自身抗体引起疑难配血的处理对策  

Treatment strategy for difficult blood cross matching caused by autoantibody

作　　者：刘敬闪[1] 田亚娟[1] 赵倩[1] 赵志弘[1] 张虹[1] 王振雷[1] 何路军[1] 

机构地区：[1]河北省血液中心,石家庄050071

出　　处：《临床血液学杂志（输血与检验）》2013年第5期669-670,673,共3页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:通过对自身抗体阳性引起疑难配血患者血样的血清学分析,了解自身抗体状况,探索自身抗体阳性患者的交叉配血试验对策。方法:对自身抗体引起疑难配血患者标本,采用盐水法(室温、37℃、4℃)、聚凝胺法、经典抗人球蛋白试验、微柱凝胶免疫试验等进行抗体特异性鉴定,根据患者自身抗体特性,选用不同的实验方法进行配血试验,选择合适的血液提供给临床,并观察输血效果。结果:在119例自身抗体阳性引起配血不合的标本中,温自身抗体88例(73.95%)。其中12例并发特异性同种抗体:抗-cE 7例、抗-E 2例、抗Jkb 1例、抗-Lea1例、抗-Leb 1例;9例特异性抗自身抗体:抗-Ce 3例,抗-E 2例、抗-c 1例、抗-cE 1例、抗M 1例;冷自身抗体20例(16.81%),其中1例并发抗-E抗体;温冷混合抗体4例(3.36%);高球蛋白血样引起配血不合的样本7例(5.88%)。根据自身抗体特性,采用不同的处理对策,取得满意的输血效果。结论:对于自身抗体阳性患者,不同的自身抗体特性所适用的配血实验方法是不同的。进行配血试验时,应根据抗体性质选择合适的实验方法,以排除患者血清中自身抗体的影响。Objective： To understand autoantibody status by the serological analysis for difficult blood cross matching caused by autoantibody, and explore the test strategy for positive autoantibody patients. Method： Using saline method （ room temperature, 3 7 ~C, 4 C ）, Polybrene method, Traditional antihumanglobulin test, microcolumn gel immuno assay identified the antibody specificity for autoantibody patients. According to the characteristics of autoantibodies in patients,different experimental methods were used for blood cross matching in order to choose the right blood for clinical, and the effect of transfusion was observed. Result： In 119 positive autoantibodies patients,88 samples were warm autoantibodies （73. 95 %）. Among them, 12 patients were with specific antibodies： Anti-cE 7,anti E 2, anti-Jkh 1,anti-Lea 1,anti-Leb 1. And 9 patients were with specific anti autoantibodies：anti-Ce 3, anti E 2, anti-c 1, anti cE 1, anti M 1 cases. Twenty samples were cold autoantibodies （16.81%） ,including 1 ca ses with anti E antibody. Four samples were warm and cold mixed autoantibodies （,3.36 % ） ;7 samples were hyperglobulinemia （5. 88%）. According to the characteristics of autoantibodies, using different treatment measures a chieved satisfactory effect of transfusion. Conclusion：In patients with positive autoantibodies,different autoantibod- ies characteristic for blood test would be different. In order to ensure the clinical blood transfusion safety, reasona ble and effective, we should master the indications for transfusion, to avoid unnecessary blood transfusion. For blood cross match test,we should select suitable experimental methods according to the antibody characteristic, to eliminate the autoantibodies effect in patients.

关 键 词：红细胞 自身抗体 疑难配血 实验方法 

分 类 号：R555[医药卫生—血液循环系统疾病]