61例自身免疫性溶血性贫血患者血型血清学特征及输血疗效评估  

Serological Characteristics and Transfusion Efficacy Evaluation in 61 Cases of Autoimmune Hemolytic Anemia

作　　者：于洋[1] 孙晓琳[1] 马春娅[1] 关晓珍[1] 张晓娟[1] 陈麟凤[1] 王可[1] 罗圆圆[1] 王旖[1] 李明伟[1] 封艳楠[1] 佟珊[1] 于帅[1] 杨璐[1] 吴月清[1] 庄远[1] 潘纪春[1] 冯倩[1] 张婷[1] 汪德清[1] 

机构地区：[1]解放军总医院输血科,解放军临床输血中心,北京100853

出　　处：《中国实验血液学杂志》2013年第5期1275-1279,共5页Journal of Experimental Hematology

摘　　要：本研究旨在分析自身免疫性溶血性贫血患者的血型血清学特征及红细胞不相容输注的疗效及安全性。通过回顾性分析特发性(21例)或继发性自身免疫性溶血性贫血患者(40例)血型血清学特征、输血不良反应发生情况,按照自身抗体类型、接受不同红细胞成分分别评价不相合输血疗效和安全性。结果表明:61例中单独IgM类冷自身抗体8例(13.1%),单独IgG类温自身抗体50例(82.0%),IgM冷自身抗体联合IgG温自身抗体3例(4.9%),合并存在同种抗体18例(29.5%);其中36例自身免疫性溶血性贫血患者在排除同种抗体干扰情况下共进行不相合红细胞输注113次,总有效率56.6%,总部分有效率15.1%,总无效率28.3%。按输注红细胞成分差异分为ABO同型非洗涤红细胞组和O型洗涤红细胞组,ABO同型非洗涤红细胞组有效率57.6%,部分有效率13.0%,无效率29.4%;O型洗涤红细胞组有效率53.6%,部分有效率21.4%,无效率25.0%,两组输注疗效比较差异无显著性(P>0.05)。按患者自身抗体类型分为IgM冷自身抗体组和IgG温自身抗体组,其中IgM冷自身抗体组有效率46.2%,部分有效率30.8%,无效率23.0%;IgG温自身抗体组有效率56.7%,部分有效率13.4%,无效率29.9%,两组输注疗效比较差异无显著性(P>0.05)。所有输血病例均无溶血性输血反应发生。结论:对于重度贫血的自身免疫性溶血性贫血患者在排除同种抗体干扰的情况下,采用同型非洗涤红细胞或O型洗涤细胞输注都是相对安全的,两种方式疗效差异无显著性,选择同型非洗涤红细胞输注更方便、快捷,还能避免O型红细胞的过度使用。This study was aimed to analyze the serological characteristics, efficacy and safety of incompatible RBC transfusion in patients with autoimmune hemolytic anemia （AIHA）. The patients with idiopathic or secondary AIHA were analyzed retrospectively, then the serological characteristics and the incidence of adverse transfusion reactions were investigated, and the efficacy and safety of incompatible RBC transfusion were evaluated according to the different au- toantibody type and infused different RBC components. The results showed that out of 61 cases of AIHA, 21 cases were idiopathic, and 40 cases were secondary. 8 cases （13.1%） had IgM cold autoantibody, 50 cases （82.0%） had IgG warm autoantibody, and 3 cases （4.9%） had IgM and IgG autoantibodies simultaneously. There were 18 cases （29. 5% ） combined with alloantibodies. After the exclusion of alloantibodies interference, 113 incompatible RBC transfu- sions were performed for 36 patients with AIHA, total efficiency rate, total partial efficiency rate and total inefficiency rate were 56.6%, 15.1% and 28.3%, respectively. Incompatible RBC transfusions were divided into non-washed RBC group and washed RBC group. The efficiency rate, partial efficiency rate and inefficiency rate in non-washed RBC group were 57.6%, 13.0% and 29.4% , respectively. The efficiency rate, partial efficiency rate and inefficiency rate in washed RBC group were 53.6%, 21.4% and 25.0%, respectively. There was no significant difference of transfusion efficacy （ P 〉 0.05） in two groups. Incompatible RBC transfusions were also divided into IgM cold autoanfibody group and IgG warm autoantibody group. The efficiency rate, partial efficiency rate and inefficiency rate in IgM cold autoanti- body group were 46.2%, 30.8% and 29.4%, respectively. The efficiency rate, partial efficiency rate and inefficiency rate in IgG warm autoantibody group were 56.7%, 13.4% and 29.9%, respectively. There was no significant differ- ence of transfusion efficacy （ P 〉 0.05 ） in two groups.

关 键 词：自身免疫性溶血性贫血 输注疗效 自身抗体 同种抗体 

分 类 号：R556[医药卫生—血液循环系统疾病] R457.1[医药卫生—内科学]