全自动血型仪检测ABO血型正反定型不符原因分析及处理策略

目的 探讨在鉴定ABO血型中全自动血型仪正反定型不符的原因,并探寻解决对策。方法 对2017年10月~2018年8月遂宁市中心医院血型仪检测的298例ABO血型正反定不符的标本进行分析,同时结合试管法、抗人球蛋白实验、吸收放散实验、不规则抗体鉴定结果及病史资料分析定型不符的原因并进行归类。结果 298例正反定型不符标本准确鉴定后归纳分为4类:可被纠正类型（标本、人员操作、试剂和仪器原因）占24.16%;抗原原因占7.38 %,其中包括抗原减弱以及ABO亚型;抗体减弱占31.88%,包括抗体合成不足（如婴幼儿）,抗体缺失（如老年人和肿瘤患者）,意外抗体等;其他原因占36.58%,主要包括自身免疫性溶血性贫血、冷凝集素综合症、高球蛋白血症等。结论 鉴定血型前标本质量控制、仪器定期的保养维护以及试剂红细胞的更换可以有效减少正反定型不符,抗体合成不足、自身免疫性疾病以及冷凝集素综合症是导致ABO正反定型不符的主要原因。建议院方根据可能原因进行相关确认实验,准确鉴定ABO血型从而保证患者输血安全。     

血型抗体减弱或缺乏导致ABO血型正反定型不相符的检测分析

目的 分析血型抗体减弱或缺乏的原因及其对ABO血型鉴定的影响和处理方法.方法 采用正反定型、抗体增强方法、吸收放散试验、抗球蛋白试验、不规则抗体筛选及交叉配血试验对患者进行血型血清学检测.结果 病例1、2、3、4正定型为O型,病例1、2反定型抗A、抗B抗体在常规方法中与Ac、Bc不凝集,病例3抗B抗体在常规方法中与Bc...     

婴幼儿ABO血型正反定型结果分析及其交叉配血试验

目的探讨婴幼儿ABO血型正反定型结果分析及其交叉配血试验.方法对126名出生3天～2岁内婴幼儿ABO 血型按常规法鉴定,交叉配血试验按聚凝胺法.结果 126例婴幼儿正反定型显示,其中红细胞定型为A型,血清中无抗-B 10例,红细胞为B型,血清中无抗-A 12例,红细胞为O型,血清中含有抗-A 而无抗-B 6例,有抗-B无抗-A 3例,无抗-A和抗-B 7例.聚凝胺法在126例中有2例阳性,其余 124例选择血型相符的血液输注,输血后均无不良反应.结论不同的年龄组其正反定型相符率也不同,正反定型一致者随着年龄的增长而逐渐增多,血清中抗体也随着年龄增长而增强.交叉配血中聚凝胺法是一种较为快速、敏感性高的方法.     

婴幼儿ABO血型正反定型结果分析及其交叉配血试验

目的　探讨婴幼儿ABO血型正反定型结果分析及其交叉配血试验 .方法　对 12 6名出生 3天～ 2岁内婴幼儿ABO血型按常规法鉴定 ,交叉配血试验按聚凝胺法 .结果　 12 6例婴幼儿正反定型显示 ,其中红细胞定型为A型 ,血清中无抗 -B 10例 ,红细胞为B型 ,血清中无抗 -A 12例 ,红细胞为O型 ,血清中含有抗 -A而无抗 -B 6例 ,有抗 -B无抗 -A 3例 ,无抗 -A和抗 -B 7例 .聚凝胺法在 12 6例中有 2例阳性 ,其余 12 4例选择血型相符的血液输注 ,输血后均无不良反应 .结论　不同的年龄组其正反定型相符率也不同 ,正反定型一致者随着年龄的增长而逐渐增多 ,血清中抗体也随着年龄增长而增强 .交叉配血中聚凝胺法是一种较为快速、敏感性高的方法     

运用PCR-SSP技术对羊水细胞ABO血型基因定型研究

目的探讨PCR序列特异性引物（PCR-sequence specific primer,PCR-SSP）技术对胎儿羊水细胞ABO血型基因定型研究,分析母儿血型吻合情况。方法选择2008年1月～2010年2月于我院优生优育门诊及产前诊断中心就诊O型血孕妇80例,其丈夫血型分别为A型40例,B型37例,AB型3例。以上80例孕妇于孕16～21周在B超直视下经腹羊膜腔穿刺抽取羊水20～30ml,其中10ml经高速离心取沉淀的羊水细胞,用常规酚氯仿法提取羊水DNA,运用PCR-SSP技术通过PCR反应特异性扩增ABO基因片段,凝胶电泳检测PCR产物,根据产生的特异性PCR产物来鉴定相应的基因来分析血型。同期运用变性高效液相色谱分析（denaturing high performance liquid chromatography,DHPLC）技术对羊水血型检测结果进行验证。余20ml羊水行细胞培养细胞遗传学分析。另回访40例已出生的胎儿,采集外周静脉血分别运用PCR-SSP技术和常规血清学检测方法鉴定ABO血型,比较产前和产后血型检测结果。结果运用PCR-SSP技术从80例羊水DNA中成功检测79例（79/80,98.75%）,其血型分别为A型21例,B型20例,O型38例。同期运用DHPLC技术对PCR-SSP技术检测结果进行验证,两种检测结果相符。已出生40例婴儿外周血血型分析结果与产前诊断血型结果相符。结论 PCR-SSP技术产前诊断胎儿羊水ABO血型具有可行性,进而分析母儿血型吻合情况,为ABO抗体效价显著增高的孕妇临床用药指导提供实验室依据。     

陕西省ABO与Rh血型分布特征及人口迁移对血型分布的影响

目的 调查分析陕西人ABO和Rh血型的分布特征,探讨区域划分及人口迁移对血型分布的影响.方法 收集陕西省十个地市20年3691624人献血者数据,以陕西省地理学特征分为陕北、陕南和关中3个地域,统计分析不同区域ABO及Rh血型分布特征.采用热图软件导入陕西省地图呈现ABO血型地图.分析对比2008年和2018年2个年份...     

ABO血型抗体缺乏分析及临床输血

目的 探讨ABO血型抗体缺乏的血清学特点、临床分析、临床安全输血.方法 对4例血型抗体缺乏患者采用血型血清学方法进行ABO血型鉴定、吸收放散试验、唾液中血型物质测定.结果 4例患者均为分泌型,抗-A缺乏2例,抗-B缺乏1例,抗-A、抗-B均缺乏1例.结论 正常人抗体缺乏见于免疫耐受现象,在紧急输血时以O型洗涤红细胞为宜.     

不同温度下冷凝集素试验对ABO血型正反定型与电子交叉配血试验结果的影响

目的:探讨不同温度下冷凝集素试验对ABO血型正反定型与电子交叉配血试验结果的影响.方法:选取我院2019年2月至2020年4月期间收治的需紧急输血患者248例作为研究对象,比较不同温度(20℃、37℃)下ABO血型鉴定结果、电子交叉配血结果、冷凝集素试验结果、交叉配血试验结果.结果:248例需紧急输血患者血液样本,血清...     

ABO血型正反定型不一致样本的分子机制及其临床输血分析

目的 分析ABO血型正反定型不一致样本的分子机制,为临床ABO血型正反不符样本的鉴定和输血提供参考.方法 收集ABO血型正反不符的样本,选取其中血清学反应格局相似的样本6份,应用血清学方法、序列特异性引物-聚合酶链反应、ABO基因直接测序及TA克隆单体型分析等方法分析其分子机制,对其进行分类,并回顾性调查临床输血情况.结果 导致该6份样本ABO血型正反不符情况有3种:抗原减弱(2份)、抗体减弱(3份)、ABO亚型(1份).遵循同型或相容性输注原则进行输血均取得满意效果.结论 ABO血型存在异质性,血清学反应格局相同的样本可由多种机制引起.     

乙肝患者与ABO血型系统相关联分析

本文通过对1580名乙肝患者与3840名正常健康人进行ABO血型检测,结果表明:乙肝患者血型分布为O>A>B>AB;正常健康人血型分布为;A>O>B>AB;乙肝患者中男性占66.5%;女性占33.5%,提示:乙肝病毒检出率与O型血患者相关联,与A型、B型,AB型不相关联,乙肝发病率男性多于女性。     

关于“人红细胞反定型试剂技术审查基本要求”的思考

在“人红细胞反定型试剂”技术审查中,有些红细胞的基本评价指标对于明确试剂质量十分重要,但该产品各申报厂家的评价指标和方法均不同,难以对产品进行充分的评价.因此,本文对于该产品申报资料的基本要求,包括综述资料、主要原材料、主要生产工艺及反应体系、分析性能评估、阳性判断值、稳定性、技术要求、说明书等资料进行了详细的分析,并对临床试验的设计和要求进行了阐述.总之,本文旨在给予申报企业一定的技术指导,使产品能够最大程度地满足临床应用的要求.     

Analysis of Donor and Recipient ABO Incompatibility and Antibody-Associated Complications after Allogeneic Stem Cell Transplantation with Reduced-Intensity Conditioning

Allogeneic hematopoietic stem cell transplantation (HSCT) can be performed across the ABO blood group barrier. The impact of ABO incompatibility on clinical outcome is controversial. A retrospective analysis of 310 patients who underwent HSCT with reduced-intensity conditioning between 1998 and 2011 was performed to investigate the frequency and clinical implications of anti-RBC antibodies in passenger lymphocyte syndrome (PLS) after minor ABO mismatch (mm), persistent or recurring recipient type ABO antibodies (PRABO) after major ABO mm HSCT, and autoimmune hemolytic anemia (AIHA). Transplantation characteristics and clinical outcome were analyzed by univariate and multivariate analysis for groups with or without anti-RBC antibodies. ABO blood group incompatibility did not affect clinical outcome despite an increased requirement of blood transfusion. Twelve patients with AIHA, 6 patients with PLS, and 12 patients with PRABO post-HSCT were identified. AIHA did not affect overall survival (OS) or transplant-related mortality (TRM), but patients with AIHA had a lower incidence of grades II to IV acute graft-versus-host disease (P = .05). OS in the PLS group was 0% compared with 61% in the whole group receiving minor ABO mm transplants (P < .001). Comparing PRABO patients with those receiving a major ABO mm HSCT, the OS was 17% versus 73% (P = .002) and TRM was 50% versus 21% (P = .03). At our center, PLS after minor ABO mm and PRABO antibodies after major ABO mm HSCT are significant risk factors for decreased OS and TRM. Our results suggest that occurrence of unexpected ABO antibodies after HSCT warrant a wider investigation individual to find the underlying cause.     

患者血清中含有冷自身抗体的处理方法

目的：通过100例冷抗体引起血型定型和交叉配型困难,探讨临床输血科(血库)规范操作ABO血型鉴定的重要性。方法应用吸收放散等血型血清学方法去除致敏在红细胞表面和血清中的冷自身抗体来进行血型鉴定和交叉配型。结果在100例患者血清中,其中冷抗体的效价1：32者93例(93%),1：64者5例(5%),其中2例患者为高效价冷抗体效价为1：1024(2%)。结论由于我省处于高原地区受气候和医疗条件的制约,为了保证临床输血安全,应规范ABO正反定型的鉴定,及时排除冷自身抗体的干扰,减少临床输血反应的发生。     

ABO血型在肾脏移植病例中的分布

目的了解肾脏移植病例中ABO血型的分布关系. 方法将143例肾脏移植患者与一般人群ABO血型进行对比分析. 结果肾脏移植病例与一般人群的ABO血型分布差异无显著性.肾脏移植患者中血型分布依次为O型占40.5%、A型占32.9%、B型占18.9%、AB型占7.7%.虽然患者中B型(18.9%)低于一般人群(22.9%),O型(40.5%)高于一般人群(34.8%),但差异无显著性.结论 ABO血型与肾脏移植病例无明显关联.     

Accurate detection of reemergent anti-donor ABO antibody is crucial for safe transfusion in ABO major incompatible HSCT patient after achieved the stages of full switch to donor type

Dynamic monitoring ABO chimera including erythroid ABO antigen and anti-A/B is crucial to not only assess the status of erythroid engraftment but also achieve personalized safety transfusion in patients post ABO incompatible hematopoietic stem cell transplantation. Transfusion support for ABO incompatible (ABOi) HSCT patients after achieved complete alteration to donor origin still remains cautious because the instant hematopoietic status on these transplant patients possibly returned to patient origin derived from early disease relapse and graft loss or failure. We reported that reemergent anti-B in a female patients (donor/patient: B/O) at the early phase after achievement complete donor type were not effectively found from partial automatic ABO blood grouping systems, which directly resulted in differential judgement of transplantation stage for about 15 days and disturbed the optimal recommendation on transfusion support. Meanwhile, the solely alteration of ABO chimera was found and earlier than changes of other markers such as MRD diagnosis, chimerism analysis by STR-PCR and sex chromosome assays, which can be an available predictors for bad transplant outcomes such as graft failure.     

A、B血型单克隆抗体临床应用的研究

为了探索人血型分型试剂工业化生产的可能性，应用人Ａ、Ｂ血型单克隆抗体，进行了抗体特性及临床血型分型的研究。经血凝特性试验，测得Ｄ２８６－Ｅ１２单克隆抗体仅对Ａ血型特异，６－１－Ｇ１１单克隆抗体仅对Ｂ血型特异。由盐水试管法测得它们的血凝滴度均为１：５１２。以血库常规人抗Ａ、抗Ｂ血清为标准对照，采用盐水试管法，对３７０４例血液样品进行了临床血型分型试验。结果显示，Ａ、Ｂ血型单克隆抗体分型试剂与标准人血清１００％相符。证明：Ｄ２８６－Ｅ１２和６－１－Ｇ１１两株杂交瘤分泌的Ａ、Ｂ血型单克隆抗体可作为非常优越的血型分型试剂。具有工业化生产血型单克隆抗体的潜力。     

北京市某医院献血者不规则抗体筛查阳性结果分析

目的 通过交叉配血次侧不合发现不规则抗体筛查阳性的献血者并鉴定不规则抗体特异性,保障输血安全。方法通过交叉配血次侧均不相合且复查血型发现不规则抗体筛查阳性的献血者,并鉴定抗体特异性;将其中4袋不规则抗体筛查阳性的悬浮红细胞制备为洗涤红细胞,并跟踪其输注效果。结果 2016年11月至2017年12月期间,34297例献血者中发现11例为不规则抗体筛查阳性,其中抗-E5例、抗-M4例、自身抗体1例、非特异性抗体1例。两名患者输注抗筛阳性洗涤红细胞后,输注有效,无不良输血反应发生。结论 常规开展献血者不规则抗体筛查项目具有重要的临床意义,将抗筛阳性的悬浮红细胞制备为洗涤红细胞,可以保障输血安全,节约血液资源。     

Effect of ABO Blood Group Incompatibility on the Outcome of Single-Unit Cord Blood Transplantation after Myeloablative Conditioning

ABO blood group incompatibility between donor and recipient has been associated with poor transplant outcomes in allogeneic hematopoietic stem cell transplantation. However, its effect on the outcome of cord blood transplantation (CBT) has yet to be clarified. We retrospectively analyzed 191 adult patients who received single-unit CBT after myeloablative conditioning for malignant disease in our institute. Major mismatch showed a significantly lower incidence of platelet engraftment compared with ABO match as a reference (hazard ratio, .57; P = .01). Nevertheless, there was no increase in graft-versus-host disease, transplant-related mortality, and overall mortality after ABO-incompatible CBT. These data suggested that donor–recipient ABO incompatibility does not have a significant impact on outcome after myeloablative CBT for hematological malignancies.     

Molecular Deciphering of the ABO System as a Basis for Novel Diagnostics and Therapeutics in ABO Incompatible Transplantation

In recent years ABO incompatible kidney transplantation (KTx) has become a more or less clinical routine procedure with graft and patient survival similar to those of ABO compatible transplants. Antigen-specific immunoadsorption (IA) for anti-A and anti-B antibody removal constitutes in many centers an important part of the treatment protocol. ABO antibody titration by hemagglutination is guiding the treatment; both if the recipient can be transplanted as well as in cases of suspected rejections if antibody removal should be performed. Despite the overall success of ABO incompatible KTx, there is still room for improvements and an extension of the technology to include other solid organs. Based on an increased understanding of the structural complexity and tissue distribution of ABH antigens and the fine epitope specificity of the ABO antibody repertoire, improved IA matrices and ABO antibody diagnostics should be developed. Furthermore, understanding the molecular mechanisms behind accommodation of ABO incompatible renal allografts could make it possible to induce long-term allograft acceptance also in human leukocyte antigen (HLA) sensitized recipients and, perhaps, also make clinical xenotransplantation possible.