凝聚胺法与微柱凝聚法检测不规则抗体的对比分析

目的探讨凝聚胺法与微柱凝聚法在不规则抗体筛选中的价值对比。方法对2010～2011年江门市新会区人民医院6 720例预约输血患者,用凝聚胺法与微柱凝聚法分别进行不规则抗体筛查,阳性结果再用谱细胞通过抗人球蛋白方法进行特异性检测。结果用微柱凝聚法筛查出不规则抗体阳性28例,阳性率为0.42%,而凝聚胺检测阳性26例,阳性率仅为0.39%,两种方法比较差异无统计学意义（P〉0.05）。其中Rh系统占总不规则抗体比例为57.1%,分别为抗-D 5例,抗-E 7例,抗-C 2例,抗-Ec 2例。结论凝聚胺法与微柱凝聚法都适用于临床筛查不规则抗体,微柱凝聚法比凝聚胺法更有利于大规模自动化筛查,对于有条件的大医院更适合临床输血前的应用和相关疾病的诊断,而凝聚胺法在基层或者临床急诊上也可合理开展。     

25例微柱凝胶法交叉配血不合的回顾性分析

目的回顾性分析微柱凝胶法(MGT)配血不合的病例,为临床输血安全提供指导作用。方法姜堰市人民医院输血科对2006年5月至2011年5月需输血治疗的患者进行MGT交叉配血,配血不合25例。结果 25例配血不合病例中,血型原因致配血不合5例(ABO血型抗原减弱3例、抗B抗体减弱1例、ABO亚型1例);自身抗体9例;患者有不规则抗体4例;献血者为多凝集红细胞和含有不规则抗体各1例;其他原因(患者使用药物右旋糖苷)5例。结论结合临床诊断、用药史、输血史、妊娠史等,合理分析影响血型鉴定和交叉配血的因素,联合使用正反定型,确保ABO血型准确,筛检有临床意义的不规则抗体,选择相应抗原阴性的红细胞进行同型交叉配血,确保输血安全。     

An evaluation of a gel technique for antibody screening compared with a conventional tube method

Summary. An antihuman globulin (AHG) gel centrifugation technique (AHG gel test) employing microtubes (DiaMed®) has been compared for sensitivity in detection of unexpected antibodies with a saline indirect antiglobulin test (SIAT) which uses a cell-to-serum ratio between 1:120 and 1:200 and provides positive reactions at a concentration of a standard anti-D of 2 ng/mL (0·01 IU/ml) or less. For most antibodies examined the AHG gel test was slightly less sensitive than the SIAT but both methods were capable of detecting anti-D at concentrations of 2 ng/ml or less. The importance of defining in detail the conventional tube test method used in such evaluations is emphasized since previous reports of sensitivity of the DiaMed AHG gel test indicate considerable variation in technique and comparative sensitivity.     

凝胶抗球蛋白试验的特点及实验分析

目的　分析评价凝胶抗球蛋白试验 (GAT)的特点 ,增加输血安全性。方法　以不同稀释度的商品化抗D(IgG)为基础制备不完全抗体和致敏红细胞为模拟标本 ,通过一系列实验 (并结合文献 )分析GAT(DiaMed产品 )的特点。结果　红细胞洗涤与否不影响GAT检测的结果 ;外加AB型血浆至 4 0 μl后 ,才使GAT(1∶6 4抗D血清 2 5 μl与 0 .8%O型混合红细胞悬液 5 0 μl反应 )产生的强阳性略有减弱 ;与专用稀释液ID diluent2比较 ,用生理盐水替代稀释液导致结果阳性程度降低 ,而换用某厂家的LIM稀释液则出现不同程度的红细胞溶血现象 ;GAT可测的抗D(IgG)最高效价为 1∶2 5 6 ,反应灵敏度明显高于试管法 ,而近似于聚凝胺法。结论　GAT反应过程中无洗涤步骤 ,使用专用稀释液 ,检测灵敏度较高。GAT检测中使用配套试剂材料和严格按照说明书操作非常重要。     

微柱凝集和聚凝胺法检测不规则抗体的对比分析与研究

目的比较微柱凝集和聚凝胺法的灵敏度和重复性,为不规则抗体的检测更新方法。方法使用微柱凝集和聚凝胺法检测不规则抗体,对比观察2种方法检出的阴、阳性结果和重复检验的准确性,从而选择灵敏度高和重复性好的方法满足临床输血需要。结果从18 000例住院患者中用微柱凝集筛选出不规则抗体阳性19例,阳性率为0.105%,其中D抗体7例,E抗体5例,C抗体3例,Ec抗体3例,Ce抗体1例;用聚凝胺法检测不规则抗体,仅有阳性为2例,阳性率为0.011%,2种方法比较差异有统计学意义（P〈0.05）;重复性检验：微柱凝集（19/19）和聚凝胺（2/2）均为100%,2种方法差异无统计学意义（P〉0.05）。结论用微柱凝集检测不规则抗体能显著提高抗体的检出率,可避免漏检而降低输血反应的发生率。     

微柱凝集和聚凝胺法检测不规则抗体的对比分析与研究

目的比较微柱凝集和聚凝胺法的灵敏度和重复性,为不规则抗体的检测更新方法。方法使用微柱凝集和聚凝胺法检测不规则抗体,对比观察2种方法检出的阴、阳性结果和重复检验的准确性,从而选择灵敏度高和重复性好的方法满足临床输血需要。结果从18 000例住院患者中用微柱凝集筛选出不规则抗体阳性19例,阳性率为0.105%,其中D抗体7例,E抗体5例,C抗体3例,Ec抗体3例,Ce抗体1例;用聚凝胺法检测不规则抗体,仅有阳性为2例,阳性率为0.011%,2种方法比较差异有统计学意义(P<0.05);重复性检验:微柱凝集(19/19)和聚凝胺(2/2)均为100%,2种方法差异无统计学意义(P>0.05)。结论用微柱凝集检测不规则抗体能显著提高抗体的检出率,可避免漏检而降低输血反应的发生率。     

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。     

微柱凝胶免疫分析技术在血小板抗体筛选中的应用

为了探讨微柱凝胶免疫分析技术在血小板输注中血小板抗体筛选和配型的临床应用价值,运用微柱凝胶免疫分析技术检测血小板抗原抗体反应,包括抗体筛检、交叉配血。结果显示：30例再生障碍性贫血（AA）、11例骨髓增生异常综合征（MDS）和25例白血病患者中24例血小板抗体的检测均为阳性,20例其他病例中有1例血小板抗体检测阳性（占5%）,20例正常献血员的血小板抗体检测均为阴性。多次输注血小板的112个AA血液标本、42个MDS血液标本和95个白血病血液标本的血小板抗体交叉相合数分别为45、20和40个,相合率分别为40.18%、47.62%和42.11%;20例多次输注血小板的病人交叉配合前的血小板增高指数（CCI）平均为4.7,交叉配合后为18.2。结论：恶性血液病患者中血小板抗体筛检的阳性率很高;249个血液标本的血小板交叉配型的相合率在40%-48%之间;交叉配型后的血小板临床使用效果明显提高。     

微柱凝集抗人球蛋白试验在贫血患者输血前的应用

目的探讨微柱凝集抗人球蛋白试验(AGT)在贫血患者输血前的应用价值。方法对234例贫血患者输血前进行微柱凝集直接抗人球蛋白试验(DAT),阳性者再利用标准抗体筛查细胞进行间接抗人球蛋白试验(IAT)。结果 234例标本中DAT阳性者10例,经抗体筛查,其中IAT阳性者3例。结论微柱凝集AGT是一种灵敏度较高的可靠方法,该方法可以检测贫血是否由抗体致敏红细胞所导致,对指导临床输血具有决定意义。     

Comparison of conventional tube test technique and gel microcolumn assay for direct antiglobulin test: a large study

Gel microcolumn assay (GMA) is a modified serological technique that has been used for ABO and Rh typing, direct antiglobulin test (DAT), detecting alloantibodies, red cell phenotyping, and other applications. However, for DAT, the role of GMA is controversial. The purpose of this large study was to compare the performance of the conventional tube test (CTT) to GMA for detecting potentially significant antibodies coating red blood cells in vivo. From January 1996 to May 2002, we performed DATs by GMA and CTT on 9,862 blood samples submitted to our reference laboratory, using LISS/Coombs cards (DiaMed-Latino America, Lagoa Santa-MG, Brazil) for GMA and polyspecific and monospecific anti-IgG reagents for CTT. Acid eluates were prepared from all positive DAT samples. The specificity of eluates was determined by GMA. We detected nonconcordant results in 2,079 out of 3,163 positive DATs (65.7%). All of these tests were only positive in GMA. Sensitivity and specificity for DATs was 100% and 83.0% for gel, and 50.7% and 97.8% for tube, respectively. Based on this study GMA showed to be more sensitive than CTT for detecting potentially significant antibodies coating red blood cells in vivo.     

凝聚胺法与微柱凝胶法在临床输血中的应用研究

目的 探讨凝聚胺法(MPT)与微柱凝胶法(MGT)在交叉配血、血液样本不规则抗体筛查中的应用价值.方法 选取2012年8月至2014年8月于山东省交通医院接受输血治疗的1 386例临床输血患者为研究对象.分别采用MPT与MGT对输血患者血液样本进行不规则抗体筛查.对于筛查结果呈阳性者,采用谱细胞进行抗体鉴定.观察MPT与MGT交叉配血检测时间,交叉配血结果及其假阳性原因,以及不规则抗体筛查结果.统计学比较MPT与MGT交叉配血检测时间、主侧阳性率、次侧阳性率、总阳性率、假阳性率、不规则抗体筛查灵敏度.本研究获得山东省交通医院人体试验委员会同意,并与患者签署知情同意书.结果 ①MPT交叉配血检测时间为(12.1±2.6)min,显著短于MGT的(33.7±3.1)min,二者比较,差异有统计学意义(t=198.83,P＜0.001).②以谱细胞鉴定结果为“金标准”,采用MPT与MGT进行交叉配血检测结果显示,二者主侧阳性率、总阳性率和假阳性率分别比较,差异均无统计学意义(P＞0.05).MPT检测次侧阳性率为0.14％(2/1 386),显著低于MGT的0.65％(9/1 386),二者比较,差异有统计学意义(x2=4.47,P=0.034).③MPT、MGT对于血液样本不规则抗体筛查的灵敏度分别为78.95％(15/19)与100.00％(19/19),二者比较,差异有统计学意义(x2=4.47,P=0.034).结论 MGT不规则抗体筛查灵敏度较MPT高,但MGT交叉配血检测时间较MPT短.临床输血检测时,可采用这2种方法相结合,降低交叉配血检测时间,同时提高临床输血安全性.     

Evaluation of the ID-gel test for antibody screening and identification

Summary. A gel technique for the detection of red blood cell (rbc) antigen-antibody reactions was evaluated for use in antenatal antibody screening and identification procedures. The evaluation was undertaken on 3,900 random antenatal samples. Results obtained in the gel test system were compared with those obtained from parallel testing using conventional serological methods. The ID gel system detected 148 (3·7%) red cell antibodies, compared with 95 (2·4%) using traditional techniques. The number of non-specific antibodies and false-positive screens were reduced using the gel test system. Antibody titres performed using the gel system were more sensitive than with our tube 1AT method. The gel system was easy to use and gave reliable, reproducible results. Antibody detection rates were enhanced compared with our existing routine techniques.     

艾滋病筛查检测结果分析

目的 探讨艾滋病初筛实验与确认实验之间的关系,为提高艾滋病检测技术提供依据。方法 本实验室2000～2004年人类免疫缺陷病毒（HIV）抗体初筛阳性标本的初筛实验和确认实验结果进行分析。结果 初筛实验一阴一阳标本确认实验阳性率0％,双阳标本确认阳性率44．7％,两种试荆初筛实验标本光密度／临界值（S/GO）≥6的标本确认阳性率为90.9％。结论两种试剂初筛S／CO≥6标本,虽可上报疫情,但应尽快送确认实验室做确认实验。     

肿瘤患者输血前相关检测的分析研究

目的调查肿瘤患者输血相关检测中血型鉴定正反不符与不规则抗体阳性的检出情况及分布,并与非肿瘤患者群体比较分析。方法选取该院自2011年11月至2015年6月在输血科进行备血的16 760例患者结果资料,分成肿瘤患者组与非肿瘤患者组,对其中血型鉴定正反不符与不规则抗体筛查实验阳性的结果进行统计分析。结果 ABO血型正定型与反定型不一致的结果共27例,肿瘤患者组的发生率为0.65%,非肿瘤组发生率为0.08%,;不规则抗体阳性共49例,肿瘤患者组有18例,发生率0.74%,非肿瘤者31例,发生率约为0.22%。显示肿瘤患者ABO血型正反不符及抗筛阳性的发生比例均高于非肿瘤患者,差异有统计学意义(P0.05)。无论对于肿瘤患者组还是非肿瘤组,引起血型鉴定问题的主要影响因素均为抗体减弱,其次为自身抗体等;引起抗筛鉴定阳性的原因在两组中均主要为特异性抗体。结论肿瘤患者疾病特征更加容易引起ABO血型正反不符和抗筛检测阳性,在工作中要对其检测结果提高重视,避免漏检,提高鉴别能力,保障输血安全。     

微柱凝胶法抗体筛查的结果分析

目的围手术期和内科输血的患者进行不规则抗体筛查,以减少或杜绝溶血性输血反应的发生。方法用微柱凝胶Coombs卡对35,210例标本进行不规则抗体筛选,阳性标本用盐水、酶、抗人球蛋白、结合谱细胞和各种血型定型试剂确定抗体特异性。结果微柱凝胶Coombs卡筛选检出不规则抗体阳性标本83例,阳性率0．236％。结论微柱凝胶Coombs卡抗体筛选能有效降低和避免溶血性输血反应的发生．保证输血的安余性。     

微柱凝胶技术在新生儿溶血病检测中的应用

目的探讨微柱凝胶免疫技术在新生儿溶血病(HDN)筛查中的应用价值。方法采用微柱凝胶技术对本院临床疑似HDN 212例患儿血液标本做直接抗人球蛋白试验、游离试验、放散试验。结果疑似HDN患儿血液样本212例,确诊为HDN 50例(23.6%),其中ABO-HDN 45例(21.2%)、Rh-HDN 5例(2.4%)。45例ABO-HDN的患儿中,A型23例,阳性率为36.5%(23/63);B型22例,阳性率为28.2%(22/78)。3项试验的检出敏感性:50例HDN确诊患儿中放散试验阳性率为100%,DTA阳性率为28%,游离试验阳性率为92%。结论微柱凝胶法能快速准确检测出HDN,具有操作简便、标本用量少、方法学敏感性高、特异性强,可为HDN提供可靠诊断依据,适用于临床推广应用。     

国产微柱凝胶抗球蛋白卡在血型血清学试验中的应用

目的探讨国产微柱凝胶抗球蛋白卡（MGAC）常规进行血型血清学试验的应用价值。方法应用微柱凝胶抗球蛋白技术（MGAT）与试管抗球蛋白技术（TAT）平行试验，鉴定不规则抗体的特异性。同时，采用该两种技术检测新生儿溶血病及自身免疫溶血性贫血患者血标本以评价国产MGAC的血型血清学诊断价值；应用前二种技术与凝聚胺技术（MPT）平行试验，检测已知IgG抗体的凝集效价来评价国产MGAC检测IgG抗体的敏感性。结果MGAT与TAT的检测特异性完全一致，其检测敏感性接近TAT，而高于MPTI．2个凝集梯度，在新生儿溶血病及自身免疫溶血性贫血的血型血清学诊断中，MGAT与TAT的结果也基本一致。结论国产MGAC可常规应用于不规则抗体的检测、孕妇产前IgG抗体效价检测、新生儿溶血病及自身免疫溶血性贫血的血型血清学检测。     

Role of enzyme-treated cells in RBC antibody screening using the gel test: a study of anti-RH1, -RH2, and -RH3 antibodies

The role of enzyme-treated cells (ETCs) in red blood cell (RBC) antibody screening has been the subject of controversy, and its place in the clinical routine remains to be determined. In this work, plasma samples containing anti-RH1 (anti-D; N = 10), anti-RH2 (anti-C; N = 10), or anti-RH3 (anti-E; N = 10) antibodies were studied. The samples were diluted in nonbuffered or buffered normal saline, as well as in a pool of AB plasma samples. Titers and scores were determined by means of the gel test, using the indirect antiglobulin test (IAT) as well as ETCs, with R(0)r, r'r, or r'r test cells. Our results showed that compared to the IAT, ETCs allowed a clearer detection of anti-RH2 and anti-RH3, but not of anti-RH1 antibodies. Based on our study, it is not clear whether the ETC phase of the gel test should be maintained for RBC antibody screening.     

Novel aspects in the evaluation of an automated blood group analyser

Background: In contrast to other studies evaluating machines by testing a great number of samples, we focused here on the sensitivity and on the influence of possible disturbing factors on automated blood group testing. Materials and Methods: As the gelcards of the DiaMed‐ID Micro Typing System are well known, this study examines reading and interpretation of the gelcards by the automated analyser Techno TwinStation. The results of automated reading were compared with visual reading of the gelcards taken out from the machine. Results: The sensitivity, tested by the titers of some complete and incomplete antibodies, was at least the same for automated as for visual reading. Samples with weak antigens were well recognised by the analyser. Mixed field agglutinations were recognised as questionable results by automated reading up to a relation of 1 : 10 for the most part. Antibody screening and reverse typing were not influenced by hyperbilirubinaemia, whereas in lipemic and haemolytic samples doubtful results were reported. Conclusion: Interpretation of the results by the automated analyser Techno TwinStation may be disturbed in some difficult samples, but in most of these cases the analyser reports not a false, but a doubtful result, thus triggering visual reading by the operator.     

16例冷凝集素造成的血型不合分析

目的 探讨冷凝集素对血型造成的影响及相应的处理效果.方法 采用37℃水浴、吸收放散试验及2-巯基乙醇等方法 消除冷凝集素的影响,并对处理后的红细胞和血清进行正反定型、交叉配血、直接抗人球蛋白实验及间接抗人球蛋白实验等实验.结果 16例患者标本在处理前均呈明显的正反定型不符,交叉配血困难,经鉴定均由冷凝集素造成.经过相应...