血型血清学检测在急性白血病病人非清髓异基因外周血干细胞移植中的意义

为了探讨ABO血型不合的急性白血病非清髓性异基因外周血干细胞移植中红细胞血型血清学检测的临床意义。采用红细胞凝集试验方法检测供，受ABO和MN血型，用Diana Gel phenotypeRh卡检测Rh血型，移植后观察受血型和红细胞凝集素效价变化以及用STR-PCR方法监测供细胞植入情况。结果显示，4例受中2例供细胞混合嵌合伴血型嵌合，其中1例在移植后100天转为完全嵌合，血型亦转为供型，另2例受细胞呈供，受混合嵌合体，但血型未见转变，其中1例在移植后154天出现移植排斥，红细胞凝集素效价检测显示，受红细胞凝集素效价高，供细胞植入率低，血型不易嵌合，反之，效价低，供细胞植入率高，血型易嵌合。结论：在非清髓外周血干细胞移植（NAPBSCT）中红细胞血型血清学检测可间接反映移植效果。协助确定临床预处理方案和移植后免疫抑制治疗的强度，估计预后，指导移植期的输血。

Significance of Serological Test of Blood Group in Nonmyeloablative Allogeneic Peripheral Blood Stem Cell Transplantation of Patients with Acute Leukemia

The purpose of this study is to explore the clinical significance of RBC blood group serological test in nonmyeloablative allogeneic peripheral blood stem cell transplantation(NAPBSCT) of ABO group incompatibility in 4 patients with acute leukemia. ABO and MN blood group of donors and recipients were determinated by hemagglutination test and Rh blood group by Diana Gel phenotype Rh card. The changes of blood group in recipients were observed and implant of donor cells was monitored by short tandem repeat PCR method. The results showed that in 2 cases of 4 recipients the marrow cells appeared mixed chimera of donor and recipient cells, and blood group changed to donor type in 1 of the 2 cases on 100 days after transplantation. In another 2 cases, the marrow cells appeared mixed chimera without blood group chimera on 154 days after transplantation, and rejection of the transplant occurred in 1 of the 2 cases. The determination of hemagglutinin titer showed that the implant rate of donor cells was lower in the recipients with higher hemagglutinin titer and blood group chimera did not appear, conversly, the implant rate was higher in the recipients with lower titer and blood group chimera appeared early. It is concluded that examination of RBC blood group in NAPBSCT can indirectly reflect effectiveness of transplantation, contribute to decide the intensity of conditioning protocol and immunosuppressive therapy after transplantation, estimate prognosis and guide blood transfusion during transplantation.