Comparison of conventional tube test with diamed gel microcolumn assay for anti-D titration

Anti-D titration is the first step in the evaluation of the RhD-sensitized patient. Traditionally, anti-D titration has been performed by tube agglutination. Gel microcolumn assay is a method that has gained widespread usage throughout the world, mainly for ABO/Rh typing, unexpected antibody screening and direct antiglobulin tests. As gel assay has become widely used as a routine method to detect red blood cell alloantibodies, a critical anti-D titer needs to be established. Seventy-nine known blood samples with anti-D (titers 1-32) were titrated simultaneously by the conventional tube test and the gel microcolumn assay. Red blood cells (R0r phenotype) were used, with a final concentration of 3% for tube and 0.8% for gel. Serial twofold dilutions (2-2.048) were prepared for each technique, followed by reading in antiglobulin phase. Anti-D titration in the gel microcolumn assay showed significantly higher titers (mean 3.4-fold) than the conventional tube test in all samples studied. Based on these data, it was not possible to determine a critical titer for anti-D titration by the gel microcolumn assay.     

传统试管法与达亚美微柱凝胶法检测抗-D效价的比较

目的：为了评价微柱凝胶技术（MGCT）检测抗-D效价。方法：用MGCT和试管抗球蛋白实验（TCT）同时检测38例孕妇血清抗-D效价。结果：MGCT检测抗-D效价高于TCT 2～6滴度（平均提高3～4个滴度）,MGCT检测抗-D效价灵敏度显著高于TCT,差异有统计学意义（P〈O．01）结论：MGCT法检测抗-D效价是一种灵敏度较高的方法。     

Comparative Evaluation of Five Different Methods of Anti‐ABO Antibody Titration: An Aid for ABO‐Incompatible Organ Transplants

The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t‐test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti‐A (128) and anti‐B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti‐A and anti‐B titers. Average agreements between the DTT‐applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti‐A (κ = 0.473) and anti‐B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.     

微柱凝胶法与试管法检测新生儿溶血病免疫性抗体的比较

目的：比较微柱凝胶法与试管法对母婴血型不合新生儿溶血病（HDN）免疫性抗体的检出率。方法：对临床表现为高胆红素血症、疑似HDN的患儿血标本同时用微柱凝胶法和试管法进行直接抗人球蛋白试验、抗体游离试验及抗体放散试验,并对患儿阳性血标本进行血型不规则抗体特异性鉴定及其效价测定。结果：在275例临床表现为高胆红素血症、疑似HDN的患儿血标本中,用试管法检出直接抗人球蛋白试验阳性180例（65.5%）,抗体游离试验阳性197例（71.6%）,抗体放散试验阳性210例（76.4%）;用微柱凝胶法检出直接抗人球蛋白试验阳性224例（81.5%）,抗体游离试验阳性238例（86.5%）,抗体放散试验阳性251例（91.3%）。微柱凝胶法比试管法的凝集强度高1＋～2＋。结论：微柱凝胶法的敏感性略高于试管法,具有操作简便,影响因素少,易于标准化,结果客观及保存时间长等优点。     

新生儿溶血病血清学检查2种方法的对比研究

目的：对比研究微柱凝胶法和抗人球蛋白试验在新生儿溶血病（HDN）血清学检查中的应用。方法：选择母婴ABO血型不合的新生儿血液标本80份。每份标本均用微柱凝胶法和抗人球蛋白试验进行HDN“三项检查”：直抗试验、游离试验和释放试验。并将数据进行统计学处理。结果：直抗试验中2种方法均无阳性结果;游离试验中2种方法比较差异无统计学意义（P〉0．05）;释放试验中2种方法比较差异有统计学意义（P〈0．05）。结论：HDN“三项检查”中微柱凝胶法优于试管法,快速、简便,标本量少,重复性强,结果判定直观,敏感性强。     

孕产妇血型抗体效价测定在产前诊断中的意义

目的：通过对孕产妇血清中血型抗体效价的测定,旨在了解异常IgG抗-A（B）或抗-D水平在孕妇中的分布情况,探讨孕妇血清中IgG类血型抗体效价与新生儿溶血病（HDN）之间的关系,为预防及治疗HDN提供重要的实验依据。方法：采用凝聚胺法分别对1316例0型血孕妇和64例Rh（D）阴性血孕妇血清中IgG抗-A（B）和抗-D水平做出测定。对新生儿运用微柱凝胶法做HDN溶血3项检测。结果：①在所检测的1316例0型血孕妇中,IgG抗-A测定有802例,效价≥64为129例,异常检出率占总抗-A的16．1％;IgG抗-B测定有744例,效价≥64为135例,异常检出率占总抗B的18．1％。其中89例IgG抗A（B）≥64O型血孕妇所生新生儿中,有22例患HDN,阳性率占24．7％;②64例Rh（D）阴性血受检孕妇中,5例检测出IgG抗-D抗体,抗体检出率占7．8％,新生儿中有3例患Rh—HDN。结论：①HDN的发病率随着母体内的IgG类血型抗体水平增高而增大;②对于Rh（D）阴性的孕妇,IgG抗-D效价与孕次成正相关。     

Evaluation of the Microcolumn Technology for Pretransfusion Testing in Multiple Myeloma Patients

Objective: Microcolumn tests are useful for serological investigations, although because of their high sensitivity, false-positive results might be expected, e.g. in hypergammaglobulinemia. The aim of this study was to evaluate these tests in multiple myeloma. Methods: Pretransfusion testing was done in 80 patients with multiple myeloma using microcolumn and traditional tube tests. Results: All sera were negative in microcolumn indirect antiglobulin test and enzyme test, positive in 58% of samples in the enzyme tube test. The microcolumn direct antiglobulin test was positive in about 40% of samples but never in the tube direct antiglobulin test. This was not due to the presence of autoantibodies but to nonspecific binding of immunoglobulins related to their concentration in sera. Conclusion: Microcolumn tests appeared to be useful for pretransfusion testing in multiple myeloma in spite of positive autocontrols.     

Decreased anti-hepatitis C virus titer and associated factors in chronic hepatitis C patients after sustained virological response: a prospective study

Background and Aim: Long‐term trends of anti‐hepatitis C virus (HCV) antibody titer and their associated factors in patients with sustained virological response (SVR) were investigated. Methods: From May 1999 to July 2005, a total of 166 SVR consecutive patients (M/F: 86/80) were enrolled. Anti‐HCV titer, samples to cut‐off (S/CO) ratios, were measured with AxSYM HCV version 3.0. Their S/CO ratios were followed every 6 months after SVR and the patterns over time were identified by trajectory analyses. Changes of recombinant immunoblot assay (RIBA) pattern before treatment and end of follow‐up were compared (n = 64). Results: The mean duration of follow‐up was 4.7 ± 1.5 years (median 4.3; range 3–9 years). The rates of S/CO ratios decreased annually (P < 0.001). Two of them (1.2%) achieved seroreversion. Trajectory groups included lower pretreatment S/CO ratios (LAB, n = 83), rapid decrease (RD, n = 62) and slow decrease (SD, n = 21) groups. Comparing LAB to RD group, odds ratio (OR) of increased platelet count per 1 unit and interferon regimen was 1.12 (95% confidence interval [CI] 1.04–1.20) and 2.17 (95% CI 1.04–4.52) respectively. Comparing SD to LAB and RD groups, the OR of advanced fibrotic stage, using mild fibrotic stage as a reference, was 4.33 (95% CI 1.49–12.63). Reaction strength of all four RIBA bands decreased significantly at the end of follow‐up. Conclusions: Anti‐HCV titers decreased annually during long‐term follow‐up after SVR. Higher pretreatment platelet count, interferon regimen and mild fibrosis were associated with decreased anti‐HCV titers. However, only a few cases achieved seroreversion. All RIBA bands decreased significantly after long‐term follow‐up.     

The value of gel test and ELAT in autoimmune haemolytic anaemia

Summary Three methods for detection of warm type IgG autoantibody were evaluated using 400 blood samples from 147 patients suspected of autoimmune haemolytic anaemia (AIHA). Three direct antiglobulin techniques (DAT) were used: conventional tube DAT, gel-DAT by micro-method and gel-DAT enzyme linked antiglobulin test (ELAT). Eluate examinations confirmed the presence of autoantibodies on red cells. These tests were compared directly using 126 selected blood samples from 85 patients with IgG molecules on their red cells detected by the gel test. In 106 of these samples, collected from 65 patients with clinical symptoms of AIHA, the presence of autoantibody was confirmed by acid elution. The ELAT was positive in 100 samples (94%), 87 samples for tube DAT (82%). The ELAT as well as the tube DAT was negative in 20 samples with non-reactive eluates by gel test. The gel-DAT was therefore not fully specific and detected IgG on red cells of patients with hypergammaglobulinaemia. However, due its higher sensitivity it proved useful as a screening test. The ELAT allowed changes in the number of IgG molecules per red cell to be monitored quantitatively. Both methods play a part in the diagnosis and monitoring patients with warm type IgG autoantibody.     

Micro-Column Affinity Test and Gel Test: Comparative Study of Two Techniques for Red Cell Antibody Screening

BACKGROUND AND OBJECTIVES: We describe the results of a comparative evaluation of a gel test (ID Micro Typing) and a micro-column affinity test (MCAT, Cellbind Screen) for red cell antibody screening and identification under routine conditions. MATERIALS AND METHODS: 3,000 serum samples of patients from the Mannheim University Hospital were tested in parallel by means of the gel test and the MCAT, using the low-ionic-strength-saline indirect antiglobulin test and the protein G affinity technique, respectively. Test cells used were the same in all tests. In addition, we performed titration studies with all detected antibodies as well as with 59 frozen sera containing antibodies of known specificity. RESULTS: A total of 154 antibodies (5.1%) were detected, 149 by gel test and 147 by MCAT. The overall sensitivity and specificity of the gel test was 96.8 and 96.5% and of the MCAT 95.5 and 97.2%. No significant differences between the gel test and MCAT were found when the titer scores of all 213 (fresh and frozen) antibodies were used to check the results. The mean scores for the gel test and the MCAT were 26.8 and 28.5, respectively. For anti-Fy(a) and anti-Kell, a significantly higher titration score could be obtained in the MCAT, whereas anti-Lu(a) showed a significantly higher score with the gel test. CONCLUSION: For the screening of unexpected red blood cell antibodies, the MCAT is as sensitive as the gel indirect antiglobulin test. The sensitivity and specificity of the two systems are more or less the same although it seems that IgM antibodies are better detected by the gel test.     

The Direct Antiglobulin Test: Still a Place for the Tube Technique?

OBJECTIVES: Antibodies of different immunoglobulin isotypes, or complement, may coat red blood cells in vivo. They are detected by the direct antiglobulin test (DAT), usually performed by the conventional tube technique. The purpose of this study was to compare the latter technique with the gel test. METHODS: Three hundred and ninety-eight consecutive samples, sent to our laboratory for direct antiglobulin testing, were analyzed with the tube technique and the gel test, using reagents from different manufacturers. Eighty-seven samples had been collected from newborns and 23 from fetuses. Results were expressed as positive or negative. RESULTS: In 162 out of 398 cases, the DAT was negative with both methods, whereas in 178 out of 398 cases, the DAT was positive with both techniques using polyspecific antibodies (observed agreement: 84.5%; kappa = 0.71). Discrepancies between the two methods were observed in 58 cases: 51 samples appeared as DAT positive using the tube method and negative with the gel test, whereas only 7 were positive exclusively with the gel test. Among the 178 samples that were positive with both techniques, 93 samples showed discordant results when evaluated with monospecific antisera (11 with anti-IgG and 82 with anti-C3d, respectively). The sensitivity of the DAT performed by the gel test, in comparison with the conventional tube technique, was 75.4% (95% confidence interval (CI): 69.4-80.8). 96. 8% (95% CI: 92.8-99.0), and 16.3% (95% CI: 9.8-24.9) with polyspecific, anti-IgG and anti-Cd3 reagents, respectively. CONCLUSIONS: The gel test appeared to be less sensitive than the conventional tube technique when utilized for DAT, particularly when C3d was present on red blood cells. These results emphasize that before implementing a new technique in the laboratory, comparison with existing techniques, using different reagents, is mandatory.     

Induction and maintenance of anti-influenza antigen-specific nasal secretory IgA levels and serum IgG levels after influenza infection in adults

Please cite this paper as: Fujimoto et al. (2012) Induction and maintenance of anti‐influenza antigen‐specific nasal secretory IgA levels and serum IgG levels after influenza infection in adults. Influenza and Other Respiratory Viruses 6(6), 396–403. Objectives To determine the induction and changes in anti‐influenza virus secretory IgA (s‐IgA) levels in nasal washes and serum IgG levels in patients with influenza. Methods The study recruited 16 patients with influenza aged 35·6 ± 9·6 years in 2007/2008 and 2008/2009 seasons. Nasal washes and serum were obtained throughout the first year. Anti‐viral s‐IgA levels and neutralization activities in nasal washes, and serum anti‐viral IgG levels and hemagglutination inhibition (HI) titers were measured. Results Anti‐viral(H1N1) s‐IgA to total IgA ratio and neutralizing antibody titer were low in nasal washes of all patients, whereas serum levels of anti‐viral IgG and HI titers varied widely at day 1·4 ± 1·0 postinfection. Both nasal s‐IgA and serum IgG levels later increased significantly, reaching peak levels at day 9·6 ± 3·3 postinfection. The induced nasal s‐IgA then returned toward the initial levels within 300 days, although the levels at day 143 ± 70 were 3·03‐fold of the initial. Individual serum IgG levels also returned toward the initial levels within 300 days, although the mean levels remained high probably because of re‐infection in a subgroup of patients. Although influenza A (H3N2) was a minor epidemic subtype in both flu seasons, a significant rise in nasal anti‐viral (H3N2) s‐IgA levels and a slightly increase in serum IgG levels were noted. Conclusion Low levels of nasal anti‐viral s‐IgA and neutralizing antibody were noted compared with a wide range of serum anti‐viral IgG and HI titers at the onset of infection. Elevated s‐IgA and IgG returned toward the initial levels within 300 days of infection with minor exceptions.     

Umbilical cord blood levels of maternal antibodies reactive with p200 and full‐length Ro 52 in the assessment of risk for cardiac manifestations of neonatal lupus

Objective

Maternal anti‐Ro autoantibodies are associated with cardiac manifestations of neonatal lupus (cardiac NL), yet only 2% of women with this reactivity have an affected child. Identification of a more specific marker would channel intense monitoring to fetuses at greater risk. This study aimed to determine whether autoantibodies against Ro 52 amino acids 200–239 (p200) confer added risk over autoantibodies to full‐length Ro 52, Ro 60, or La.

Methods

Anti‐Ro–exposed pregnancies resulting in cardiac NL or no cardiac manifestations were identified from the Research Registry for Neonatal Lupus and the PR Interval and Dexamethasone Evaluation study. Umbilical cord (n = 123) and maternal (n = 115) samples were evaluated by enzyme‐linked immunosorbent assay.

Results

The frequencies of p200, Ro 52, Ro 60, and La autoantibodies were not significantly different between affected and unaffected children. However, neonatal anti–Ro 52 and Ro 60 titers were highest in cardiac NL and their unaffected siblings compared to unaffected neonates without a cardiac NL sibling. Although both maternal anti–Ro 52 and p200 autoantibodies were less than 50% specific for cardiac NL, anti‐p200 was the least likely of the Ro autoantibodies to be false‐positive in mothers who have never had an affected child. Titers of anti–Ro 52 and p200 did not differ during a cardiac NL or unaffected pregnancy from the same mother.

Conclusion

Maternal reactivity to p200 does not confer an added risk to fetal conduction defects over full‐length Ro 52 or Ro 60 autoantibodies. Mothers who may never be at risk for having an affected child have lower anti–Ro 60 titers and may require less stringent echocardiographic monitoring compared to women with high‐titer autoantibodies.     

43例待产孕妇Rh血型抗体筛查阳性分析

目的：研究多次妊娠妇女体内Rh血型抗体与新生儿溶血病的关系。方法：运用微柱凝胶免疫法鉴定Rh抗体和分型,抗人球试验法测定抗体效价。结果：待产孕妇16845例,检出意外抗体48例,其中43例为Rh血型抗体且夫妇ABO顺式相容。分析抗体特异性种类和效价,抗D抗体8例,效价8～512;抗c抗体5例,效价16～128;抗E抗体16例,效价8～64;抗C抗体12例,效价4～8;抗e抗体2例,效价8。由此得出Rh血型抗原性强弱为D〉c〉E〉C〉e。结论：多次妊娠妇女体内Rh相关抗体效价强弱是引起新生儿溶血的原因之一。     

EDTA-K2抗凝血在血型鉴定中的应用

目的：探讨EDTA-K2抗凝血在血型鉴定中的应用。方法：对100例住院患者和100例体检健康者的EDTA—K2抗凝血和未抗凝血进行玻片法、试管法和微柱凝胶法血型鉴定,对结果进行比较分析。结果：EDTA—K2抗凝血和未抗凝血进行玻片法、试管法和微柱凝胶法血型鉴定时,结果一致,差异无统计学意义（P〉0．05）;EDTAK2抗凝血的结果均清晰易判读,而非抗凝血标本中的自然凝块易对观察结果产生干扰,容易引起错误鉴定。结论：EDTA—K2抗凝血进行血型鉴定时优于未抗凝血,可以代替传统的无抗凝血标本进行血型鉴定。     

Titration emulation: a computer-assisted technique that simplifies the quantification of anti-dsDNA antibodies using the Crithidia luciliae assay.

Titers of anti-double-stranded (ds) DNA antibodies in sera from patients with systemic lupus erythematosus (SLE) using the Crithidia luciliae assay method were compared by conventional titration vs the titration emulation method (ImageTiter) to evaluate whether the latter assay can replace manual titration. Titers by the two methods were identical or within one dilution in 98% (41/42) of samples. A single sample showed a two-dilution difference. Titration emulation showed a tendency to under-estimate the titer of high titer anti-dsDNA samples, although the difference was small. Titration emulation is a suitable alternative to the conventional titration method, offering an accurate and cost-effective approach to quantification of anti-dsDNA antibodies.     

Association of α‐actinin–binding anti–double‐stranded DNA antibodies with lupus nephritis

Objective

Anti–double‐stranded DNA (anti‐dsDNA) antibodies may contribute to the pathogenesis of glomerulonephritis (GN) by cross‐reacting with α‐actinin in murine models and in some patients with systemic lupus erythematosus (SLE). We therefore sought to determine possible disease associations with serologic and clinical features and to characterize this new autoantibody specificity.

Methods

One hundred patients with SLE were recruited into this multicenter study, as well as 100 rheumatic disease controls and 2,100 healthy blood donors. Clinical disease was evaluated by the SLE Disease Activity Index (SLEDAI; excluding the anti‐DNA component). Anti‐dsDNA antibodies were detected by conventional enzyme‐linked immunosorbent assay (ELISA) and by a commercial enzyme immunoassay (EIA). Anti–α‐actinin antibodies were detected by ELISA, and their specificity was confirmed by Western blotting and by indirect immunofluorescence using rat kidney sections and mesangial cells as substrates. Highly positive sera were selected for absorption experiments and were affinity‐purified for cross‐reactivity studies and measurement of antibody avidity.

Results

Sera from 62 of the SLE patients had anti‐dsDNA antibodies; 21 of these sera also had anti–α‐actinin antibodies, as compared with 1 of the 38 sera without anti‐dsDNA antibodies. Of the 22 patients with anti–α‐actinin antibodies, 10 had GN, as compared with 14 of the 78 without anti–α‐actinin antibodies (P < 0.01). In patients with GN, anti–α‐actinin, but not anti‐dsDNA, antibodies correlated with the SLEDAI score (minus the anti‐DNA component) and with treatment. The fraction of serum anti‐dsDNA antibodies that cross‐reacted with α‐actinin exhibited high avidity for dsDNA, as determined using a commercial EIA for high‐avidity anti‐dsDNA antibodies and an in‐house conventional ELISA.

Conclusion

The α‐actinin–binding antibodies are significantly associated with GN in SLE. Whether such autoantibodies may anticipate the development of this complication of SLE remains to be verified.

     

Reduction of the risk of transfusion‐transmitted viral infection by nucleic acid amplification testing in the Western Cape of South Africa: a 5‐year review

Background and Objectives In October 2005, individual donation nucleic acid amplification testing (ID‐NAT) for HIV, HBV and HCV was introduced in the Western Cape Province of South Africa. After 5 years, the impact on HIV, HBV and HCV transmission risk was assessed. Materials and Methods A total of 649 745 donations were tested by ID‐NAT using the Ultrio assay on the Tigris instrument (Novartis Diagnostics) and for anti‐HIV, HBsAg and anti‐HCV (Abbott Prism). Initial reactive samples were repeated in duplicate. Discrepant repeat reactive samples were subjected to confirmatory assays. ID‐NAT nonrepeat reactive donations were further screened for occult HBV infection (OBI) by anti‐HBc assay. Results ID‐NAT yielded 6 HIV‐RNA‐positive donations in the anti‐HIV‐negative window period (WP) but only 2 were p24 Ag nonreactive (1:325 000). Mathematical modelling estimated a similar HIV transmission risk for lapsed and repeat donations, in the order of 3 per million. The WP risk for HBV was 13 per million. Eight acute (1:81 000) and 13 chronic OBI yield cases (1:50 000) were interdicted. There were significantly more anti‐HBc‐positive donors in the Ultrio initial reactive/nonrepeat reactive group (12%) than in an Ultrio nonreactive control group (6%). Conclusion ID‐NAT in the Western Cape Province of South Africa has contributed significantly to enhancing blood safety, particularly for HBV transmission risk and to a lesser extent for HIV. Anti‐HBc testing of NAT nonrepeat reactive donations seems useful in identifying a subgroup of donors with OBI who may be at risk of transmitting HBV.     

Anti‐C1q antibodies are associated with systemic lupus erythematosus global activity but not specifically with nephritis: A controlled study of 126 consecutive patients

Objective

Several studies have shown that anti‐C1q antibodies correlate with the occurrence and activity of nephritis in systemic lupus erythematosus (SLE). However, the significance of anti‐C1q antibodies in SLE has not been fully characterized. The aim of this study was to investigate associations between anti‐C1q antibodies and clinical and serologic parameters of SLE.

Methods

An enzyme‐linked immunosorbent assay kit was used to measure anti‐C1q antibodies in the sera of 126 consecutive patients with active SLE who were admitted to our university hospital from 2007 through 2009. Sera obtained from patients with high titers of anti‐C1q antibodies at the initial evaluation (n = 20) were reevaluated following treatment. Control sera were obtained from patients with other autoimmune diseases and from normal healthy control subjects (n = 20 in each group). Associations between anti‐C1q antibodies and clinical and serologic parameters of SLE were statistically analyzed.

Results

Anti‐C1q antibodies were detected in the sera of 79 of 126 patients with SLE. The prevalence and titers of anti‐C1q antibodies were significantly (P < 0.0001) higher in SLE patients than in patients with rheumatoid arthritis, patients with systemic sclerosis, and normal healthy control subjects. The prevalence and titers of anti‐C1q antibodies were not significantly associated with active lupus nephritis (P = 0.462 and P = 0.366, respectively). Anti‐C1q antibody titers were significantly correlated with SLE Disease Activity Index 2000 scores and the levels of anti–double‐stranded DNA antibodies, C3, C4, CH50, and C1q (P < 0.0001 for all comparisons). Moreover, anti‐C1q antibody titers significantly decreased as clinical disease was ameliorated following treatment (P = 0.00097).

Conclusion

These findings indicate that anti‐C1q antibodies are associated with SLE global activity but not specifically with active lupus nephritis.

     

高效价自身冷抗体致血型鉴定和交叉配血困难的处理方法

目的：探讨高效价的自身冷抗体致血型鉴定和交叉配血困难的处理方法。方法：对高效价自身冷抗体致血型鉴定和交叉配血困难的患者,通过ABO血型鉴定、冷抗体效价滴定、血清抗体筛查、抗人球蛋白试验以及凝聚胺和微柱凝胶交叉配血等血清学检测,寻找血型鉴定和交叉配血困难的原因,并提出相对应的处理方法。结果：收集由于高效价自身冷抗体引起血型鉴定和交叉配血困难共7例,其中6例患者冷抗体效价在128～256之间,通过37℃水浴,血型鉴定正反定型一致,交叉配血相合;1例患者冷抗体效价为1024,通过37℃加热洗涤和4℃冷吸收之后进行血清学试验,血型鉴定正反定型一致,交叉配血相合。结论：高效价自身冷抗体引起的血型鉴定和交叉配血困难时,可以根据自身冷抗体效价的高低以及冷凝集强度,选择37℃水浴或37℃加热洗涤、4℃冷吸收等不同鉴别试验进行排除,以期达到正确的血型鉴定和有效的交叉配血,保证临床输血安全。