ABO血型抗体吸附剂:冻干红细胞膜的初步研究

目的制备冰冻干燥红细胞膜,探索其作为ABO血型抗体吸附剂去除血型抗体、制备通用型红细胞的可行性。方法收集A、B型红细胞膜,作冰冻干燥处理,与O型血浆中血型抗体反应后,检测血浆中抗体效价,评价其对血浆抗体的吸附效果;检测红细胞结构、功能及血浆中凝血因子活性变化,评价冻干红细胞膜与红细胞及凝血因子的兼容性;采用离心的方法去除残留的冻干红细胞膜。结果冰冻干燥红细胞膜上的抗原可有效吸附血型抗体、降低血浆中的血型抗体效价,全血中红细胞的变形指数、ATP含量,与反应前比较差异无统计学意义(P>0.05),反应前后均在正常参考范围内;全血血浆中各种凝血因子活性在吸附前后比较差异亦无统计学意义(P>0.05)。采用离心法可去除冻干红细胞膜,清除率约为77%。结论冰冻干燥的红细胞膜保持了很好的抗原性,作为ABO血型抗体的吸附剂能够有效去除ABO血型抗体;冰冻干燥红细胞膜不影响其中红细胞和凝血因子的理化性状和生物活性,并可通过离心的方法去除。     

通用O型全血的初步研究

目的探讨冰冻干燥红细胞膜的制备技术及通用O型去除血型抗体全血的可行性。方法将A型及B型红细胞膜经过冰冻干燥处理后,加入O型全血中,经反应后测定血浆中血型抗体效价,并检测红细胞结构及功能,检测血浆中凝血因子活性变化。结果经过冰冻干燥处理后,红细胞膜仍具有抗原性,可有效降低血浆中的血型抗体效价,而全血中红细胞的变形指数、ATP含量与反应前差异无显著性,反应前后均在正常参考范围内;全血血浆中各种凝血因子活性在吸附前后比较,差异无显著性。结论尽管红细胞膜在体内是否产生大量抗体及其清除过程等尚需进行动物实验确定,但使用冰冻干燥红细胞膜制备通用型血液过程简便易行,具有进一步的研究价值。     

红细胞血型抗体测定与抗体鉴定

红细胞血型抗体测定与抗体鉴定陈忠（苏州医学院附一院，２１５００６）抗体测定（ａｎｔｉｂｏｄｙｄｅｔｅｃｔｉｏｎ）与抗体鉴定（ａｎｔｉｂｏｄｙｉｄｅｎｔｉｆｉｃａｔｉｏｎ）是血型血清学中十分重要的工作，而且有时是非常复杂的问题。因此，血库工作者必须充分...     

红细胞血型抗原和抗体与疾病的关联

１　血型抗原红细胞血型抗原是多态的，遗传的，由位于ＲＢＣ膜外层的蛋白质，糖蛋白或糖脂类结构所组成。红细胞抗原的多态性用于监控输入ＲＢＣ在体内的存活力，以及在遗传学，法医学及人类学的研究［１］。经国际输血协会（ＩＳＢＴ）批准，红细胞表面抗原命名委员会将红细胞抗原分为４类：即系统，集合，低频率抗原系列及高频率抗原系列。血型系统是由１个或几个十分紧密联锁的同源基因控制的抗原组成。集合由血清学，生物化学或遗传学相关的抗原组成，这种抗原并不符合系统的标准。低频率和高频率系列，分别包括少见的和常见的抗原。这…     

2638名患者红细胞血型不规则抗体调查

目的研究孝感地区住院患者中红细胞血型不规则抗体的发生频率和分布特点。方法采用常规血型血清学试验方法,对不规则抗体筛选和免疫球蛋白类型鉴定。结果红细胞血型不规则抗体的检出率为0.80%,确认抗体特异性18例(85.71%);自身抗体3例(14.29%)。其中抗-D1例(4.76%);抗-C2例(9.52%);抗-c4例(19.05%);抗-E4例(19.05%);抗-M2例(9.52%);抗-N1例(4.76%);抗-P12例(9.52%);抗-Lea2例(9.52%)。免疫球蛋白类别为IgM抗体4例占19.05%;IgG抗体14例占66.67%;IgM+IgG抗体3例占14.29%。结论本文筛选的红细胞血型不规则抗体的发生频率和分布特点与文献报道(0.3%—2.0%)基本相符合;同时提示女性患者不规则抗体的发生频率高于男性。     

献血者红细胞血型不规则抗体筛查必要性的探讨

目的了解福州地区献血者血型不规则抗体的频率和分布特点,探讨对献血者进行不规则抗体筛查的必要性。方法选择含特定抗原的红细胞,采用固相红细胞微板法和盐水凝集微板法,筛查献血者血型不规则抗体;检出的抗体进行效价测定。结果从14460名献血者中,共检出不规则抗体42例,检出率为0.29%,其中冷自身抗体16例(IgM)、非特异性不规则抗体11例、抗-Mur3例、抗-M5例、抗-Leb5例、抗-Lea1例、抗-P11例,检出的不规则抗体以效价<16、37℃无活性的IgM型抗体为主。结论我们认为仍没有明确的证据表明,应对Rh(D)阳性献血者进行普遍的强制性红细胞血型不规则抗体筛查。     

伴血型抗体缺乏的全凝集红细胞1例报告

<正> 1 病例简介 患者宋××,女,37岁,已婚。1993年11月10日因高烧伴贫血住院,诊断为包囊性脓胸。11月17日查血型,正反定型似“AB”型,但与AB型血交叉配血主侧阴性,次侧2+凝集,经检定确定为B型,红细胞呈全凝集,血清中免疫球蛋白低下,血清中缺乏抗-A;输B型血400ml无不良反应,经抗感染治疗病情明显好转。1994年1月22日发现红细胞全凝集消失,血型为B型,但血清中免疫球蛋白含量仍低。原因待查。     

红细胞血型抗体与输血安全

溶血性输血反应(hemolytic transfusion reaction,HTR),是较为常见的输血不良反应,即使在临床输血管理比较规范的国家,如英国,HTR(不包括因受血者身份识别错误所致的HTR)仍占全部输血不良反应的8.4%[1].国内至今尚未建立输血不良反应监控体系,因而缺乏这方面的权威数据,但根据我国目前的临床输血管理现状,可以推断HTR的发生率可能不低.HTR的发生,将影响患者病情和输血疗效,严重时还可能导致患者死亡;而另一方面,对HTR的担心和在血液选择上的困惑,也可能导致一些患者未能得到及时的输血治疗.因此,如何选择适当的血液输注,保证输血安全有效,至关重要.我们对红细胞血型抗体(以下简称抗体)与HTR、抗体检测和血液选择等问题加以概述,希望能为临床输血决策者提供有益的参考.     

太原地区红细胞血型抗体筛查细胞的研制及临床意义

血型鉴定、抗体筛查、交叉配血是输血前试验的三道保险,是临床安全有效输血的保障[1].由于抗体筛查细胞有种族和地区特殊性加上保存时间短、运输条件要求高等原因,极大地影响了临床抗体筛查项目的开展.现将太原地区红细胞血型抗体筛查细胞的研制报告如下.     

唯酶红细胞抗体的血型血清学特性的研究

本研究的目的是探讨唯酶抗体的血型血清学特性及在临床输血中的意义，为安全输血提供依据。采用含唯酶抗体的病人血清在多种介质中与ABO同型献血红细胞、谱细胞和自身细胞进行反应，并通过吸收释放试验来判断唯酶抗体的血型血清学特性。结果表明，该唯酶抗体仅在木瓜蛋白酶介质中与献血红细胞和谱细胞反应呈阳性结果，且自身对照亦呈阳性反应，而在其它介质中均呈阴性反应。吸收实验后抗体效价降低。采用乙醚放散，放散液中未测出抗体。该病人输注ABO及Rh同型献血红细胞600ml后无任何不良反应。结论：该倒唯酶抗体仅在木瓜蛋白酶介质体外检测中表现出凝集，不会引起溶血性输血反应。     

The characteristics of ABO antibodies in group O Thai blood donors

This study aimed to characterize anti-A and anti-B hemolysins, IgM, and IgG titers in Thai blood donors. Altogether, 300 serum samples from group O donors at the National Blood Centre, Thai Red Cross Society, were screened for anti-A and anti-B hemolysins and treated with 0.01 M dithiothreitol to characterize IgM and IgG titers by standard tube technique. Antibody titers were compared with hemolysis grade. Male and female ratio = 1:1.3 and ages ranged from 17 to 60 years. The overall prevalence of anti-A and anti-B hemolysins was 69%. Anti-A and anti-B hemolysins comprised 18.3% and 16.7%, respectively and 34% had both antibodies. High titers of anti-A hemolysins were associated with females (P< 0.05), and only anti-B IgM titers were associated with age (P< 0.05). Interestingly, the association of anti-A IgM titers, anti-A IgG titers, and hemolysin grade was demonstrated (P< 0.05). A significant association between hemolysin grade and anti-B IgM titers was found (P< 0.05). The prevalence of anti-A and anti-B hemolysins and high titers of IgM and IgG in Thais are high. Hemolysin grade showed significant associations with IgM titers; therefore, when providing ABO-incompatible platelet transfusion, especially for female plateletpheresis donors, IgM high titers of anti-A and anti-B screening is suggested.     

模拟公路运输对血液质量影响的探讨

目的探讨公路运输对血液质量的影响。方法采用随机震动试验对全血及悬浮红细胞作模拟公路运输,根据相关标准设计振动强度为0.38、0.52和1.04grms,负重60kg,振动120min,试验前抽取血样5ml作为对照组,实验开始后每隔30min抽取血样5ml检测其K+、游离血红蛋白(FHb)和红细胞渗透脆性。结果强度0.38grms振动90min、0.52grms振动60min时全血红细胞脆性增加(P<0.01),FHb和血K+仍在正常允许范围。悬浮红细胞在强度0.38、0.52和1.04grms振动30min时红细胞脆性即增加,FHb和血K+在0.38grms振动120min、0.52grms振动120min和1.04grms振动60min后增高(P<0.01)。结论红细胞脆性对振动强度较敏感,FHb和血K+增高与振动时间有关,公路运输时全血质量优于悬浮红细胞。     

川芎嗪对回收红细胞和机体凝血功能影响的研究

目的观察川芎嗪对回收自体血中红细胞及回输血后机体凝血功能的影响，评价提高红细胞回收率的价值。方法40例择期脊柱手术患者，随机分成两组，试验组于收集血液前静脉滴注川芎嗪，并在肝素盐水和洗涤盐水内加入川芎嗪。检测回输血液样本的红细胞（RBC）、血红蛋白（Hb）、红细胞压积（HCT），计算红细胞回收率；测定术前、回输血后即刻、术后24h的血常规、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（FiB）；描记术前、回输血后即刻血栓弹性描记图（TEG）。对照组不予静脉滴注川芎嗪，肝素盐水和洗涤盐水内不加川芎嗪。结果试验组红细胞回收率高于对照组（75．3％±8．3％vs66．5％±5．3％，P〈0．01）；与术前比较，试验组回输血后Hb、HCT、PLT计数明显降低（P〈0．01），PT、APTT、反应时间（R）显著延长（P〈0．01），FiB和最大宽幅（MA）降低（P〈0．01），但两组变化趋势一致。结论川芎嗪能提高红细胞回收率，并且未对凝血功能产生明显的影响。     

Understanding the demand for phenotyped red blood cell units and requests to perform molecular red blood cell typing for Australian patients

BackgroundAustralian Red Cross Lifeblood has seen a 50 % increase in demand for phenotyped red blood cell (RBC) units between 2016–2018 and a 30 % increase in demand in 2018 to perform molecular RBC typing on patient samples. Lifeblood conducted a survey to understand transfusion laboratory practices for requesting patient phenotyping and/or molecular RBC typing and for selecting phenotyped RBC units in various patient groups.Study design and methodsAn electronic Qualtrics survey form was sent to 296 transfusion laboratories with questions designed to understand the practice of selecting phenotyped RBC units and reasons for requesting extended serology or molecular RBC typing.Results49 (16.6 %) transfusion laboratories provided data. Reasons to request extended phenotyping and/or molecular RBC typing for patients included; chronic transfusion (n = 31 laboratories), sickle cell disease (n = 25), Thalassemia (n = 23), requirement for anti-CD38 or other MAB therapy (n = 23) or Myelodysplasia (n = 22). Forty-seven transfusion laboratories provided responses with reasons for requesting molecular RBC typing which included: predicting phenotype in patients with multiple antibodies (n = 31), prior to administering anti-CD38 or other MAB therapies (n = 29), for pregnancy related transfusions (n = 28) or for confirming the phenotype of recently transfused patients (n = 18).ConclusionTransfusion laboratory practices indicated that phenotyped RBC units were selected for patients requiring chronic transfusion support and/or undergoing MAB therapy. Requests for molecular RBC typing occurred for more complex patient requirements where serological investigations were not suitable or possible due to reagent restrictions.     

库存血红细胞流变特性的变化

目的 观察血液保存时间对红细胞流变特性的影响。方法 选择56例健康献血员,常规采血及保存。取新鲜血(采集后1小时)、采集后1周、2周及3周的血液于4个时相点．用MOPEL R80型电脑全自动血液流变学测定仪．检测全血高切粘度、中切粘度、低切粘度、红细胞压积及RBC聚集指数(AI)和刚性指数(IR)。结果 红细胞压积、中切粘度在保存3周内无显变化,高切粘度在第3周显升高．而低切粘度则下降。AI在第3周显降低;IR则在第2周时显上升．第3周更为明显。结论 随库存血保存时间的延长．对RBC的变形性及聚集性会产生重要影响．特别是在第3周出现显性变化。     

Automated red blood cell depletion in ABO incompatible grafts in the pediatric setting

Bone marrow ABO incompatible transplantations require graft manipulation prior to infusion to avoid potentially lethal side effects. We analyzed the influence of pre-manipulation factors (temperature at arrival, transit time, time of storage at 4 °C until processing and total time from collection to red blood cell depletion) on the graft quality of 21 red blood cell depletion procedures in ABO incompatible pediatric transplants. Bone marrow collections were processed using the Spectra Optia^® (Terumo BCT) automated device. Temperature at arrival ranged between 4 °C and 6 °C, median transit time was 9.75 h (range 0.33–28), median time of storage at 4°–6 °C until processing was 1.8 h (range 0.41–18.41) and median time from collection to RBC depletion was 21 h (range1–39.4). Median percentage of red blood cell depletion was 97.7 (range 95.4–98.5), median mononuclear cells recovery was 92.2% (range 40–121.2), median CD34+ cell recovery was 93% (range 69.9–161.2), median cell viability was 97.7% (range 94–99.3) and median volume reduction was 83.9% (range 82–92). Graft quality was not significantly different between BM units </> median age. Our preliminary data show that when all good manifacturing practices are respected the post-manipulation graft quality is excellent also for those units processed after 24 h.     

Preparation of packed red blood cell units in the blood bank: Alteration in red blood cell deformability

BackgroundDonated blood is stored in the blood bank as packed red blood cell units. In the process of packed cells preparation, the red blood cells (RBCs) are subjectedto high level of shear stress, which can induce alterations in their properties.In the present study, we examined the effect of packed RBCs preparation (which included leuko-filtration) on red cell deformability.MethodsBlood samples were collected from 25 healthy donors and from corresponding units of packed RBCs. The portion of undeformable cells (%UDFC) was determined for each sample.ResultsThe median value of %UDFC was equal to 6.75 ± 0.70 %, for freshly-donated RBCs, and to 6.36 ± 0.51 %, for packed cells. Wherein, %UDFC may increase or decrease following packed cells preparation, depending upon the initial portion of undeformable cells.ConclusionLikely, exposure of RBCs to high shear stress, during packed cells preparation, induces opposing effects: (a) removal/destruction of rigid (undeformable) cells, thereby reducing their total amount (i.e., decreasing the %UDFC) on the one hand, and (b) mechanical damage to the cell membrane and subsequent reduction of the cell deformability (thereby increasing the %UDFC) on the other. As a consequence, the final impact of packed cells preparation is primarily determined by the initial state of erythrocytes in the blood of the donor.     

血细胞分析仪自动计数外周血有核红细胞的应用研究

目的评价血细胞分析仪自动计数外周血有核红细胞(NRBC)的方法学特点,并探讨其临床应用价值。方法选择115例血液病及非血液病患者,用SysmexXE2100全自动血细胞分析仪及显微镜计数法计数其外周血中NRBC数量。结果SysmexXE2100与显微镜计数法计数外周血中NRBC数量有极好的相关性(r>0.97),并且2种方法的计数结果差异无显著意义(P=0.2018)。高值、中值和低值NRBC标本绝对计数的批内CV平均<6.5%。在(0～15)×109/L范围内计数NRBC有极好的线性(r=0.9998)。SysmexXE2100自动计数外周血中NRBC的灵敏度和阴性预测值均为100%。外周血中NRBC增高时,WBC显著高于去除NRBC的计数结果(P=0.0168)。结论SysmexXE2100血细胞分析仪可灵敏、准确、精密地自动计数外周血中NRBC,并且可在NRBC增高的标本中准确计数白细胞数量。除白血病、贫血等血液病患者外,非血液病(如肿瘤化疗)等患者外周血中也可出现NRBC。血细胞分析仪自动计数外周血中NRBC,有助于一些血液病及非血液病患者的筛查与诊断。     

8860名学生ABO血型分布及批量检测ABO血型错检原因分析

[目的]了解学生群体中的ABO血型分布情况,有利于临床医务人员及相关工作人员掌握血源概况,为血液血型贮备对策提供科学依据,并分析造成批量ABO血型错检的原因。[方法]运用玻片凝集法和试管离心法对8860名学生进行ABO血型鉴定,对可疑血液样本做盐水试管法的正反定型试验。[结果]血型分布为A型占27．75％,B型占31．65％,O型占29．65％,AB型占10．95％。[结论]8860名学生血型分布为B〉O〉A〉AB。当发现血型鉴定出现可疑时,首先应重复做试验一次,严格执行操作规程,细心观察结果,按步骤一步步排除错检的可能性。     

白细胞滤除对保存期内红细胞流变性和形态的影响

目的 探讨白细胞滤除对保存期红细胞流变性及形态的影响.方法 选择30名健康献血者的血液制备成红细胞悬液,随机分为实验组(n=30):使用去白细胞输血过滤器去除红细胞悬液中的白细胞(简称滤白组);对照组(n=30):未滤白的红细胞悬液;2组一起常规保存.取采血后d0、d7、d14、d21、d28、d35的血标本作白细胞(WBC)和红细胞计数(RBC)、红细胞压积、血液高剪切力、低剪切力及细胞形态学检测.结果 过滤前后红细胞悬液内的WBC为(6.80±0.85)(× 109/L) vs (3.12±0.26)(×106/L) (P ＜0.01);保存d21时低、高切粘度分别为:对照组(11.28±1.88)1/s、(2.85±0.29)200/s,滤白组(12.36±1.57)1/s、(2.93±0.22) 200/s,较保存1～2周明显上升(P＜0.05),但组间比较未见明显著变化(P＞0.05);瑞氏染色结果显示2组细胞形态也有不同变化,滤白组红细胞形态保存较好.结论 白细胞滤除能有效减少白细胞崩解产物或分泌因子对红细胞形态的影响.