基层输血科自制室内质控品的方法与可行性探讨

目的探讨如何利用基层输血科现有实验室条件,选则自制质控品对ABO血型正反鉴定、Rh D血型鉴定、不规则抗体筛查和交叉配血试验进行室内质量控制。方法回顾性分析我院输血科2013年7月—2014年7月13次自制质控品的可靠性和特异性,评价自制质控品的临床应用效果。自制单独血浆与红细胞质控品,经亲和力、抗体效价检测、凝集强度和稳定性等验证后,按照自行设计的室内质控模式,进行ABO血型鉴定、Rh D血型、交叉配血试验及不规则抗体筛查等试验。结果各检测项目共有1 780个室内质控结果,其中1次(0.06%)属于"警告",2次(0.11%)属于"失控";失控中随机误差1次(50%),系统误差1次(50%)。随机误差和系统误差各占质控总数的比例为0.06%。结论本院输血科自制的室内质控品,其有效性、特异性、稳定性和可靠性,符合《ISO15189医学实验室认可准则》中对IQC的基本要求,可以有效控制输血差错事故的发生。     

脐带血在早产儿输血相容性试验中的应用

目的 探讨脐带血在早产儿输血相容性试验中的应用价值。方法 选取2020年6月至2021年12月昆明市儿童医院、昆明市妇幼保健院、曲靖市妇幼保健院收治的早产儿595例,收集早产儿配对的脐带血和静脉血标本,用微柱凝胶卡式法将2组血标本进行输血相容性试验,包括ABO及RhD血型鉴定、不规则抗体筛查、交叉配血试验。结果 在ABO、RhD血型鉴定试验中,2组血标本试验结果完全相符,符合率100%;在不规则抗体筛查试验中,抗体阳性检出率1.5%,2组血标本试验结果完全相符,符合率100%;在交叉配血试验中,交叉配血不相合120例,不相合检出率20.2%,其中,主侧不相合检出率10.6%,次侧不相合检出率9.6%,2组血标本试验结果完全相符,符合率100%。结论 脐带血可替代静脉血进行早产儿输血相容性试验,能减少早产儿医源性失血和侵入性损害。     

输血前相容性检测试验的室内质控体会

目的为了保证临床输血前患者ABO、Rh(D)血型鉴定、血型不规则抗体筛查、交叉配血等3项试验结果准确可靠。方法介绍在试验前、试验中及试验后三阶段所开展的室内质控方法、注意事项等。结果规范室内质控对疑难血型鉴定分析、提高不规则抗体检出率、处理疑难配血试验、降低输血不良反应等均有重要意义。结论输血前3项试验室内质控显著减少危害发生概率,是保障临床用血安全的必要手段。     

血型不规则抗体检测在临床输血中的作用

目的探讨血型不规则抗体检测在临床输血中的作用,提高输血的安全性及有效性。方法对15例微柱凝集法交叉配血不合的患者进行血型不规则抗体检测,用谱细胞筛查,鉴定特异性抗体试验。对其结果进行回顾性分析。结果抗体筛选阳性在交叉配血不合中占80%,Rh血型抗体检出率为60%。结论不规则抗体筛选检测的应用,发现交叉配血不合的原因,其中Rh血型抗体所致居多,Rh血型抗原E、e、c、C的检测作为RhD抗原之后输血前项目,可以避免一些不合理输血,提高输血的安全性及有效性。     

达拉木单抗致交叉配血不合的3例报道

目的探讨达拉木单抗对抗体筛查、鉴定及交叉配血试验的干扰和处理方法。方法对3例应用达拉木单抗(CD38单抗类药物)患者的血型、不规则抗体筛查、抗体鉴定的反应格局及交叉配血结果与患者输血效果进行综合分析,探讨最优的处理方法。结果达拉木单抗的使用未影响本研究中3例患者ABO及RhD血型鉴定结果,可导致患者不规则抗体筛查转为阳性(1-2+凝集),十六系抗体鉴定均阳性(1-2+凝集)且无特异性。交叉配血采用抗球蛋白法均不合,盐水法1例不合,凝聚胺方法均相合。结论达拉木单抗影响输血前相容性检测结果,最好在用药前完成相关检测。对于用药前抗体筛查阴性的患者可以使用凝聚胺配血等方法,尽量去除药物对试验的干扰,避免血液发放延迟,及时输血缓解患者贫血症状。     

1种全自动血型分析仪的临床应用与评价

<正>准确鉴定献血者及患者ABO、RhD血型是临床安全输血的最根本保证。献血者血液的ABO、RhD血型鉴定,及患者输血前3项检查(包括ABO及RhD血型鉴定、意外抗体筛查、交叉配血试验)均为保障其安全输血的前提。传统的试     

模拟电子交叉配血的临床应用分析

目的探讨电子交叉配血技术在我国临床输血中的可行性与安全性。方法采用全自动血型仪和试管法对患者和献血者进行血型鉴定和抗体筛查。患者和献血者2次血型鉴定结果一致及抗筛试验结果阴性,与传统血清学交叉配血法相符,模拟进行红细胞悬液出库。结果电子交叉配血法与传统血清学交叉配血法结果相符的4435 U红细胞悬液模拟出库给2 330名患者输注,未观察到ABO/RhD血型不合的输血不良反应。电子交叉配血法与传统血清学交叉配血法结果不相符,未模拟出库红细胞悬液65 U。主要原因为患者不规则抗体筛查漏检抗-Mur;患者直接抗球蛋白C3试验阳性需输注洗涤红细胞,患者直接抗球蛋白IgG试验阳性;献血者直接抗球蛋白Ig G试验阳性。结论在完善血型不规则抗体筛查试剂抗原谱和增加患者、献血者直接抗球蛋白试验的基础上,电子交叉配血技术在我国临床输血中具有可行性与安全性。为了临床输血安全,对不符合电子交叉配血条件的应采用血清学交叉配血作为补充。     

IgG型抗-Fy~b合并抗-H案例分析

目的通过一系列免疫血清学试验进行不规则抗体鉴定,查找引起血型正反定型不符的原因。方法用试管法做血型正反定型试验和不规则抗体筛查试验,用抗球蛋白法进行不规则抗体筛查、鉴定以及交叉配血试验、抗体吸收试验、热放散试验(56℃)等,以明确患者血清中存在的抗体种类和性质。结果患者血型为AB型,血清中检测出Ig G型抗-Fyb合并抗-H冷抗体,造成血型正反定型不符,与O型红细胞交叉配血不相合。结论血型检测时,反定型有必要加O型红细胞,输血前有必要进行不规则抗体筛查,以检测ABO血型系统以外的抗体。若结果阳性,应当明确抗体性质和种类,交叉配血时归避相应抗原,不可盲目输注O型红细胞,以保证临床输血安全。     

临床血液相容性检测的质量控制

红细胞相容性检测管理是针对ABO正反定型、RhD、抗体筛检和交叉配血检测的关键环节的控制.如试剂的选择、ABO血清试剂的效价、RhD血清试剂抗体种类、检测方法的组合、结果相容和相合性的分析、室内质控品选择、质控方式等.仅就输血检测的特点按同样顺序介绍如何进行这一过程的质量管理.     

输血相容性试验标准检测流程

输血前相容性检测直接关系着输血安全,检测内容包括受血者和献血者的ABO和RhD血型测定,受血者的抗体筛选,受血者与献血者间的血液交叉匹配试验[1-5].建立本标准流程旨在规范输血前相容性试验采用的实验室检测程序,确保受血者的ABO及RhD血型抗原抗体与献血者的相容,确定受血者血清中是否有临床意义的不规则抗体、受血者血清与献血者红细胞是否有相对应的抗原抗体,从而达到安全、有效输血.     

The computer crossmatch: a safe alternative to the serological crossmatch

The crossmatch has evolved from including a wide range of techniques through a test purely to eliminate ABO incompatibility (immediate spin) to computer crossmatching in which no serological testing is carried out and validation ensures the correct ABO/RhD type blood is issued. The crossmatch was always considered to be the most important feature of the compatibility test and in particular the antiglobulin phase; however, there are potential risks associated with serological and computer crossmatching including technical and procedural errors. The use of immediate spin and computer crossmatch change the emphasis for safety of the compatibility test from the crossmatch to the antibody screen. UK guidelines have now been published describing the features necessary for the introduction of computer crossmatching. Computer crossmatching is used by many institutions in various countries. It is considered safe practice and brings benefits to the laboratory and the patient. Compatibility testing is only one element of the blood transfusion procedure; the others are equally as important and include correct patient identification at the time of collection of the blood sample and at the administration of the blood transfusion.     

Limitations of the immediate spin crossmatch when used for detecting ABO incompatibility

In the eleventh edition of the AABB's Standards for Blood Banks and Transfusion Services the requirement for an antiglobulin crossmatch was deleted if no clinically significant unexpected antibodies are detected in recipient serum testing and if there is no history of detection of such antibodies. Test methods that demonstrate ABO incompatibility remain a requirement; however, the means to accomplish this may prove controversial. The immediate spin crossmatch has been used for the purpose of detecting ABO incompatibility by many workers. Nonetheless, limitations of this technique became apparent in tests between A2B donor red cells and group B patient sera. The results of 204 of 531 immediate spin crossmatches, between these two blood groups, were found to be negative.     

自制输血相容性检测室内质控品保存条件的研究

本研究目的是利用输血相容性检测实验室现有血液标本资源,建立自制室内质控品技术。随机选取24名A型RhD阳性的健康献血者,分别采集静脉血4ml,采用析因设计方法,根据使用抗凝剂种类、是否添加红细胞保存液以及标本每日室温存放时间,将24个标本随机平均分成8组,将所有盛装标本的试管盖帽后4℃保存,每天在室温放置1小时或2小时。分别在保存的0、7、14、21、28、35天测定所有标本的ABO、RhD血型（记录正反定型的凝集强度）、IgM抗B抗体效价和上清液中游离血红蛋白浓度并计算其增量值。结果表明：使用ACD-B抗凝剂并添加MAP红细胞保存液,每天室温放置1小时（A282C1）组标本的红细胞损伤最小,各时间点FHb浓度及其增量值均最低（P〈0．01）,35天时FHb浓度仅为（245．1±84,5）mg／L。保存过程中A抗原、D抗原及kM抗B抗体反应活性无明显变化（P〉0．05）。结论：在输血相容性检测实验室现有条件下,可以利用本研究建立的A282C1方案制备出性能相对稳定、可有效保存的能够满足室内质控要求的改良全血室内质控品。     

Electronic verification of donor-recipient compatibility: the computer crossmatch

Background: This article describes standard operating procedures (SOPs) for a computer crossmatch to replace the immediate-spin crossmatch for ABO incompatibility between patient blood samples submitted for pretransfusion testing and the blood component selected for transfusion. These SOPs were developed following recent changes to the Standards for Blood Banks and Transfusion Services of the American Association of Blood Banks (AABB). Study Design and Methods: SOPs were developed, utilizing currently available software, for pretransfusion testing. The SOP for donor unit processing entails bar code entry of the unit number, component name, and ABO/Rh type; computer entry and interpretation of serologic reactions; warning of discrepancies between bar code-entered blood type and result interpretation; and quarantine of the donor unit in such instances. The SOP for patient sample testing requires bar code entry of specimen accession number, which accesses patient demographics; computer entry and interpretation of ABO/Rh tests; repeat blood typing at the time of crossmatch if only one patient blood type is on record; and warning if there are nonconcordant current and historical blood types. The computer crossmatch SOP requires bar code entry of specimen accession and donor unit numbers; release of group O red cells pending resolution of discrepancies; and immediate-spin crossmatch during computer downtime. Tables validated on- site prompt warning messages and prevent both computer crossmatch and release if blood components of the wrong ABO type are selected. Results: These SOPs meet the requirements of the 15th edition of the AABB Standards. Projected annual time savings at this institution are > 100,000 workload recording units. Further benefits include reduced patient sample volume requirements, less handling of biohazardous material, and elimination of unwanted positive or negative reactions associated with the immediate-spin crossmatch. Release of incompatible blood components when the wrong patient blood type is on record is addressed by requiring the use of group O red cells in the absence of two concordant blood types, one of which must be from a current sample. Conclusion: A combination of existing computer programs and carefully developed SOPs can provide a safe and efficient means of detecting donor-recipient incompatibility without performance of serologic crossmatch.     

745例患者疑难交叉配血检测结果分析

目的：回顾性分析本地区导致临床输血交叉配血不相合产生的原因,为预防溶血性输血反应,保障临床输血安全,拯救病人提供有效依据。方法：对2006-2013年番禺、南沙两区各医院因交叉配血困难而送检的标本745例检测结果进行血型鉴定、不规则抗体筛选和鉴定、交叉配血。结果：ABO血型不合引起的交叉配血不相合15例、血浆蛋白异常引起的交叉配血不相合33例,血型不规则抗体引起的151例。其中ABO血型不合引起配血不相合的A亚型12例,B亚型3例;不规则抗体引起配血不相合分别是：自身抗体57例,药物抗体7例,同种特异性抗体87例．分别为：抗-E31例、抗-cE12例、抗-c5例、抗-Ce1例、抗-M10例、抗-Mur9例、抗-E伴抗-Mur3例、抗-Le^a 5例、抗～Le^b 3例、抗-P16例、抗-Jk^b 2例。结论：本地区导致交叉配血不相合的原因主要是同种不规则抗体,异常血浆蛋白次之,最后是ABO亚型。同种不规则抗体以1Kh血型系统的抗体为主,抗-E比例最多;建议交叉配血试验不配合时,应考虑ABO血型定型是否错误,排除异常血清蛋白影响,开展不规则抗体筛选和鉴定,建立Rh系统数据库,选择相合的血液输注,预防免疫性输血反应,保障临床输血安全。     

抗球蛋白试验在疑难交叉配血过程中的重要性分析

目的通过对患者输血前血样进行抗球蛋白试验检查,查找导致临床患者配血不合的原因,配合性输注,确保临床输血安全。方法通过不规则抗体筛选试验,检测患者血清中抗体性质。结果 61例交叉配血不合患者抗球蛋白试验结果显示,由温、冷性自身免疫性抗体及冷凝集素影响配血不合30例;ABO血型系统以外不规则抗体同种免疫性抗体31例,由Rh血型系统同种免疫性抗体导致配血不合占大多数,其中与抗-E抗体有关的患者17例,占由同种免疫性抗体引起配血不合的54.84%。结论患者体内产生的ABO血型系统以外不规则同种免疫性抗体或者温、冷性自身免疫性抗体及冷凝集素等几种因素的影响,是造成临床交叉配血不合的主要原因,Rh血型抗原的复杂性和多态性应引起临床的重视,Rh血型同型输注可降低输血不良反应的发生率。     

83例疑难ABO血型鉴定及分析

目的检测和鉴定ABO疑难血型,为安全输血提供质量保障。方法采用血型血清学方法进行盐水介质正、反定型;对盐水介质正、反定型不合者使用聚凝胺法检测和不规则抗体检测;采用吸收试验和放散试验进行ABO血型的检测,以准确鉴定ABO疑难血型。结果 83例标本ABO血型检测结果为,AB亚型9例、B亚型1例、弱A抗原7例、弱B抗原6例、低抗-A效价2例、低抗-B效价3例、不规则抗体阳性7例、无抗体O型4例、低抗-B效价O型2例、无抗-B抗体A型5例;37例标本经盐水介质和Polybrine法检测,正、反定型结果符合。结论用聚凝胺法、吸收试验和放散试验进行ABO疑难血型检测,能准确、及时鉴定ABO疑难血型。     

36例ABO血型亚型检测及血清学分析

目的对本院2008～2011年36例ABO血型亚型患者及献血者进行血型血清学分析,以探讨ABO亚型的分布状况及亚型患者的临床输血安全。方法采用输血相容性检测实验室全自动血型/配血系统、试管法检测ABO正反定型,通过检出血清中不规则抗-A、抗-B,吸收放散试验等方法进行ABO血型亚型的鉴定。结果 36例ABO血型亚型中有12例A亚型,23例B亚型和2例cisAB亚型。结论准确鉴定ABO血型亚型对于降低亚型患者输血治疗风险有重要意义。     

A proposal for compatibility testing incorporating the manual hexadimethrine bromide (Polybrene) test

In November 1984, the Standards Committee of the American Association of Blood Banks changed the requirements for pretransfusion testing by making the performance of an antiglobulin crossmatch optional when the antibody screening test is negative. The crossmatch would be necessary only to confirm ABO compatibility. Many will welcome this change; others will persist in their current methods. This article presents data supporting the use of the manual hexadimethrine bromide (Polybrene) test, a 1-minute room temperature procedure, as a crossmatch technique when the antibody screening test is negative. The manual Polybrene test (MPT) is an effective method for detecting ABO incompatibility. Forty-seven randomly selected serums gave expected results with A1, A2, and B red cells. Only 66 percent of 84 group B sera were serologically incompatible with A2B red cells by MPT, but the same results (69% positive) were observed using a 5-minute low-ionic-strength solution (LISS) room temperature technique. As only 37 percent of these crossmatches were incompatible using a LISS immediate spin (IS) method, the reliability of an IS method is questioned. An MPT crossmatch provides added security in that most unexpected blood group antibodies are demonstrable by this method. Of 106 serums tested which contained antibodies, 83 reacted. We believe that the MPT provides a rapid and sensitive test that, accompanied by a carefully performed antibody screening test, meets the requirements of Standards and will provide for safe red cell transfusion without the need for an antiglobulin crossmatch.     

国内医疗机构胎儿新生儿溶血病免疫血液学检测情况分析

目的 调查目前国内胎儿新生儿溶血病(hemolytic disease of fetus and newborn,HDFN)实验室免疫血液学检测的开展情况,为制定HDFN实验室检测操作规范、检测标准及专家共识提供依据,以提高国内HDFN实验室检测水平.方法 编写《胎儿新生儿溶血病实验室检测情况调查表》,并向国内医疗机构...