Transient coagulation abnormalities after incompatible blood transfusion.

This report describes an unusual hemolytic transfusion reaction. A group O donor was inadvertently transfused with 100 ml of group A red cells during the course of plasmapheresis. Granulocytopenia, thrombocytopenia, hypofibrinogenemia and low levels of factors V, VIII, and IX developed immediately after the infusion. The levels of the cellular elements and coagulation proteins returned to normal in less than an hour; too rapid for a de novo synthesis after consumption of coagulation proteins. We postulate that activation of the kinin system was responsible for the phenomena rather than intravascular coagulation with secondary fibrinolysis.     

不相容性输血的免疫控制策略

目的探讨建立解决临床上不相容性输血的免疫控制策略。方法血清学检测2名拟输血的患者(分别为丙肝肝硬化及妊娠期高血压患者)ABO、Rh、Kidd、Lewis、Duffy血型;同时对其做不规则抗体的筛查与鉴定;采用基因分型的方法检测患者稀有血型抗原;通过采取不同的免疫控制策略,即主动免疫控制(为患者提供配血试验相合以及抗原相同的血液)及被动免疫控制(提供最低不相合的血液),为患者选择合适的血液输注。结果患者1血型为O、RhC-c+D+E+e-、Jk(a-b+)、Le(a+b-)、Fy(a+b+),存在IgG抗-Ce、IgG抗-Jk~a;患者2为B、RhC+c+D+E-e+、Jk(a+b-)、Le(a+b-)、Fy(a+b+),基因分型Kp(a-b+),Lu(a-b+),Di(a-b+),Wr(a-b+),Yt(a+b-),Co(a+b-),Kn(a+b-),Do(a-b+),除了有IgM抗-E、IgG抗-E外,还存在特异性不明的抗高频抗原抗体;采取免疫控制策略制定不同的输血方案,取得了良好的输血治疗效果。结论当临床遇到交叉配血不相合但需紧急输血的患者时,采取不同的免疫控制措施后输注相应的血液,可以在提高输血疗效的同时降低输血不良反应的发生,达到及时、安全、有效的输血目标。     

Immune response to blood transfusion invery-low-birthweight infants

BACKGROUND: Allogeneic blood transfusion is common in the treatment of neonatal anemia of prematurity or anemia due to multiple phlebotomies. The immune response of neonates to passenger leukocytes from allogeneic red cells was investigated. STUDY DESIGN AND METHODS: Fourteen infants (4 male, 10 female) prospectively were randomly assigned to receive either white cell-reduced (Group 1) or non-white-cell reduced (Group 2) irradiated blood. Blood samples were taken before and at various time intervals after transfusion (Days 1, 5-7,and 10-14). Cord blood from 11 healthy term infants was used for comparison. The following surface markers were used to assess immune modulation by flow cytometry: CD45RA/CD45RO, CD4/CD8, CD25/CD28, CD3/DR, CD14/B7, and CD3/CD56+CD16. Donor cell microchimerism was studied using semi-quantitative polymerase chain reaction Y-chromosome detection in female infants who received male donor blood. Donor and recipient HLA class II typing was performed with polymerase chain reaction with sequence specific primers. RESULTS: The lymphocyte counts in both groups were significantly increased after transfusion, and there was a significant increase in lymphocytes expressing CD45RA, CD3-/CD16+CD56, CD80, and CD3-/DR on Day 14. The premature infants' pretransfusion natural killer cell population (CD3-/CD16+CD56) was significantly lower than that of term infants, but it reached a similar level by Days 10-14. CD8 subpopulations were increased but not CD4+ cells. Two female infants (of 6) had circulating Y chromosomes 1 day after transfusion, and most of the infants effectively cleared the donor cells within 24 hours of transfusion. Two Group 2 infants who by chance received presumably HLA-haploidentical donor blood developed necrotizing enterocolitis. CONCLUSION: Blood transfusion alters immune cell antigen expression in premature neonates and may initially be immunostimulatory and later immunosuppressive.     

Plasmapheresis in ABO incompatible kidney transplant

In patients with an end-stage renal disease, dialysis a or kidney transplant are required to prolong live. For survival of the transplanted kidney, besides the HLA-system, the ABO blood type of donor and patient is also of importance. When the donor organ is derived from a living donor, time can be available prior to the transplant to reduce blood type AB antibodies in case of ABO major incompatibility between organ donor and recipient by double filtration apheresis.     

ABO血型不合的异基因骨髓移植

目的 探讨ＨＬＡ 相合,ＡＢＯ 血型不合的异基因骨髓移植（ａｌｌｏＢＭＴ） 中存在的免疫及造血问题。方法 对本所３８ 例ＡＢＯ 血型主要不合,２３ 例次要不合的ＨＬＡ 相合的ａｌｌｏＢＭＴ 受者进行分析,并选用同期ＡＢＯ 血型相合的ａｌｌｏＢＭＴ 患者作配对比较。结果ＡＢＯ 血型不合的ａｌｌｏＢＭＴ患者,输注骨髓后无一例发生急性溶血。经配对ｔ 检验及χ２ 检验,ＡＢＯ 血型不合对骨髓植活、血小板恢复,ＧＶＨＤ 及５ 年无病生存率均无影响; 在ＡＢＯ 血型主要不合组, 红系开始恢复时间明显延迟,使红细胞输用量明显增多;其中５ 例患者发生纯红细胞再生障碍（ 纯红再障） ,持续约７ ～２４ 个月。发生纯红再障者均为“Ｏ”型血受者,红系恢复与血型抗体滴度具有相关性。结论ＡＢＯ 血型不合可以进行ａｌｌｏＢＭＴ,但对发生纯红再障高危的患者宜慎重。     

ABO血型主要不合的供者外周血造血干细胞采集

目的:应用血细胞分离机采集血型主要不合的供者外周血造血干细胞的效率,观察不去除红细胞进行造血干细胞移植的安全性。方法:实验于1998-10/2006-10在华中科技大学附属协和医院血液科完成。①实验对象:健康异基因造血干细胞供者23例,均与受者经HLA配型证实为全相合,亲缘性供者21例,中华骨髓库无血缘关系供者2例;供者为A型血、患者为O型血15例,供者为B型血、患者为O型血8例。23例受者中,急性淋巴细胞白血病患者9例,急性非淋巴细胞白血病患者8例,慢性粒细胞白血病患者5例,再生障碍性贫血患者1例。实验经医院伦理委员会批准,供、受者均知情同意。②实验方法:23例供者均在采集前5d皮下注射粒细胞集落刺激因子5μg/(kg·d)进行干细胞动员,至第5天供者外周血白细胞计数达20×109L-1、单个核细胞所占比例达10%以上时,应用CobeSpectra血细胞分离机的自动外周血干细胞采集程序进行外周血造血干细胞采集,平均循环血量为9210mL,分离过程中平均采血速度为42mL/min,每例供者均采集2次,共46次,采集时可静脉注射或口服10%葡萄糖酸钙,或采集前3d口服钙片,一定程度上可预防低钙反应、麻木甚至抽搐等不良反应。23例受者每次输注干细胞采集物前给予相关干预措施以防止溶血反应及保护肾功能,每例受者均输注2次,共46次。③实验评估:供者采集完毕后留取标本检查有核细胞数、红细胞比容、CD34 细胞计数和细胞存活率锥虫蓝拒染情况。受者输注后注意观察生命体征、尿液颜色及是否有溶血相关不良反应等。结果:①供者外周血造血干细胞采集时不良反应:46例次的供者采集中,4例次(8.7%)出现复方枸椽酸钠相关低钙反应,表现为口周、四肢麻木感、胃肠道反应、胸闷、头昏等,经加大口服10%葡萄糖酸钙症状均得到控制,每例供者平均每次采集的补钙量为50mL,最多者补充80mL;1例次(2.17%)出现血管迷走神经性面色苍白、出汗症状。②受者外周血造血干细胞输注时不良反应:每例供者采集物中的有核细胞数为(3.76±0.89)×108/kg,CD34 细胞计数为(3.23±0.89)×106/kg,采集物锥虫蓝拒染率均为100%,红细胞混入量即血红蛋白为(18±4)g/L,不去除红细胞,直接输给受者,23例受者46次输注后仅1例次出现较严重的溶血性输血反应,应用地塞米松、静脉滴注5%碳酸氢钠并加大输液量后症状逐渐减轻直至完全消失。所有患者造血功能均获得重建。结论:应用血细胞分离机采集ABO血型主要不合供者的外周血造血干细胞,回输时不去除采集物中的红细胞,可获得足够的干细胞数量并安全用于移植。     

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.     

ABO血型不合的夫妇产前血型抗体效价测定在产前诊断中的意义

[目的]通过对ABO血型不合的孕妇血清中血型抗体效价的测定,了解异常IgG抗A／B的分布情况及临床意义,为预防治疗新生儿溶血病（HDN）提供重要的实验依据。[方法]选择夫妇ABO血型不合者660例,采用微柱凝胶法进行IgG抗A／抗B的ABO血型抗体效价检测。[结果]660例ABO血型不合的孕妇血清中,IgG抗A／抗B效价〉1：64者170人,占25．8％,且抗体的效价与妊娠年龄及妊娠次数呈正相关。[结论]O型血孕妇与丈夫血型不合时,产前应及时检测血清中IgG抗体水平,及早发现及时治疗,可减少由于母婴血型不合引起的新生儿溶血性疾病的发生。