CRRT机血浆置换预防儿童ABO血型不合骨髓输注的溶血反应  

Prevention of the hemolysis in ABO-incompatible unrelated donor bone marrow transplantation by plasma exchange

作　　者：常平[1] 朱为国[1] 曾其毅[2] 郑亦男[2] 张传仓[1] 封志纯[1] 

机构地区：[1]南方医科大学珠江医院儿科,广东广州510280 [2]广州市儿童医院,广东广州510120

出　　处：《小儿急救医学》2005年第6期453-455,共3页Pediatric Emergency Medicine

基　　金：广州市科委重大攻关课题;2003Z2-E0181

摘　　要：目的观察血浆置换技术在ABO血型主侧不合的非亲缘异基因供髓骨髓移植中的应用价值。方法对3例ABO血型主侧不合非亲缘供髓骨髓移植的患儿进行血浆置换,均先置换6%羟乙基淀粉注射液500 ml,再根据体重大小置换不同剂量的AB血型血浆,以去除血浆抗红细胞抗体,防止异型骨髓输注ABO血型不合的溶血反应,检测血浆置换前后受者血浆抗红细胞抗体浓度并观察溶血反应。结果血浆置换后,3例患儿血浆抗红细胞抗体IgM抗体滴度分别由最高1:1 024、1:32、1:256降为1:8、1:0、1:0,IgG抗体滴度分别由1:256、1:32、1:128降为1:16、1:0、1:4,分别输注ABO血型主侧不合骨髓680 ml8、00 ml1、000 ml,仅1例发生轻微急性溶血反应,未出现迟发性溶血反应,3例患儿均植入成功,其中1例发生Ⅰ度、2例发生II度急性移植物抗宿主病(皮肤型)。结论血浆置换是预防ABO血型主侧不合骨髓移植溶血反应的安全有效的方法。Objective To explore the value of plasma exchange in preventing the hemolysis of ABO- incompatible unrelated donor bone marrow transplantation. Methods Three children accepted plasma exchange before ABO-incompatible unrelated donor bone marrow transplantation, The plasma of the recipients were replaced by 500 ml 6% hydroxyethyl starch first and then different quantity of AB type plasma from other health bodies according to the recipients＇ body weight. Results The isohemagglutinin IgM titers of the three children reduced from 1 ： 1 024,1 ： 32,1 ： 256 to 1 ： 8,1 ： 0,1 ： 0 after plasma exchange and the isohemagglutinin IgG titers from 1 ： 256,1 ： 32,1 ： 128 to 1 ： 16,1 ： 0,1 ： 4 Only a slight acute hemolysis occurred in one child when be transfused with 680 ml,800 ml, 1 000 ml of ABO-incompatible unrelated donor bone marrow respectively, the others were normal. All the three children were engrafted. Conclusion Plasma exchange can prevent the hemolysis in ABO-incompatible unrelated donor bone marrow transplantation.

关 键 词：骨髓移植 血浆置换 ABO血型不合 溶血反应 

分 类 号：R457[医药卫生—治疗学]