血小板输注无效患者血小板同种抗体及血小板特异性糖蛋白抗体表达的研究

目的 探讨血小板输注无效与血小板同种抗原或血小板特异性抗原的相关性.方法 选择65例临床确诊血小板输注无效患者作为研究对象,应用酶联免疫吸附实验(ELISA)方法检测血清、血小板洗脱液中血小板特异性抗体;应用HLA抗体特异性检测试剂盒,对组合反应性抗体(PRA)阳性的患者进行HLA抗体特异性分析;用HPA分型试剂盒检测8个血小板同种抗原系统HPA-1、2、3、4、5、6、9、15;用HLA分型试剂盒对HLA-A/B抗原进行基因分型.结果 65例患者HLA-A/B抗原,HPA-1、2、4、5、6、9、15抗原的基因频率分布与健康献血员比较差异无统计学意义.HPA-3a、3b抗原频率分别为0.65、0.35,与健康献血员比较差异有统计学意义(P＜0.05).65例患者中HLA抗体单独阳性24例(36.9%),HLA抗体和血小板特异性糖蛋白抗体共同阳性14例(21.5%);HLA抗体和血小板洗脱液特异性糖蛋白抗体共同阳性6例(9.2%),血小板洗脱液特异性糖蛋白抗体阳性13例(20%),HLA抗体、血小板特异性糖蛋白抗体及血小板洗脱液特异性糖蛋白抗体共同阳性4例(6.2%);HLA-A/B特异性抗体中,HLA-A*9抗体占全部抗体的46.2%,HLA-B*40抗体占33.6%.血清血小板特异性抗体以GPⅡb/Ⅲa为主(26.2%),其次为GP Ⅰa/Ⅱa(21.5%),血小板洗脱液中,血小板特异性抗体以GPⅡb/Ⅲa和GP Ⅰb/Ⅸ为主(41.5%).对2例患者进行了遗传学调查,发现产生的血小板特异性糖蛋白抗体和HLA抗体与父母血小板抗原及HLA抗原不相合呈密切相关.结论 血小板输注无效患者中,HLA抗体占主要地位,其次为血小板特异性糖蛋白抗体.     

免疫性输血反应的调查及预防研究

目的　对各类输血反应进行调查研究 ,同时建立输血前免疫血液学检查新技术 ,以预防和治疗免疫性输血反应。方法　对上海地区 13家医院的 30 776名输血病人进行调查 ,并应用改良Polybrene、简易致敏红细胞血小板血清学试验 (SEPSA)等新技术 ,进行同种特异性抗体的筛选、鉴定及交叉配型试验。结果　发生各类输血反应5 0 8例 (1.6 5 % ) ,其中检出引起免疫性输血反应的同种抗体 6 4例 (12 .6 % ) ,抗体特异性分别为血小板抗体 (包括HLA) 5 1例 ,红细胞不规则抗体 13例 ;各项新技术的应用对预防免疫性输血反应的发生具有显著相关性 (χ2 >3.84 ,P <0 .0 5 )。结论　使用研究建立的输血前免疫血液学新技术能有效地诊断、预防和治疗免疫性输血反应的发生 ,提高了输血的安全性和有效性     

广州地区无偿献血者HLA抗体筛查和特异性分析初探

目的对广州地区部分无偿献血者HLAⅠ、Ⅱ类抗体的分布及特异性进行调查和分析,为安全输血提供相应的实验数据。方法随机收集无偿献血者标本368份,应用Antigen Tray-LATM和LAT1240检测HLA抗体,PCR-SSP方法检测阳性标本HLAⅠ、Ⅱ类抗原,并根据相应的抗原对抗体特异性进行分析,并对男、女献血者HLA抗体分布的差异进行统计学分析。结果在368名献血者中,13名HLA抗体阳性(3.53%)。HLA抗体出现以女性献血者为主,达到10.78%,均有孕产史,而男性献血者HLA抗体的出现频率仅为0.75%(P0.05)。13份阳性标本中HLAⅠ类抗体阳性8份,且女性献血者也明显高于男性(P0.05)。群体反应性抗体(PRA)分析,PRA20%占61.5%、PRA(20%～30%)占15.4%、PRA(30%～40%)占7.7%、PRA40%占15.4%。抗体特异性分析,抗-A19(53.85%),抗-B40(30.77%),抗-DR4(30.77%),并且以复合性抗体为主。结论初步探讨了本地区无偿献血者中HLA抗体分布情况,女性献血者的HLA抗体出现频率明显高于男性献血者。本研究为HLA系统引起的输血免疫相关并发症预防措施的建立提供了初步的实验基础。     

36287名患者红细胞不规则抗体特异性及其分布

目的对本院住院患者红细胞不规则抗体特异性进行分析,为临床疑难输血提供依据。方法收集整理2006年6月-2013年5月本院住院患者不规则抗体筛查及相关抗体鉴定资料,分析不规则抗体阳性检出率及人群特征。结果本组患者血液标本共计362 87例,抗体筛选阳性571例,阳性率1.574%(571/36 287)。鉴定出特异性抗体312例,阳性率0.860%(312/36 287);自身抗体259例,阳性率0.714%(259/36 287);直接抗球蛋白阳性284例,阳性率0.78%。同种特异性抗体,230例Rh系统抗体所占构成比最高,为73.72%(230/312),阳性率为0.634%;其中抗-E阳性共191例,占61.22%(191/312),阳性率为0.526%;Lewis系统36例,占11.54%(36/312),阳性率为0.099%;MNSs系统34例,占10.89%(34/312),阳性率为0.094%。女性不规则抗体阳性率显著高于男性(P0.001),有妊娠输血史者的检出率显著高于无妊娠、输血史者(P0.05),血液病患者产生不规则抗体居首位。结论住院患者输血前进行不规则抗体筛查,可避免免疫性溶血性输血反应的发生,尤其是对女性,及有妊娠史、输血史患者具有重要意义。     

血小板输注无效患者的血小板抗体分析

目的分析临床血小板输注无效的主要原因并寻找解决的方法.方法应用酶联免疫吸附试验(ELISA)方法,对223例临床发生血小板输注无效的病人进行血小板抗体检测和鉴定.结果血小板抗体阳性80例(35.87%),其中人类白细胞抗原(HLA)抗体阳性75例(33.63%),血小板特异性抗原(HPA)抗体阳性1例(0.45%),同时含有HLA和HPA抗体者4例(1.79%).结论引起血小板输注无效的抗体以HLA抗体为主;针对不同抗体,可采取不同方法选择血小板供者.     

血小板输注无效患者的血小板抗体分析

目的　分析临床血小板输注无效的主要原因并寻找解决的方法。方法　应用酶联免疫吸附试验(ELISA)方法 ,对 2 2 3例临床发生血小板输注无效的病人进行血小板抗体检测和鉴定。结果　血小板抗体阳性80例 ( 3 5 .87% ) ,其中人类白细胞抗原 (HLA)抗体阳性 75例 ( 3 3 .63 % ) ,血小板特异性抗原 (HPA)抗体阳性 1例( 0 .45 % ) ,同时含有HLA和HPA抗体者 4例 ( 1.79% )。结论　引起血小板输注无效的抗体以HLA抗体为主 ;针对不同抗体 ,可采取不同方法选择血小板供者     

血小板输注前检测人类白细胞抗原抗体的必要性探讨

目的 探讨血小板输注前检测人类白细胞抗原(HLA)抗体的必要性.方法 对106例血小板输注无效患者检测其人类白细胞抗原抗体,以同样多次输血而再次输注血小板有效者作为对照. 结果实验组中HLA 同种抗体阳性52例(49.05%),对照组阳性13例(10.66%),两组比较差异有统计学意义(χ2= 6.689,P<0.01).结论 对于输血患者,特别是多次输血患者,开展HLA抗体筛查是非常必要的,另外,对于血小板输注无效的患者,还应开展血小板配型.     

实体器官移植失败患者HLA和HPA抗体筛查及特异性分析

目的了解广州地区实体器官移植失败患者中HLA抗体和HPA抗体的分布和特异性,初步探索HLA抗体及HPA抗体与实体器官免疫性排斥反应的相关性。方法随机收集广州地区实体器官移植失败患者标本136例,利用Lifecodes Life Screen Deluxe(LMX)筛查标本的HLA抗体,阳性者再分别利用LIFECODES LSATMClassⅠ和LIFECODES LSATMClassⅡ(Single Antigen)鉴定抗体特异性;利用Lifecodes PAKR 2LE对HPA抗体进行筛查,阳性标本利用MAIPA进行最终确证。结果广州地区136例实体器官移植失败患者中,抗-HLA阳性率55.15%(75/136),其中HLA-Ⅰ类抗体出现频率为38.97%(53/136),HLA-Ⅱ类抗体出现频率为42.65%(58/136)。HLA-Ⅰ类抗体中出现频率较高的分别是抗-A~*02 35.85%(19/53)、抗-B~*15 47.17%(25/53)和抗-Cw~*07 28.30%(15/53),HLA-Ⅱ类抗体出现频率最高者是抗-DRB1~*04 39.66%(23/58)和抗-DQB1~*03 46.55%(27/58)。此外,检出HPA-5bb抗体一例。结论初步探讨了广州地区实体器官移植失败患者HLA抗体及HPA抗体的分布情况,证实HLA抗体与移植后的免疫排斥反应密切相关。     

无偿献血者与患者血小板抗体检测结果分析

目的探讨固定无偿机采血小板献血者与临床患者血小板抗体阳性比例特点,进一步降低临床输血反应。方法采用固相凝集法分别对600例固定无偿机采血小板捐献者及795例临床患者进行血小板抗体检测。结果男性献血者(390例)血小板抗体均阴性,女性(210例)血小板抗体阳性6例(妊娠史>3次者5例,妊娠史<3次者1例)阳性率为2.9%,P<0.05;临床男性患者(392例)血小板抗体阳性17例(输血史>3次者15例,输血史<3次者2例)阳性率为4.3%,女性(403例)血小板抗体阳性21例(输血史>3次且无妊娠史13例占7.9%,无输血史且妊娠史>3次者8例占3.3%)阳性率为5.2%。结论多次妊娠及反复输血可产生血小板抗体。对献血者进行血小板抗体筛查,可避免抗体阳性血小板进入受者体内,血站应尽量减少采集有妊娠史女性和反复输血者的血液,保证安全有效输血。对患者进行血小板抗体检测,抗体阳性者通过输注基因相合的血小板,可降低免疫性血小板输注无效的发生率,减轻患者的经济负担,避免血液资源的浪费。     

血小板输注无效与抗HLA抗体相关性

目的 研究抗HLA抗体与血小板输注无效的关系.方法 用流式细胞术检测患者抗HLA抗体,并通过检测输注血小板前后的血小板数量计算出血小板增加校正值(CCI)来分析抗HLA抗体与血小板输注无效的关系.结果 25名患者中抗HLA抗体阳性16例,占64%;血小板输注无效16例中,抗HLA抗体阳性15例,阴性1例.抗HLA抗体阳性患者血小板输注无效率显著高于抗HLA抗体阴性患者.结论多次输血患者体内易产生抗血小板抗体,导致血小板榆注无效,其中抗HLA抗体是引起血小板输注无效的重要原因之一.     

不规则抗体48480例筛查结果分析

目的探讨不规则抗体筛查在临床输血中的意义。方法用强生全自动血型分析仪对2011年5～12月的输血标本进行不规则抗体筛选,阳性标本进一步做抗体鉴定,同时查阅2006年1月至2011年4月的不规则抗体筛查结果及患者相关信息。结果 48 480例输血申请者中,不规则抗体阳性297例,阳性率为0.61%。结论不规则抗体筛查能有效降低或避免溶血性输血反应的发生,保证输血安全,尤其对输血史和妊娠史患者非常重要。     

不规则抗体筛查对提高临床输血安全的价值研究

目的：探讨输血前不规则血型抗体筛查对提高临床输血安全的意义。方法对2000例预输血患者进行抗体筛查,对不规则抗体筛查阳性的标本进行抗体特异性鉴定,统计不规则抗体的特异性和检出率。结果共筛出不规则抗体阳性者8例,阳性检出率为0．4％。其中血液系统疾病和肿瘤患者6例,占75．0％,高于其他疾病患者所占比例（2例,25．0％）,比较差异有统计学意义（P＜0．05）。不规则抗体阳性患者抗体特异性鉴定结果显示, Rh系统抗体占62．5％,MNS系统抗体（抗-M抗体）占37．5％。结论输血前对患者进行不规则抗体检测,有利于选择适合患者的血液,有效减少或避免溶血性输血反应的发生,保证了患者的输血安全。     

受血者不规则抗体筛查与临床输血安全分析

目的研究受血者不规则抗体的阳性率、输血者与妊娠者阳性率差异性,以及不规则抗体的分布情况,为提高临床输血安全性提供依据。方法患者取静脉血3 ml离心,分别进行不规则抗体阳性筛查和不规则抗体的特异性鉴定,并记录输血患者与妊娠患者不规则抗体阳性率的差异。结果 8 432例患者病例中不规则抗体呈阳性者30例,阳性率0.36%。其中5 288例输血者阳性16例,阳性率0.30%,3 144例妊娠者阳性14例,阳性率0.45%,两组阳性率具有统计学差异(P<0.05)。不规则抗体阳性者筛查中非特异性抗体2例,占6.67%,特异性抗体28例,占93.33%。特异性不规则抗体的分布情况为:抗-M比率最高,占28.57%,其次是抗-D、抗-E、抗-C不规则抗体。结论不规则抗体的筛查与研究可为临床输血提供大量的事实依据,从而为临床寻找新的相合血液争取时间,能够有力地提高输血安全性。     

Comparison of acute non-haemolytic transfusion reactions in female and male patients receiving female or male blood components

To study the relationship between antibodies detected in patients' and/or donors' sera and the clinical features of acute non-haemolytic transfusion reactions (ANHTRs), and to determine any gender-related difference. ANHTRs range from urticaria to transfusion-related acute lung injury (TRALI). Antibodies to human leukocyte antigen (HLA), granulocytes, platelets, and/or plasma proteins are implicated in some of the ANHTRs. A higher antibody positivity is expected for females than for males. A comparative study of ANHTRs for antibody positivity and their clinical features between females and males for both patients and donors is helpful for characterizing ANHTRs including TRALI more clearly, but such studies are few and outdated. Two hundred and twenty-three ANHTR cases reported by 45 hospitals between October 2000 and July 2005 were analysed. The patients and 196 donors of suspect blood products were screened for antibodies to HLA Class I, HLA Class II, granulocytes, and platelets. The patients were also screened for anti-plasma protein antibodies. The types and severity of ANHTR did not differ significantly between female and male patients. The frequency of the anti-HLA antibodies, but not that of the non-HLA antibodies, was significantly higher in females. Non-HLA antibodies were significantly associated with severe reactions in females. All the TRALI cases had predisposing risk factors for acute lung injury, and 60% of the cases showed anti-leucocyte antibodies. Although the anti-HLA antibodies were detected more frequently in females than males, no significant association of ANHTRs including TRALI with gender, not only for patients, but also for donors, could be shown in this study.     

Acute non‐hemolytic transfusion reactions and HLA class I antibody: advantages of solid phase assay compared with conventional complement‐dependent assay

To evaluate the specific reactivity of HLA Class I antibodies (HLA‐I Abs) in acute non‐hemolytic transfusion reactions (ANHTRs) using solid phase assays (SPAs) and conventional complement‐dependent lymphocyte cytotoxicity test (LCT). ANHTRs are major issues in transfusion medicine. Anti‐leukocyte antibodies have been implicated as one of the causative agents of transfusion‐related acute lung injury (TRALI) and febrile reaction. Antibodies to HLA Class I and/or Class II (HLA Abs) have been intensively studied using SPAs for TRALI, but not for febrile reaction. About 107 patients and 186 donors associated with ANHTRs were screened for HLA Abs by SPAs such as enzyme‐linked immunosorbent assay (ELISA) and the Luminex method. When HLA‐I Ab was detected, its specific reactivity was evaluated by comparing its specificity identified by the Luminex method using recombinant HLA molecules and cognate HLA antigens (Ags), as well as LCT with or without anti‐human globulin (AHG). The incidences of HLA Abs were as high as 32·7% of patients' serum samples and 16% of donors' serum samples. The incidence of HLA‐I Abs did not differ significantly between cases of febrile and allergic reactions. However, HLA‐I Abs associated with febrile reaction showed a significantly higher rate of possessing specific reactivity to cognate HLA Ags than those associated with allergic reactions. In addition, the Luminex method enabled the detection of HLA‐I Abs much earlier than AHG‐LCT in serum samples from a patient with febrile reaction and platelet transfusion refractoriness (PTR). SPAs seem more useful than AHG‐LCT for evaluating reactivity of antibodies in ANHTR cases.     

输血前不规则抗体筛查与临床输血安全

目的 回顾性分析该院不规则抗体产生的频率及其特异性,探讨不规则抗体筛查阳性时的分析处理方法和临床意义,以确保临床输血安全.方法 对2005年11月至2010年7月在该院拟输血或手术备血的10 479例患者进行不规则抗体筛查,结果阳性的标本送北京市血液中心进行抗体鉴定,分析抗体特异性.结果 检出不规则抗体阳性70例,阳性率为0.67%,其中有临床意义的抗体49例,包括血液病22例、恶性肿瘤12例、良性肿瘤5例、肾病4例、其他疾病6例,血液病和肿瘤患者占79.6%,抗体鉴定确定自身抗体10例;自身抗体和同种抗体4例;确定同种特异性抗体35例.结论 输血前不规则抗体筛查十分必要,发现不规则抗体筛查阳性一定要做进一步的抗体鉴定,并选择无相应抗原的配血相合的血液输注.     

Screening plateletpheresis donors for HLA antibodies on two high‐throughput platforms and correlation with recipient outcome

BACKGROUND: To determine the prevalence and impact of transfusing plasma containing white blood cell antibodies, we compared two high‐throughput HLA antibody screening assays and prospectively examined the medical records of all platelet (PLT) recipients to detect subtle manifestations of transfusion‐related acute lung injury and other transfusion reactions. STUDY DESIGN AND METHODS: Serum samples from 136 plateletpheresis donors were tested for HLA Class I and II antibodies using microbead (LABScreen PRA, One Lambda) and microchip (Dynachip, Invitrogen) assays. Electronic medical records of all recipients were reviewed for vital signs and nursing documentation before and after transfusion. RESULTS: In the microchip assay with a cutoff value of 0.25, 2.9% of samples were positive for Class I and 8.9% for Class II antibodies; with a cutoff value of 0.1, the results were 14.9 and 21.6%, respectively. In the microbead assay (normalized background ratio, 1.5), 15% were positive for Class I and 21% for Class II antibodies. The prevalence of HLA antibodies was 17% in donors without pregnancy or transfusion history and 47% in donors with such history. The PLTs were transfused in 265 episodes to 67 patients. There were no reported reactions; however, symptoms or vital sign changes were noted in seven transfusion episodes. The incidence of reactions was 2.7% (2/75) for antibody‐positive units and 2.6% (5/190) for antibody‐negative units. CONCLUSIONS: Microbead and microchip assays yielded similar results. The prevalence of HLA antibodies was greater in donors with a history of pregnancy or transfusion, but no increase in the incidence of transfusion reactions was noted in recipients of components from donors with HLA antibodies.     

不规则抗体筛查在临床输血中的意义探讨

目的探讨通过抗体筛查和鉴定,发现有临床意义的不规则抗体,以避免不规则抗体引起的溶血性输血反应发生,并选择相合的血液,确保患者输血安全。方法采用微柱凝胶抗人球蛋白法检测978例神经外科择期手术需要输血患者的血清（浆）不规则抗体,结果阳性的标本再送南京市血液中心进行抗体特异性进一步鉴定。对不规则抗体筛查结果进行分析。结果 978例择期手术患者的不规则抗体筛查发现不规则抗体阳性6例,阳性率0.61%。筛检阳性的6例标本经南京市血液中心进行抗体特异性鉴定,发现在6例不规则抗体阳性患者中抗-E 3例、抗-D 1例、抗-cE 2例。对6例不规则抗体阳性患者提示少输或不输血,其中2例未输血,4例输注经南京市血液中心配合型血液,无1例发生溶血性输血反应。结论在输血前对受血者进行不规则抗体筛查可发现有意义的不规则抗体,以及选择和准备相适合的血液,防止溶血性输血反应。这对确保临床输血安全具有重要的意义。     

抗-HI抗体的筛查和鉴定在临床输血中的应用价值

目的探讨抗-HI抗体的筛查和鉴定在临床输血中的应用价值。方法选取2016年2-11月该院4例抗-HI抗体阳性患者作为研究对象,采用抗人球蛋白法和盐水试管法进行不规则抗体的筛查和鉴定,并对临床输血效果进行评价。结果 4例患者均为ABO血型,其中A型RhD阳性2例,AB型RhD阳性2例。抗人球蛋白法的筛查结果均为弱阳性,盐水试管法的筛查结果均为阳性。在盐水介质条件下,4例患者血清与16系谱细胞反应结果均为阳性,与自身红细胞反应结果均为阴性;在抗人球蛋白介质条件下,4例患者血清与16系谱细胞反应结果除1例弱阳性外均为阴性,与自身红细胞反应结果均为阴性。2例治疗用血患者输血后,血红蛋白上升达到预期效果,无输血不良反应发生。结论为抗-HI抗体阳性患者输血时,应选择ABO同型且盐水试管法及抗人球蛋白法配血结果均相合的血液。