临床Rh表型血清学检测及其同型输注必要性分析

目的统计Rh血型系统抗原中C、c、E、e在人群中的分布情况,分析临床常规检测Rh表型及其同型输注的必要性。方法采用血清学方法对19 061例输血患者和18 331例献血员样本进行Rh系统C、c、E、e和D 5种抗原表型分型,采用抗人球蛋白法对输血患者进行不规则抗体筛选及鉴定。结果 Rh D阳性人群主要以C、e抗原频率占优势,Rh D阴性人群主要以c、e抗原占优势;在检出26例同种抗体中,Rh血型系统23例,占88.5%,其中,抗E 18例、抗e 2例、抗C 1例、抗D 1例、抗Ce 1例。结论掌握人群中Rh血型系统抗原表型分布情况,及时提供Rh表型相合血液,可在一定程度上防止和减少高频抗体的产生,有利于降低患者输血不良反应的发生率。     

南阳市RhD/C/c/E/e血型分型库建立的意义及应用

目的:了解南阳市无偿献血者Rh血型分型规律,建立Rh D/C/c/E/e抗原阴性供者库,为临床急救用血患者提供帮助,保障输血安全。方法:采用血型血清学方法对2014年南阳市81 462例无偿献血者血标本进行Rh D血型鉴定;经初筛和确证试验后,对Rh D阴性的血标本进行Rh E/e/C/c血型分型;采取统一的标准,对献血员详细资料认真登记;采用计算机管理系统,建立无偿献血者Rh E/e/C/c血型分型资料库及实物库。结果:Rh D阴性献血者300例(0.37%),Rh抗原表型为ccdee和Ccdee者占83.0%。结论:南阳市人群中Rh D阴性血型在所占的比例大约为4%,Rh D阴性献血者Rh E/e/C/c血型分型情况为:ccdee(50.67%)Ccdee(33.00%)ccd Ee(5.67%)CCdee(5.33%)Ccd Ee(5.33%)。建立Rh E/e/C/c血型分型库对临床输血具有深远的意义。     

2例RhD--表型的基因型分析及家系调查

Rh血型在红细胞血型系统中最为复杂,其临床意义仅次于ABO血型.Rh血型抗原目前已发现40多个,但有临床意义的主要是D、C、c、E、e.Rh血型抗原D、C/c和E/e分别由RHD和RHCE这2种同源基因编码[1].RhD——表型是人类红细胞Rh血型系统的1种基因变异.稀有的D——个体,特征性地缺失全部的C/c和E/e抗原,并且D抗原过度表达.据文献报道,这种稀有表型与D抗原的表达有关,而与C、c、E、e抗原(也称非D抗原)的表达无关[2].我们在工作中遇到2例D——先证者,在用血清学方法分析了其家族的表现型基础上,又采用PCR-SSP方法对其家族进行了基因型分析,现将我们的研究报告如下.     

Rh血型抗原CcEe在临床输血中的意义

目的研究Rh血型抗原CcEe在住院患者中的分布情况,以及Rh血型抗原、抗体检测在临床输血中的意义,为临床RhCcEe同型输血提供参考依据。方法对2008～2016年本院4756例住院患者进行Rh D、C、c、E、e抗原检测,对2013～2016年11644例住院患者进行不规则抗体筛查及抗体鉴定。结果 4756例住院患者样本中Rh血型D、C、c、E、e抗原阳性率为D(96.97%)、C(85.37%)、c(59.16%)、E(47.09%)、e(91.89%),且CcEe抗原阳性率在RhD阳性和阴性人群中的分布差异有统计学意义;11644例住院患者样本不规则抗体筛查阳性中,Rh血型抗体占48.84%,证实了临床检出的不规则抗体主要集中在Rh血型系统。结论对供、受双方除进行常规的ABO、RhD血型检测外,还应进行CcEe抗原表型的检测,并做到这些抗原的同型输注,从而降低因输血产生免疫性抗体的概率,避免再次输血困难。     

咸阳地区供血者Rh血型系统抗原频率分析

目的了解Rh血型抗原在本地人群中的分布频率,为Rh血型抗原C、c、E和e的同型输注原则提供理论依据。方法随机抽取2010年RhD(+)献血者5 052人份标本和2008～2010年经初步血清学定为RhD(-)献血者775人份标本,采用血清学方法进行表型检测,分析2种人群的抗原频率特点;同时将RhD(+)献血者的表型和同期的RhD(-)献血者的表型进行H-W平衡分析。结果献血者的表型结果符合Hardy-Weinberg平衡;RhD(+)献血者C抗原频率为88%,c抗原频率为58%,E抗原频率为57%,e抗原频率为98.9%;RhD(-)献血者C抗原频率为31%,c抗原频率为97%,E抗原频率为15%,e抗原频率为99%。结论对于妊娠患者和需要多次输血的患者,尽可能的做到Rh血型系统D、C、c、E和e都能相合,避免以后再次输血配型困难或者造成迟发性输血反应。     

西安地区供受血者红细胞Rh表型匹配输注及追踪分析

目的 研究受血者Rh表型分布特征,并探索其红细胞(red blood cell,RBC)配合规律.方法 Aigel 300检测并传输1117例受血者ABO血型、Rh表型、抗筛及3174例供血者Rh表型,TMIS9.5接收并实现供受双方Rh表型Ⅰ、Ⅱ、Ⅲ级匹配.输注RBC后15日开始对受血者做为期6个月抗筛追踪,并运用S...     

RhC、c、E、e抗原在输血相容性中的意义

目的研究C、c、E、e抗原在人群中的分布规律及其在输血相容性中的意义。方法分别采用PCR-SSP基因分型以及血清学方法,对152例样本进行Rh D、C、c、E和e分型,并采用抗人球蛋白法对本地区的输血人群进行抗体筛查和鉴定。结果 C、c、E、e抗原在中国人群中呈多态性分布,而且在RhD阳性和阴性人群中的分布差异存在统计学意义;在阳性人群中主要以c抗原阴性率62.5%(50/80),E抗原阴性率67.5%(54/80)为多态性的特征;在阴性人群中,C抗原阴性率为59.7%(43/72),c抗原阴性率为2.7%(2/72),E抗原阴性率为93.1%(67/72),e抗原阴性率为0;在检出32例同种抗体中,Rh血型系统26例,占81.25%,其中抗-E 18例、抗-D 5例,抗-cE 2例、抗-c 1例。结论在ABO、RhD同型输血实施后,应着力解决Rh系统其他抗原,特别是E、c抗原随机输注产生免疫性抗体的问题。     

微柱凝胶技术在Rh血型鉴定中的应用

目的探讨微柱凝胶法在Rh血型鉴定中的应用。方法用聚凝胺法、微柱凝胶法对31例Rh(D)阴性标本进行Rh血型D、C、c、E、e抗原鉴定。结果 31例Rh(D)阴性标本Rh血型D、C、c、E、e抗原的表达聚凝胺法和微柱凝胶法结果完全相符。结论采用微柱凝胶技术进行Rh血型D、C、c、E、e抗原的检测,其准确性和凝聚胺法相同,两种方法可以替代使用。微柱凝胶法弥补了常规仅做Rh(D)的不足,微柱卡有效期长,易于保存,可一次完成Rh血型5种抗原的鉴定,宜在实验室推广应用。     

电子匹配信息系统辅助的Rh血型五抗原配合性输注的安全性和有效性研究

目的 调查分析汉族人群Rh系统抗原分布,探讨供、受血者Rh血型系统抗原分配情况及电子匹配选定配血的实施效果。方法 对2021年1月1日—2021年12月31日在南方医科大学珠江医院受血者14602例次和同时段的献血者23262人次,进行ABO血型鉴定及Rh血型系统抗原检测,建立Rh表型数据库,运用输血管理系统,按照电子匹配选定配血优先级原则,对受血者实施ABO、Rh系统抗原选定匹配,进行配血。统计分析Rh系统抗原分布和配血不相容人次。结果 受血者C、c、e和E抗原频率分别为72.70%、27.30%、78.24%和21.76%,献血者抗原频率分别为73.53%、26.47%、79.25%和20.75%。受血者DCCee、DCc Ee、Dccee和DCCEE表型分别为52.01%、30.10%、0.42%和0.02%,献血者表型分别为53.07%、29.30%、0.41%和0.01%。受血者优先Ⅰ级交叉配血占58.76%。统计2021年配血不相容占比和抗筛阳性占比,对比未引进电子匹配选定配血时的2020年统计有明显改善,也使得输血更加安全可靠(P <0.05)。结论 采用ABO和R...     

肿瘤患者的Rh血型分析

人类RH血型系统自1939年被发现以来，因导致新生儿溶血病(HDN)，溶血性输血反应而成为红细胞血型中仅次于ABO血型的重要系统。其抗原系统主要有D、C、E、c、e五个抗原组成，其中最重要的是D抗原；临床上根据红细胞表面有无D抗原，分为Rh( )和Rh(-)，Rh(-)受血必须输注Rh(-)同型血液。《中孱输血技术规范》也明确规定：输血前要进行Rh血型D抗原检测。我院近几年来对肿瘤患18965例进行了RH血型和表型筛查统计，分析如下。     

天津市滨海新区Rh+无偿献血者Rh血型表型的分布调查

目的 探讨天津市滨海新区Rh+献血者Rh血型表型的分布情况,建立Rh+血型表型数据库,确保临床输血安全,减少输血不良反应的发生.方法 采用简单随机抽样法选择2013年1月至2015年12月天津市第五中心医院输血科留存的2 672份Rh+库存悬浮红细胞为研究对象.研究对象纳入标准:①所有悬液红细胞均来自天津市滨海新区中心血站;②血液经Rh系统中抗-D检测,确定为Rh+血型;③血液入库时,严格核对运输条件、物理外观、血袋封闭及包装、标签等,均应符合血液入库标准.采用微柱凝胶法进行Rh血型系统的抗-D、抗-C、抗-c、抗-E、抗-e检测,并根据抗原检测结果计算Rh血型各表型频率.结果 本组2 672例Rh+无偿献血者的Rh抗原中,按照抗原阳性率由高至低排序,依次为抗-D(100.0％)、抗-e(90.8％)、抗-C(86.7％)、抗-c(58.2％)及抗-E(48.8％)抗原.本组2 672例Rh+无偿献血者中,共检测出9种Rh血型表型,按照抗原频率由高至低排序,依次为CCDee (40.5％)、CcDEe(35.5％)、CcDee(9.4％)、ccDEE(9.2％)、ccDEe(4.1％)血型表型,其他4种表型仅占1.3％(35/2 672).结论 天津市滨海新区Rh+无偿献血人群的Rh血型表型以CCDee为主.建立Rh+血型表型数据库,可为临床及时提供表型相合的Rh+血液,防止由于Rh血型系统不合引起的输血反应,确保临床输血安全.     

Developing a databank for multiple transfusion patients: Rh antigen and phenotype distribution among 3000 regular blood donors in Iran

BackgroundRhesus (Rh) blood group system is clinically the most significant protein-based grouping system. The Rh system is of vital importance in blood transfusion, and incompatibility between the donor and recipient leads to alloimmunization. Alloimmunization is commonly seen in multiple-transfusion recipients (e.g. thalassemia patients). There are a few studies about the prevalence of Rh antigens, except for D, in Iran; and regarding the high prevalence of thalassemia in the country, in this study we have determined antigens and phenotypes of the Rh among population of regular blood donors with the aim of developing a detailed Rh databank.Materials and methodsThis cross-sectional study randomly enrolled 3000 regular blood donors from three provinces of Sistan-Balouchestan, Khuzestan and Gilan in Iran, from September 2018 to May 2019. A fully automated system, based on hemagglutination, was used to Rh typing of blood samples.ResultsThe prevalence of Rh antigens were as follows: D: 88.9 %; E: 30.9 %; C: 74.1 %; e: 96.2 %; and c: 72.8 %. The most common antigen and phenotype were "e" and R₁r (DCcee), respectively.ConclusionDue to the high rate of alloimmunization incidence against Rh blood group antigens among multiple transfusion recipients, development of regular blood donor's Rh databank can facilitate extensive matching for the Rh antigens and it likely reduces the risk of alloimmunization.     

电子配血技术对减少输血患者Rh血型系统同种抗体产生的意义

目的 探讨电子配血技术应用对减少受血者Rh血型同种抗体产生的意义.方法 将本院2018年1月1日-2020年3月31日期间住院且仅输注去白悬浮红细胞的Rh(D)阳性的患者(22 528人,将电子配血符合优先级Ⅰ级、Ⅱ级的患者21 334人设为对照组,将符合优先Ⅲ级的患者共1 194人设为试验组,对用血者和献血者进行AB...     

陕西铜川地区无偿献血人群Rh血型表型分布调查

目的 调查铜川地区无偿献血人群Rh血型表型分布情况,建立Rh血型表型数据库,为临床安全输血提供有力保障。方法 使用卡式微柱凝胶法,对2015年6月～2017年3月来自铜川市中心血站的3 419例无偿献血者红细胞样本进行Rh血型抗原检测,用间接抗人球蛋白试验对RhD初筛阴性的标本进行确认,确定其Rh血型表型,并进行分类统计、计算机存档。与国内其他地区Rh血型表型分布情况比较采用t检验。结果 3 419例无偿献血者RhD阴性率0.55%,Rh其他抗原阳性率分别为D:99.45%,C:90.41%,c:55.10%,E:45.51%和e:92.19%; Rh抗原基因频率分别为D:0.921,C:0.6737,c:0.3207,E:0.2755和e:0.7306; Rh表型分布特征为:CCDee>CcDEe>CcDee>ccDEE>ccDEe>CcDEE>ccDee>RhD阴性。统计分析显示,铜川地区的CCDee和ccDEE构成比与南宁和黔南地区比较差异具有统计学意义(χ2=21.552,P=0.016; χ2=18.519,P=0.001),而与唐山、沈阳、邢台、天津滨海四地区比较差异无统计学意义(χ2=0.227～1.31,均P>0.05)。结论 铜川地区Rh表型分布具有北方地域特点^[1～4],RhD阴性率符合我国汉族人群分布特点,中国南北方地区在不同的Rh表型方面存在差异,Rh血型表型分布调查对于保证输血安全具有重要意义。     

血型血清学与电子交叉配血试验的比较研究

目的初步探讨电子交叉配血在临床输血中的应用价值。方法采用微孔板法检测4 126名献血者的ABO和Rh系统血型;用微柱凝胶法筛查意外抗体及鉴定抗体特异性;在此基础上建立献血者数据库。采用微柱凝胶法对10 685名住院患者作常规ABO和Rh(D)血型以及意外抗体筛查和鉴定,配血以血型血清学和电子交叉配血2种方式进行;对9 996名住院患者以ABO和Rh(D)血型相容作血清学交叉配血,并对其中2 920人作电子交叉配血;同时对689名住院患者作ABO和Rh系统血型鉴定和意外抗体筛查,对意外抗体筛选结果为阴性的患者作电子和血清学交叉配血。结果初步建立了可应用于电子交叉配血的献血者数据库,对2 920名经ABO和Rh(D)血型检测及无意外抗体的住院患者和657名经ABO和Rh血型检测及无意外抗体的住院患者,与4 113名献血者分别作了6 109次和1 227次电子交叉配血与血清学交叉配血试验,2种方法结果完全一致;电子交叉配血与血清学交叉试验配血时间分别为15和45 min。结论电子交叉配血的建立和临床应用是可行的,除了同样准确外,其最大的优势是比血清学交叉配血试验时间明显缩短。     

Isoimmunization after Massive Transfusion for Open Heart Surgery

One hundred consecutive patients subjected to open heart surgery received an average massive transfusion of 17 units. The group consisted of 43 males and 57 females; 75 were below 40 years of age. Routine testing for blood factors in the ABO, Rh and Kell systems were performed on all donors and recipients. The sera of all donors and recipients were screened for atypical antibodies. The number of recipients and their "average antigenic dose," as well as the number of negative antibody screenings at postoperative visits, are tabulated. Nineteen rh' (C)-negative patients received an average of 11.4 units of rh' (C)-positive blood. Thirty-three rh"(E)-negative patients, two hr' (c)-negative patients, three hr" (e)-negative patients and 37 Kell-negative patients received an average antigenic dose of 4.2, 8.5, 12.7 and 1.8 units, respectively. Two antibodies, anti-rh'(E) and anti-H, were attributed to isoimmunization. The authors conclude that the risk of detectable red cell isoimmunization by massive transfusion is probably no greater than that incurred by transfusion of a single unit.     

青岛市部分患者与献血者人群Rh表型及单体型频率分布特征分析

目的 了解本院患者人群与本地献血者人群Rh血型系统抗原表型及单体型和不规则抗体等的分布特征,以确保临床安全、有效输血及提高临床用血合理性与科学性.方法 选取本院2015年10月～2020年3月住院患者和在此期间青岛市中心血站发往本院的献血者血液共113 326人(份)的Rh抗原分型和不规则抗体检测结果数据,回顾性分析并...     

Molecular characterization of RhD variant phenotypes among blood donors: A study from the coastal region of India

BackgroundRhD expression varies with population and ethnicity. Accurate typing of RhD antigen among blood donors is important to prevent development of anti-D among recipients of blood transfusion. We aimed to screen blood donors for variant D phenotypes and accurately characterize them by genotyping.Material and methodsWe have done prospective study on blood donors by performing RhD typing using three different commercial monoclonal anti-D reagents by both column agglutination and conventional tube techniques. Samples that showed ambiguous results were further screened with the Bio-Rad Partial RhD typing kit. Minor phenotyping for C, c, E, e antigens was performed. Multiplex PCR and Sequencing of all RHD exons with Sanger’s sequencing was performed for molecular characterization of variant D.ResultsA total of 16,974 blood donors were screened during the study period. Among them, 31 (0.18 %) donors were found to have a RhD variant phenotype. The male to female ratio was 10:1. The presence of ‘C’ antigen was noted among all RhD variant samples. Serological typing identified two samples as DV phenotype and the rest could not be characterized. Molecular genotyping characterized 90.3 % of the samples as Indian specific weak D type 150 variants. Three samples were subjected to Sangers sequencing and showed wild type pattern.ConclusionThe present study showed that the most common variant in this population was Weak D type 150. This study highlights that serological methods may serve as a screening tool, however, molecular techniques are essential for characterization of RhD variants.     

Surface decoration of red blood cells with maleimidophenyl-polyethylene glycol facilitated by thiolation with iminothiolane: an approach to mask A, B, and D antigens to generate universal red blood cells

BACKGROUND: The surface decoration of red blood cells (RBCs) by polyethylene glycol (PEG) chains has been an approach developed to camouflage the blood group antigens from their antibodies. A PEGylation protocol, however, that can mask the antigens appropriately to inhibit the agglutination of RBCs with the respective antibodies is not available so far. STUDY DESIGN AND METHODS: A new approach for PEGylation of RBC membrane proteins has been designed with thiolation-mediated maleimide chemistry. The accessibility of the surface lysine residues of membrane proteins to bulky PEG reagents was increased by linking an extension arm carrying a thiol group. RESULTS: RBCs have been PEGylated by thiolation-mediated chemistry with maleimidophenyl-PEG (Mal-Phe-PEG) reagents of different chain lengths. Mal-Phe-PEG-5000 chains alone masked the most important antigens of the Rh system (C, c, E, e, and D) from their antibodies. The masking of the A and B antigens needed a combination of Mal-Phe-PEG-5000 and Mal-Phe-PEG-20000 chains to inhibit the agglutination of RBCs completely with anti-A or anti-B. CONCLUSIONS: Thiolation-mediated PEGylation of RBCs with Mal-Phe-PEG-5000 and Mal-Phe-PEG-20000 converts Group A Rh(D)+ and B Rh(D)+ RBCs into RBCs with serologic behavior comparable to Group O Rh(D)- RBCs that are considered as universal RBCs for transfusion.     

High-throughput multiplex single-nucleotide polymorphism analysis for red cell and platelet antigen genotypes

BACKGROUND: Transfusion recipients who become alloimmunized to red cell or platelet (PLT) antigens require antigen-negative blood to limit adverse transfusion reactions. Blood collection facilities use regulated and unregulated antibodies to phenotype blood, the cost of which can be prohibitive depending on the antisera and demand. An alternative strategy is to screen blood for these antigens with genomic DNA and the associated single-nucleotide polymorphisms (SNPs). STUDY DESIGN AND METHODS: A multiplex polymerase chain reaction (PCR)-oligonucleotide extension assay was developed with genomic DNA and a SNP genotyping platform (GenomeLab SNPstream, Beckman Coulter) to identify SNPs related to D, C/c, E, S/s, K/k, Kp(a/b), Fy(a/b), FY0 (-33 promoter silencing polymorphism), Jk(a/b), Di(a/b), and human PLT antigen (HPA)-1a/1b. A total of 372 samples were analyzed for 12 SNPs. The genotypes were compared to the blood group and PLT antigen phenotypes. RESULTS: Individual sample results varied from 98 to 100 percent for 11 of 12 SNPs. D was correctly identified in 292 of 296 (98.6%) D+ donors. The RHCE exon 5 E/e SNP analysis had the lowest concordance (89.5%). Thirty-three R(1)R(1) and 1 r"r were correctly identified. PCR-restriction fragment length polymorphism (RFLP) on selected samples confirmed the presence of the FY0 silencing polymorphism in nine donors. Homozygous HPA-1b/1b was identified in four donors, which was confirmed by PCR-RFLP (n = 4) and anti-HPA-1a serology (n = 2). The two HPA-1a-negative donors were recruited into the plateletpheresis program. CONCLUSION: The platform has the capacity to genotype thousands of samples per day. The suite of SNPs provides genotype data for all blood donors within 36 hours of the start of testing.