抗-cE及抗-Jk^b和抗-Mur混合抗体致疑难配血分析——附1例报告

目的探讨1例疑难交叉配血不合的原因。方法通过ABO血型鉴定、Rh分型、直接抗人球蛋白试验、不规则抗体筛查、抗体特异性鉴定及抗体效价测定对患者配血不合进行分析。结果对照谱细胞反应格局,患者血清中检出抗-cE、抗-Jk^b和抗-Mur。结论患者血清中不规则抗体是导致交叉配血不合的主要原因。     

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。     

直接抗球蛋白试验阳性对ABO及Rh血型鉴定的干扰

直接抗球蛋白试验（DAT）阳性患者,由于红细胞上存在致敏自身抗体和/或血清中存在游离的自身抗体,干扰血型鉴定、抗体筛查及交叉配血.本文探讨DHA阳性对ABO及Rh血型定型的干扰.     

高效价低频抗-Mur漏检致疑难配血及其处理

目的 通过研究1例高效价低频抗-Mur漏检导致疑难配血的处理思路与方法，提高对MNS血型系统的认识，确保临床输血的安全。方法 对交叉配血主侧不合的献血者进行直接抗人球蛋白试验，检测患者血清的不规则抗体，更换不同的患者与该献血者及不同的献血者与该患者重复交叉配血，对不规则抗体常规筛查“阴性”的患者追加谱细胞检测并根据阳性反应格局来确定抗体的类型及特异性，测定抗体效价，运用荧光PCR法对患者MNS血型系统进行基因分型。结果 交叉配血主侧4+、次侧-,更换不同患者和献血者多次交叉配血结果均相合。该献血者直接抗人球蛋白试验为阴性。患者血清中存在(IgG+IgM)型抗-Mur, IgG抗体效价128,IgM抗体效价16,MNS血型系统基因分型结果为M(+)N(+)S(-)s(+)Mur(-)。结论 不规则抗体筛查细胞存在局限性，可导致抗-Mur等低频抗体的漏检。交叉配血主、次侧不合时，我们要多方寻找原因。即使不规则抗体筛查结果呈阴性，我们也需根据不同介质、实验条件，追加谱细胞进行抗体特异性鉴定以避免低频抗体的漏检，保障临床输血的安全性和有效性。     

抗-Ec合并抗-M抗体致疑难配血实验分析

不规则抗体是指ABO血型抗体以外的血型抗体,而有临床意义的不规则抗体会导致机体发生溶血性输血反应[1]。不规则抗体的出现是引起ABO血型鉴定困难和配血困难的主要原因,而其中最常见的是与Rh血型系统相关的不规则抗体,该系统不规则抗体可单独存在,也可以联合其他抗体共同存在。本课题组在工作中发现1例由抗-Ec合并抗-M抗体引起的正反定型不符及交叉配血不合,现将试验分析过程报道如下。     

抗c和抗E抗体引起配血不合一例

目的检测对临床输血有意义的不规则抗体,保证输血安全。方法检测对临床输血有意义的不规则抗体,保证输血安全。结果患者血型为O型,CCDee,血清含抗c、抗E抗体,选择不含c、E抗原的献血者悬浮红细胞交叉配血并输注,无任何不良反应发生。结论在输血前血型血清学试验中,抗体筛选对检测抗c、抗E等临床有意义的不规则抗体,对有效避免溶血性输血反应的发生有重要意义。     

抗-E合并抗-Dia致疑难配血试验分析

不规则抗体是指除抗-A、抗-B红细胞以外的血型抗体。不规则抗体是导致溶血性输血反应、新生儿溶血病、疑难配血及血型鉴定困难的主要原因[1-2]。对献血员和患者进行抗体筛选,可避免因为找不到相合的血液给患者而延误治疗,因此抗体筛查试验在临床配血中非常重要。引起临床疑难交叉配血最常见的抗体是Rh血型系统的相关不规则抗体,该系统不规则抗体可单独存在,也可以联合其他抗体的形式存在。本实验室在工作中发现1例抗-E合并抗-Dia引起的交叉配血不合,现将试验分析过程报道如下。     

抗E抗体致配血困难1例

红细胞血型不规则抗体是引起迟发性溶血性输血反应、血型鉴定及交叉配血困难的主要原因。尽管临床输血技术规范规定：凡交叉配血不合时,有输血史、妊娠史或短期内需要接受多次输血的患者需作不规则抗体筛选,甚至不规则抗体筛查的相关文献报道也较多,但仍有一些医院血库输血前检测不规范,一些临床医生对此不够重视。现将本院在配血过程中发现的抗E抗体致配血困难的情况报道如下。     

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。     

抗-E、抗-c抗体致迟发性溶血性输血反应1例分析

目的 分析Rh血型系统中抗-E、抗-c抗体导致迟发性溶血性输血反应（DHTR）的原因和血型血清学的情况。方法 对1例输血患者,在输血前进行常规定型,发生DHTR后进行各项血液学、生化指标和血型血清学检查。结果 患者红细胞表面缺乏E、c抗原,血清中检出抗-E、抗-c抗体,血液学、生化指标的变化证实发生DTHR。结论 患者由于血型不合的妊娠为初次刺激,输注含回忆反应抗原（E抗原、c抗原）的红细胞,激发免疫应答产生不完全抗体,导致DHTR发生,提示有输血史及妊娠史的患者输血时,必须采用能检测出不完全抗体的酶、抗人球蛋白或更灵敏的方法配血,防止DHTR的发生。     

抗心磷脂抗体与反复自然流产关系的探讨

应用间接ＥＬＩＳＡ法检测１０５例反复自然流产患者血清中的抗心磷脂抗体，同时对ＡＮＡ、扩ｄｓ－ＤＮＡ、抗－Ｓｍ，抗－ＲＮＰ、ＲＦ进行了测定。结果表明：ＲＳＡ组ＡＣＡ阳性率为２８．６％，明显高于其他自身抗体及对照组（Ｐ＜０．０１），ＡＣＡ与ＲＳＡ患者的孕龄及流产次数无相关性（Ｐ＞０．０５），三种类别Ｉｇ中，以ＩｇＧ、ＩｇＧ、ＩｇＭ型ＡＣＡ检出率较高，中等或高水平的阳性结果占３３．３％（１０／３０），其     

Human leukocyte differentiation antigens as therapeutic targets: the CD molecules and CD antibodies

The cell membrane presents an attractive target in a number of different disease situations. Most obviously, malignant cells may be killed by damaging their cell membranes. There are also more subtle, though effective, ways of rendering cells harmless by engaging proteins at the cell surface. The cells of the immune system may be targeted, for example to stop a damaging immune reaction, such as acute inflammation or rejection of a transplanted organ. If we are to make the best use of the opportunities to modulate disease by targeting the cell membrane, we need a detailed understanding of the many proteins, glycoproteins and glycolipids that are attached to or inserted in the cell membrane. The CD (cluster of differentiation) Workshops, more properly known as the HLDA (Human Leukocyte Differentiation Antigens) Workshops have, since 1982, focussed on the study of the membrane molecules of leukocytes, including the major cells of the immune system and malignant cells derived from them. The scope has extended to molecules on endothelium which are important in interaction with leukocytes. Many of the molecules characterised as leukocyte antigens are also expressed on other tissue. The approaches developed by the HLDA Workshops are useful in the study of the molecular composition and function of cells of other organ systems. Some of the antibodies produced in order to study the CD molecules have proved useful as therapeutic agents. This review describes the CD system, how it has developed and what it means and introduces the field of therapy based on antibodies against CD or similar molecules. The author is responsible for organising the next (8th) HLDA Workshop and invites readers to suggest ways in which the therapeutic relevance of the Workshop may be enhanced.     

乙型肝炎患者血清自身抗体检测的研究

目的　检测乙型肝炎患者血清自身抗体并分析其临床意义。方法　以 HEP- 2细胞、鼠胃和鼠肾组织为抗原 ,采用间接免疫荧光法对 1 1 7例乙型肝炎患者血清及 30例正常人血清作抗核抗体、抗平滑肌抗体和抗线粒体抗体检测。结果　乙型肝炎患者自身抗体总阳性率为 1 8.8% ,高于正常对照组 ,差异有显著性 (χ2 =4.1 9,P<0 .0 5 )。自身抗体以低滴度为主 ,多见于抗平滑肌抗体和抗核抗体。结论　乙型肝炎患者存在多种自身抗体 ,观察其自身抗体的滴度与类型对乙型肝炎患者的治疗有一定的参考价值。     

ANA,抗ds—DNA,抗ENA谱联合检测在诊断SLE病人中的应用

为了提高ＳＬＥ的检出率,应用免疫荧光法、金标法和免疫印迹法联合检测５０例ＳＬＥ患者血清中的ＡＮＡ、Ｄｄｓ－ＤＮＡ和ＥＮＡ谱,其结果单一检测阳性率为６０％－７４％,而联合检测的阳性率为９０％,表明联合检测在ＳＬＥ诊断中肯互补性,并能提高检出率。     

Anticardiolipin antibodies in migraine

Antiphospholipid antibodies have occasionally been observed in small series of migraine patients, possibly signalling an immunological pathogenesis in a subgroup. We have measured anticardiolipin antibody levels in a series of 94 migraine patients (35 patients having migraine with aura, 59 without aura), during acute attacks and between attacks. Platelet counts were normal and VDRL was negative in all patients. A low positive anticardiolipin antibody level was found in only one patient, which was negative six months later. There appears to be no association between the presence of anticardiolipin antibodies and migraine. Antiphospholipid antibodies are unlikely to have a material pathogenetic role. Statistically, the incidence of significantly raised anticardiolipin antibody levels in this group of patients does not exceed 4% at a 95% probability level.     

Prevalence of antiphospholipid and antiplatelet antibodies in human immunodeficiency virus (HIV)-infected Chilean patients

Antiphospholipid (aPL) and antiplatelet (aPlt) antibodies, found in patients with autoimmune diseases, are also detected in infectious diseases. The purpose of this study was to examine the prevalence of these antibodies in HIV patients and to evaluate an association of these antibodies with thrombocytopenia and/or thrombosis. Sixty-three HIV-seropositive patients and 52 normal controls were studied. Anti-cardiolipin (aCL), anti-beta(2) glycoprotein I (anti-beta(2)GPI), and antiprothrombin (aPT) antibodies were determined and the lupus anticoagulant (LA) test was performed. Antiplatelet antibodies (aPlt) were also determined. Seven out of 63 (12.7%) HIV patients were positive for aCL, four of 63 (6.3%) for anti-beta(2)GPI, and five of 63 (7.9%) for aPT. No patients studied were LA positive. Six out of 63 (9.5%) patients were positive for aPlt. One of them showed weak reactivity for GPIb-IX. The platelet count of patients (202+/-63 x 10(3) platelets/microL) was significantly lower than in the controls (343+/-6 x 10(3) platelets/microL) (P<0.001). There was no correlation between the presence of aPL and/or aPlt and thrombocytopenia. Of the HIV-infected patients, 22.2% presented aPL and 9.4% aPlt antibodies. In this study, the presence of aPL and aPlt antibodies was not associated with the development of thrombosis and/or thrombocytopenia.     

Therapeutic plasma exchange as a steroid‐sparing therapy in a patient with limbic encephalitis due to antibodies to voltage‐gated potassium channels

Autoantibodies to the voltage‐gated potassium channel (VGKC) complex cause a spectrum of non‐paraneoplastic neurologic syndromes including limbic encephalitis (LE). We report a case of a man with LE who underwent a course of therapeutic plasma exchange (TPE) in addition to other immunomodulatory therapies and experienced sustained clinical resolution of his symptoms. This report adds to the existing literature supporting TPE in cases of LE due to VGKC complex autoantibodies. J. Clin. Apheresis 31:63–65, 2016. © 2015 Wiley Periodicals, Inc.     

Association of CagA-Dositive infection with Helicobacter pylori antibodies of IgA class

cagA gene, the best known virulence factor of Helicobacter pylori, codes for an immunodominant CagA protein. In this study, CagA antibodies of the IgG class were measured by immunoblot or enzyme immunoassay in subjects with positive H. pylori serology, and the presence of CagA antibodies was compared with that of H. pylori antibodies of IgA and IgG classes. Serum samples were available for a total of 1481 subjects, including gastroscopied patients with biopsy-verified H. pylori infection, smoking men with a normal or low serum pepsinogen I level indicating atrophic corpus gastritis, and subjects who later developed gastric cancer and their matched controls. CagA antibodies were significantly more prevalent among individuals with elevated H. pylori antibody titres of the IgA class than in those with IgG antibodies only, with the exception of a small subgroup of individuals who later developed gastric cancer. CagA-positive H. pylori strains seem to induce an immune response with a markedly higher frequency of IgA than what is found in inflammation caused by CagA-negative strains. The presence of serum IgA antibodies to H. pylori seems to indicate a higher risk for CagA-positive H. pylori infection and possibly more severe late sequelae of the disease.     

Prevalence of antiphospholipid antibodies in Chilean patients with rheumatoid arthritis

Antiphospholipid (aPL) antibodies found in patients with autoimmune diseases are also detected in those with inflammatory diseases. The purpose of this study was to examine the prevalence of these antibodies in patients with rheumatoid arthritis (RA), and to evaluate the association of these antibodies with thrombosis and/or other clinical characteristics of this inflammatory disorder. Eighty-four patients with RA and 82 normal controls were studied. Anticardiolipin (aCL), anti-beta(2) glycoprotein I (anti-beta(2)GPI), and antiprothrombin (aPT) antibodies and the lupus anticoagulant (LA) activity were determined. Seven out of 84 (8.3%) patients were positive for aCL, six out of 84 (7.2%) for anti-beta(2)GPI, and six out of 84 (7.2%) for aPT, while in controls the overall prevalence of aPL antibodies was 3.6% (3 out of 82). All patients and controls were LA negative. There was no correlation between the presence of aPL with thrombosis and/or other clinical features of the antiphospholipid syndrome. We found aPL antibodies in 19.1% (16 out of 84) of the patients with rheumatoid arthritis and this prevalence was statistically higher than in normal controls (P<0.003). In this study, the presence of aPL antibodies was not associated with the development of thrombosis and/or thrombocytopenia. Whether the presence of aPL antibodies implies an increased risk for thrombosis and atherosclerosis in these patients should be studied further.     

原发性胆汁性肝硬化85例实验室检测指标的分析

目的探讨原发性胆汁性肝硬化（PBC）的免疫学实验诊断特点。方法观察85例PBC患者的临床表现,并分析有关实验室检查资料。结果本组患者临床症状不典型。所有患者γ-谷氨酰转移酶（GGT）升高,98．8％（84／85）的患者碱性磷酸酶（ALP）升高,87．1％（74／85）的患者总胆红素（TBil）和结合胆红素（CBil）升高,81．2％（69／85）的患者丙氨酸转氨酶（ALT）、78．8％（67／85）的患者门冬氨酸转氨酶（AST）、52．9％（45／85）的患者球蛋白（GLB）、95．7％（22／23）的患者总胆汁酸（TBA）、84．0％（21／25）的患者高密度脂蛋白胆固醇（HDL-C）升高。自身抗体检测有59例抗核抗体（ANA）阳性（69％）,其中32例为核膜型,20例为着丝点型;85例患者抗线粒体抗体（AMA）均为阳性,其中80例（94．1％）AMAM2阳性。结论PBC无典型性临床症状,医生可以通过临床表现结合AMA,尤其是AMAM2的检测结果获得诊断信息。