35例疑难交叉配血患者血清中不规则抗体结果分析

目的了解临床患者血清中不规则抗体对交叉配血不合的影响。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 35例交叉配血不合患者血清中,抗-E抗体13例、抗-Ec抗体4例、IgG抗-D抗体1例、抗-Ce抗体1例、抗-c抗体1例、抗-e抗体1例、抗-M抗体4例、抗-Mur抗体1例、无规律ABO系以外不规则同种免疫性抗体9例。结论有多次输血史、妊娠史患者体内容易产生ABO系以外不规则抗体,而Rh血型系统同种免疫性抗体是造成临床配血不合的主要原因之一。     

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。     

抗-E抗体致配血不合5例分析

多次、大量输血及妊娠均可使机体产生红细胞不规则抗体,引起不良输血反应、血型鉴定困难及交叉配血不合。我们于200901／200906通过抗体筛选试验和交叉配血检出5例抗-E抗体,筛选无相应抗原的红细胞输注,无一例发生溶血性输血反应,报告如下。     

同种及类同种特异性抗体检测结果与临床沟通的必要性探讨

在输血治疗过程中,由ABO血型系统以外的不规则抗体引起的血型鉴定困难、交叉配血试验不合,甚至溶血性输血反应等屡见报道.本文选择2011年1月至12月本院收治的2例不规则抗体特异性鉴定标本为研究对象,进行同种及类同种特异性抗体检测分析,旨在探讨将检测结果与临床沟通的必要性.     

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。     

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。     

抗-E合并抗-Dia致疑难配血试验分析

不规则抗体是指除抗-A、抗-B红细胞以外的血型抗体。不规则抗体是导致溶血性输血反应、新生儿溶血病、疑难配血及血型鉴定困难的主要原因[1-2]。对献血员和患者进行抗体筛选,可避免因为找不到相合的血液给患者而延误治疗,因此抗体筛查试验在临床配血中非常重要。引起临床疑难交叉配血最常见的抗体是Rh血型系统的相关不规则抗体,该系统不规则抗体可单独存在,也可以联合其他抗体的形式存在。本实验室在工作中发现1例抗-E合并抗-Dia引起的交叉配血不合,现将试验分析过程报道如下。     

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。     

205例交叉配血试验主侧不相合原因的研究

目的：探讨205例交叉配血试验主侧不相合的原因,为临床解决疑难配血提供参考。方法用盐水法、凝聚胺法和微柱凝胶法进行交叉配血等实验,并对其中交叉配血试验主侧不相合的标本和原因进行检测和分析。结果交叉配血试验主侧阳性205例,有自身抗体为21.46%（44/205）,仅有自身抗体为15.61%（32/205）;有同种抗体为76.59%（157/205）,仅有同种抗体为70.73%（145/205）;自身抗体合并同种抗体为5.85%（12/205）;其他原因引起为7.80%（16/205）,其中高粘滞血症引起的为2.44%（5/205）,献血员直接抗球蛋白试验强阳性引起为1.46%（3/205）,不明原因引起的为5.37%（11/205）。157例含血型系统抗体,其中29例因血型抗体的特异性无法鉴定,未能确定血型系统,占18.47%（29/157）,128例血型系统抗体涉及ABO、Rh、MNSs、Lewis、Duffy、Kidd 6个血型系统,其中Rh血型系统抗体占血型系统抗体的75.16%（118/157）,Rh血型系统抗体又以抗-E和抗-c为主,分别为85.59%（101/118）、24.58%（29/118）。结论交叉配血试验主侧不合的主要原因是不规则抗体和自身抗体,其中血型系统抗体以Rh血型系统抗体为主,特别是抗-E抗体和抗-c抗体。     

肿瘤影响血型鉴定及交叉配血不合原因分析

目的 解决临床用血工作中所遇到的难题.方法 采用微柱凝胶法检测ABO血型、不规则抗体筛查、交叉配血.结果 1100例病人,正反定型不符17人.Rh(-)血型鉴定RhD5例、占0.45%.RhC128例,占11.6%.RhE567例,占51.5%.血型鉴定双群现象:ABO血型5例,占0.45%,RhC58例,占5.2%.RhE171例,占15.5%.645例病人中不规则抗体6人.其中:抗-E4例;抗-C2例.3317份交叉配血,323人用血,主次侧不合7人,次侧不合56人,肿瘤患者22人,占37.9%.血液病人34人,占58.6%.结论 ABO及Rh血型鉴定、不规则抗体筛查应作为交叉配血在临床输血前的常规.对肿瘤病人影响交叉配血,要明确原因,避免盲目输血和盲目拒绝输血.确保临床用血安全具有重要意义.     

南宁地区疑难输血患者红细胞不规则抗体的分析

目的对南宁地区疑难输血患者中红细胞不规则抗体检出情况进行分析,以了解本地区患者红细胞不规则抗体的发生情况。方法对2008-2018年间南宁市各医院送检的疑难配血案例标本1 463例,应用盐水法、凝聚胺法、抗球蛋白法、微柱凝集法、酶法、吸收放散法检测红细胞不规则抗体。结果共鉴定确认红细胞不规则抗体335例,发生率为22.90%(335/1463)。主要涉及6个血型系统:Rh系统55.52%(186/335),Kidd系统2.69%(9/335),MNS系统18.21%(61/335),Lewis系统4.48%(15/335),P系统5.07%(17/335),Rh合并Lewis系统0.30%(1/335),Rh合并P系统0.60%(2/335),Rh合并MNS系统5.97%(20/335),Rh合并Kidd系统5.67%(19/335),Rh、MNS合并Kidd系统1.19%(4/335),Rh、Kidd合并Duffy系统0.30%(1/335)。结论从南宁地区疑难输血患者红细胞不规则抗体检出情况分布看,以Rh和MNS血型系统为主,以Rh合并MNS血型系统的不规则抗体比率最高,尤其是Rh系统和抗-Mur同时存在多见。     

常州地区Rh、MNS血型不合致新生儿溶血病的试验结果分析及治疗

目的分析常州地区Rh、MNS血型系统不规则抗体所致新生儿溶血病的抗体分布特点及治疗效果。方法对常州地区2013-2019年由不规则抗体引起的新生儿溶血病患儿溶血筛查试验结果及治疗效果进行回顾性分析。结果23例由不规则抗体导致的新生儿溶血病致病抗体来自Rh和MNS两个血型系统,其中由抗-E引起的溶血病13例,由抗-D引起的溶血病8例,由抗-M引起的溶血病2例。有7例患儿进行了换血治疗,换血治疗后患儿红细胞计数、血红蛋白水平升高,胆红素水平明显降低,差异有统计学意义(P<0.05)。结论目前常州地区抗-E是Rh血型系统新生儿溶血病中最常见的抗体,且患儿母亲均有多次妊娠史。为预防新生儿溶血病的发生,对有妊娠史和输血史的孕妇,要加强产前不规则抗体血清学检测,并合理制订个体诊疗及换血方案,这对重症新生儿溶血病患儿的救治具有重要意义。     

不规则抗体导致ABO正反定型不符处理探讨

目的探讨不规则抗体导致ABO正反定型不符原因,并提出解决方法。方法总结分析12例不规则抗体导致ABO正反定型不符血型血清学试验结果,通过不规则抗体筛查、不规则抗体鉴定、相应血型检测明确不规则抗体导致ABO正反定型不符确切原因,用相应抗原阴性红细胞重新进行ABO血型反定型。结果 12例标本中抗-M 4例,抗-N 1例,抗-M合并抗-N 1例,抗-Lea1例,抗-P11例,抗-I 1例,抗-D 1例,抗-E 1例,抗-A11例。用相应抗原阴性红细胞重新进行ABO血型反定型,正反定型结果均相符。结论不规则抗体是导致ABO正反定型不符的常见原因,经过适当处理可以正确鉴定ABO血型。     

83例疑难ABO血型鉴定及分析

目的检测和鉴定ABO疑难血型,为安全输血提供质量保障。方法采用血型血清学方法进行盐水介质正、反定型;对盐水介质正、反定型不合者使用聚凝胺法检测和不规则抗体检测;采用吸收试验和放散试验进行ABO血型的检测,以准确鉴定ABO疑难血型。结果 83例标本ABO血型检测结果为,AB亚型9例、B亚型1例、弱A抗原7例、弱B抗原6例、低抗-A效价2例、低抗-B效价3例、不规则抗体阳性7例、无抗体O型4例、低抗-B效价O型2例、无抗-B抗体A型5例;37例标本经盐水介质和Polybrine法检测,正、反定型结果符合。结论用聚凝胺法、吸收试验和放散试验进行ABO疑难血型检测,能准确、及时鉴定ABO疑难血型。     

Electronic verification of donor-recipient compatibility: the computer crossmatch

Background: This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate-spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB). Study Design and Methods: SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code-entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate-spin crossmatch during computer downtime. Tables validated on- site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected. Results: These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate-spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample. Conclusion: A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor-recipient incompatibility without performance of serologic crossmatch.     

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。     

Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation

The management of hemotherapy in 31 cases of ABO- or Rh-incompatible bone marrow transplantation is described. Our experience confirms that ABO or Rh incompatibility does not adversely affect engraftment, patient survival, or incidence of graft-versus-host disease. Eighteen recipients with ABO antibodies against the donors' red cells (major incompatibility) were managed by different combinations of plasma exchange, transfusion of incompatible donor type red cells, and removal of donor-type red cells from the bone marrow before transplant. The only serious complication was delayed hemolysis in seven of nine patients who received incompatible red cell transfusions before transplant. Thirteen patients received bone marrow containing ABO antibodies against their red cells (minor incompatibility). Five were managed by centrifuging the bone marrow to remove plasma and reduce the amount of antibody. This did not cause substantial loss of stem cell activity (60-100% of original marrow), and no patients had complications related to the marrow transfusion. In contrast, two of seven patients who received uncentrifuged bone experienced hemolysis. Two of four Rh positive recipients who received marrow from an Rh negative donor developed anti-D, possibly due to Rh positive blood components transfused after transplantation. None of eight Rh negative patients who received an Rh positive transplant has developed anti-D. Blood components should be selected to avoid transfusion of incompatible red cells and to avoid transfusion of a large amount of incompatible plasma. This may necessitate use of plasma components of a different ABO type than the red cell components.     

Transfusion policy in allogeneic hematopoietic stem cell transplantation

The incompatibility of ABO blood group between the recipient and the donor is not a barrier to perform allogeneic hematopoietic stem cell transplantation (Allo-HSCT). However, ABO incompatibility may lead to many complications during and after stem cell transplantation at the early or late period. Therefore, the typing of the blood group of the recipient and the donor should be done prior to the transplantation. In addition, the ABO/Rh group of blood products for transfusion should be determined according to the type of ABO-incompatibility. In this review, the subtypes of ABO blood group-incompatibility and transfusion policies will be discussed in detail.