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。

Analysis of the Causes of Disagreement Between ABO Blood Type Positive and Negative Types by Automatic Blood Type Instrument and Treatment Strategy

Objective To explore the causes of the inconsistency between the positive and negative stereotypes of the automatic blood type meter in the identification of ABO blood type, and to explore solutions.Methods A total of 298 ABO blood group positive and negative samples were analyzed from October 2017 to August 2018 in Suining Central Hospital. The combination of test tube method, anti-human globulin test, absorption and release experiment, irregular antibody The identification results and medical history data were analyzed and the reasons for the inconsistency were classified. Results 298 cases of positive and negative type inconsistency specimens were classified into 4 categories after accurate identification: 24.16% of the types that can be corrected (specimen, personnel operation, reagents and instrument reasons); 7.38% of antigens, including antigen attenuation and ABO subtype; Antibody attenuation accounted for 31.88%, including insufficient antibody synthesis such as infants and young children, antibody deletion such as elderly and tumor patients, accidental antibodies, etc.; other causes accounted for 36.58%, mainly autoimmune hemolytic anemia, cold agglutinin syndrome, highball Proteinemia and the like.Conclusion The quality control of the blood type pre-sample, the regular maintenance of the instrument and the replacement of the reagent red blood cells can effectively reduce the positive and negative stereotypes. The lack of antibody synthesis, autoimmune diseases and cold agglutinin syndrome are the main reasons for the ABO positive and negative stereotypes. It is recommended that the hospital conduct relevant confirmation experiments according to the possible reasons to accurately identify the ABO blood type to ensure the patient's blood transfusion safety.