起的凝集,不规则抗体引起的凝集等。临床用血前交叉配血应选择能同时检测完全抗体和不完全抗体的方法,确保患者输血安全。     

微柱凝胶法配血不合的原因分析与处理

目的 分析交叉配血不合的原因并找到处理方法,使患者能及时、有效、安全地输血.方法 采用微柱凝胶法(MGT)进行血型复检、不完全抗体筛查及交叉配血实验.对交叉配血不合者,用凝聚胺法(MPT)作为交叉配血对照实验,并进行直接抗人球蛋白实验(DAT)及自身对照实验.结果 19例交叉配血不合患者中,5例不完全抗体筛查阳性,5例...     

血液性疾病疑难交叉配血分析

目的分析血液性疾病交叉配血不合的原因及处理方法。方法对患血液性疾病需输血的患者做ABO及Rh血型鉴定和交叉配血试验,对交叉配血不合者,进行抗体筛选及抗体鉴定。结果共收集49例交叉配血不合的血液性疾病病例,其中盐水介质不合31例,抗球蛋白交叉配血不合16例,盐水法及抗球蛋白法配血皆不合2例;49例交叉配血不合中,多发性骨髓瘤10例、急性白血病9例、恶性淋巴瘤1例、自身免疫性溶血性贫血16例、巨球蛋白血症2例以及多次输血11例。结论一些血液性疾病的特性使ABO及RhD同型输血也可能出现交叉配血不合,应根据不同病因来去除影响交叉配血不合的因素,以确保安全输血。     

微柱凝胶法交叉配血不合原因分析

目的探讨微柱凝胶法交叉配血不舍的原因并审j定相应的输血策略,以确保临床输血安全。方法采用微柱凝胶法进行交又配血试验,并对交叉配血不合的受血者、供血者血样进行血型血清学检查。结果21735例交叉配血试验;交叉配血不合193例;其中红细胞直抗阳性155例,占交叉配血不舍80．3％;不规则抗体阳性17例,占交叉配血不舍8．8％;自身抗体阳性14例。占交叉配血不合7．3％;其他原因7钢,占交叉配血不合3．6％。结论红细胞直抗、不规则抗体、自身抗体是引起微柱凝胶法交又配血不合的主要原因。     

抗球蛋白试验在疑难交叉配血过程中的重要性分析

目的通过对患者输血前血样进行抗球蛋白试验检查,查找导致临床患者配血不合的原因,配合性输注,确保临床输血安全。方法通过不规则抗体筛选试验,检测患者血清中抗体性质。结果 61例交叉配血不合患者抗球蛋白试验结果显示,由温、冷性自身免疫性抗体及冷凝集素影响配血不合30例;ABO血型系统以外不规则抗体同种免疫性抗体31例,由Rh血型系统同种免疫性抗体导致配血不合占大多数,其中与抗-E抗体有关的患者17例,占由同种免疫性抗体引起配血不合的54.84%。结论患者体内产生的ABO血型系统以外不规则同种免疫性抗体或者温、冷性自身免疫性抗体及冷凝集素等几种因素的影响,是造成临床交叉配血不合的主要原因,Rh血型抗原的复杂性和多态性应引起临床的重视,Rh血型同型输注可降低输血不良反应的发生率。     

交叉配血主侧不合48例分析

目的了解本院48例交叉配血主侧不合的原因。方法对用盐水法、凝聚胺方法和抗球蛋白法对交叉配血中主侧不合的48份标本的鉴定结果进行分析。结果 48例主侧不合,其中,由特异性血型抗体引起37例,单纯自身抗体引起7例,药物引起1例,B亚型引起1例,献血者红细胞直抗阳性引起2例。结论输血前试验可有效地降低或避免溶血性输血反应的发生,提高输血安全性。     

3例聚凝胺交叉配血不全的原因分析

交叉配血试验是保障临床输血安全的及时、有效的重要手段,有时会出现同型血配血不合的现象。使用安全、有效的方法进行交叉配血试验,检查受血者和献血者的抗原及抗体成分是否相容,分析确定交叉配血不合的原因,采取相应的处理方法,对预防输血反应的发生和解决临床输血有重要意义。聚凝胺试验是一种快速检测不完全抗体的方法,目前已广泛用于交     

抗-E、抗-c和抗-M引起交叉配血不合1例

临床输血中的交叉配血不合多由不规则抗体引起,大多情况下不规则抗体性质比较单一.我们在工作中发现1例由多种不规则抗体引起的交叉配血不合,现报告如下.     

抗-cE及抗-Jk^b和抗-Mur混合抗体致疑难配血分析——附1例报告

目的探讨1例疑难交叉配血不合的原因。方法通过ABO血型鉴定、Rh分型、直接抗人球蛋白试验、不规则抗体筛查、抗体特异性鉴定及抗体效价测定对患者配血不合进行分析。结果对照谱细胞反应格局,患者血清中检出抗-cE、抗-Jk^b和抗-Mur。结论患者血清中不规则抗体是导致交叉配血不合的主要原因。     

The computer crossmatch: a safe alternative to the serological crossmatch

The crossmatch has evolved from including a wide range of techniques through a test purely to eliminate ABO incompatibility (immediate spin) to computer crossmatching in which no serological testing is carried out and validation ensures the correct ABO/RhD type blood is issued. The crossmatch was always considered to be the most important feature of the compatibility test and in particular the antiglobulin phase; however, there are potential risks associated with serological and computer crossmatching including technical and procedural errors. The use of immediate spin and computer crossmatch change the emphasis for safety of the compatibility test from the crossmatch to the antibody screen. UK guidelines have now been published describing the features necessary for the introduction of computer crossmatching. Computer crossmatching is used by many institutions in various countries. It is considered safe practice and brings benefits to the laboratory and the patient. Compatibility testing is only one element of the blood transfusion procedure; the others are equally as important and include correct patient identification at the time of collection of the blood sample and at the administration of the blood transfusion.     

微柱凝胶卡式法在临床输血中的应用价值分析

目的：探讨微柱凝胶卡式法在临床输血中的应用价值,以确保临床输血安全。方法在输血前,使用微柱凝胶法对有输血史、妊娠史、短期内需要多次输血或交叉配血不合的输血或备血标本进行不规则抗体筛检,筛检阳性者,进一步作抗体特异性鉴定,再选取该抗体对应抗原阴性的供血者与患者进行交叉配血。结果在932例患者病例中,共筛检出不规则抗体3例（0.32%）,经抗体特异性鉴定,为抗-E 2例（0.21%）,抗-c 1例（0.11%）,选取不规则抗体相应抗原阴性的供血者与患者进行交叉配血,配血成功。另检出患者已致敏红细胞所引起的交叉配血次侧凝集2例（0.21%）,假凝集1例（0.11%）,自身抗体2例（0.21%）。结论微柱凝胶法对于保证临床输血安全具有重要的临床应用价值;交叉配血前必须进行不规则抗体的筛检,这对有输血史、妊娠史以及短期内需多次输血的患者尤为重要。     

新生儿血型抗体892例探讨

目的 分析新生儿血型抗体,探讨新生儿血型抗体在新生儿输血配合试验中的应用。方法 对892例新生儿血清作盐水介质,间接抗人球蛋白血型血清学试验。结果 892例新生儿血清在盐水介质中检出ABO血型抗体725例,阳性率占81.3％;在抗人球蛋白介质中检出ABO血型抗体845例,阳性率占94.7％。结论 新生儿大部分产生ABO血型抗体,而且抗体性质大部分为IgM,少部分为IgG。抗人球蛋白试验较盐水试验灵敏,血型抗体检出率高。新生儿交叉配血不容忽视血型抗体。     

Hemorrhagic and Hemolytic Transfusion Reaction Due to Anti-Lea

A case is described in which a severe hemolytic and hemorrhagic reaction occurred as the result of incompatibility involving an anti-Le^a antibody of "immune" type. This antibody must have developed before the surgical procedure at which the reaction occurred, but was not detected because patient specimens for crossmatching had not been obtained frequently enough during multiple transfusions. The patient had a stormy postoperative course, mainly as a result of hematoma formation and renal shutdown, but recovered completely. Five months after the reaction, the antibody was detectable only after EDTA treatment of the serum or the addition of complement. This appears to be the first example of a hemorrhagic syndrome due to anti-Le^a.     

凝聚胺法、微柱凝胶法两种配血方法学评价

目的对凝聚胺法(MPT)、微柱凝胶法(MGT)两种交叉配血方法进行方法学比较。方法以1456例输血患者为研究对象,分别用MPT、MGT两种方法进行交叉配血,对交叉配血试验过程中的阳性患者行不完全抗体检测,评价两种交叉配血方法的优缺点。结果 MPT、MGT两种交叉配血方法总阳性率分别为5.5‰、9.6‰,次侧阳性率分别为3.4‰、8.9‰,次侧阳性率经卡方检验分析比较差异有统计学意义(P<0.05),主侧阳性、总阳性率及假阳性率比较差异无统计学意义(P>0.05)。MGT方法学灵敏度、特异度、正确诊断指数、符合率分别为100%、99.9%、0.99、99.9%均好于MPT。结论微柱凝胶法适于输血工作的标准化检测,有很好的灵敏度、特异度对不规则抗体的检测有优势,凝聚胺法能为急诊患者的抢救赢得时间。     

Human monoclonal gamma G-cryoglobulins with anti-gamma-globulin activity

Seven human gammaG-myeloma proteins which were also cryoglobulins were studied with respect to their reactivity with gammaG-globulins as well as with regard to their antigenic classification within the gammaG-heavy chain subclasses. Five of the seven cryoglobulins studied were positive in at least two of the three tests used to assay for anti-gamma-globulin activity. One protein was only weakly positive in one test system and another was negative in all test systems. The structures which were recognized by the cryoglobulins were localized to the Fc-fragment. Only primate gammaG-globulins contained these antigenic determinants and in some cases the cryoglobulin appeared to show specificity for one human heavy chain subclass over the others. Antigenic analysis revealed that four of the five cryoglobulins with definite antibody activity belonged to the gammaG3-subclass, the fifth belonged to the gammaG1-subclass. The two cryoglobulins which reacted only weakly or failed to combine with gammaG-globulins were both of the gammaG1-subclass. These findings taken together with the localization of the combining site to the Fab-fragment suggests that many of these cryoglobulins may represent antibodies to gammaG-globulin, and that the cryoprecipitate in these cases represents antigen-antibody complexes of such a nature that they precipitate only in the cold.     

Electronic crossmatching

The crossmatch (XM) is an important part of routine pretransfusion testing. It is used to detect ABO incompatibility and other clinically significant antibodies. The XM has been modified many times and, in recent years, has been abbreviated. The 2 common types of XM currently being done are the immediate spin XM for antibody-negative patients and the antiglobulin XM for the rest. The antiglobulin phase of the XM is generally considered optional, unless a clinically significant antibody is present. Originally, the XM was intended to be a final check for ABO compatibility and for the detection of unexpected antibodies. Electronic crossmatching was first introduced at the University of Michigan Medical Center in 1992. This paper summarizes the basic principles, current guidelines, regulatory requirements, and some recommendations that may prove useful for the implementation of electronic crossmatching.