直接抗人球蛋白试验在临床贫血及输血患者中的应用  

A Direct Antiglobulin Test in the Clinical Application of Anemia and Transfusion

作　　者：阳福桂 刘芳 戚志萍 李宁[1] 

机构地区：[1]湖南中南大学湘雅一附院输血科,长沙410008 [2]江西省萍乡市湘雅萍矿合作医院输血科

出　　处：《临床输血与检验》2015年第6期498-500,共3页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的研究直接抗人球蛋白试验在临床贫血及输血患者中的阳性分布率及其对临床输血效果的影响。方法采用微柱凝胶抗人球蛋白检测卡对血红蛋白含量正常的住院患者、不同血红蛋白含量的内外科住院贫血患者及接受输血患者的血液标本进行抗人球蛋白试验,对内科患者中直抗阳性检出者继续进行分型试验。结果外科贫血患者的直接抗人球蛋白阳性率为17.1%,内科贫血患者的则为40.9%,两组患者直抗阳性率的差异有统计学意义。内科住院患者63例直抗阳性者标本经分型为抗-Ig G＋抗-C3d 42例,占66.7%;抗-Ig G 12例,占19%;抗-C3d 9例,占14.3%。内科贫血患者的直抗阳性率分布以血红蛋白含量在50~59 g/L范围的阳性率为最高,达到60.9%。科室分布以消化科、重症监护科、肿瘤科、中医肾病科患者的直抗阳性率为高,均达到50%以上,直抗阳性的贫血患者的输血频率亦高于阴性患者。结论直接抗人球蛋白试验阳性是影响患者贫血状态的重要因素之一,应重视对贫血患者进行直接抗人球蛋白试验检测及分型试验,对于内科需接受输血治疗的患者,在输血治疗过程中应注重去除造成直接抗人球蛋白试验阳性的因素,以保障有效输血。Objective To study the distribution of direct antiglobulin test in positive probability of anemia and transfusion of patients and positive impact on the clinical effects of transfusion. Method Microgel Coombs test card was used for normal hemoglobin content of hospitalized patients and patients with different levels of hemoglobin who have received blood transfusions. Blood samples were subjected to anti-human globulin test; the patients with positive antibodies were given typing test. Results Anti-human globulin positive rate was 17. 1% for direct anemia of patients in surgery,positive rate was 40. 9% in the direct anti-human globulin anemia in internal medicine. Significant differences were noted in the positive rates of antibodies in the two groups of patients. Sixty three cases of hospitalized patients in internal medicine were typed for direct positive antibodies,among them,42 cases（ 66. 7%） of anti-Ig G and anti-C3 d,12 cases（ 19%） of anti-Ig G,and 9 cases（ 14. 3%） of anti-C3 d. The highest positive frequency of direct antibodies was located in the range of 50 ~ 59 g / L hemoglobin,reaching as high as 60. 9%. The positive direct antibodies were mostly seen in the patients from gastroenterology,ICU,oncology,nephrology of Chinese Medicine,reaching over 50%. A higher frequency of blood transfusion occurred in the anemia patients with direct positive antibodies than those with negative antibodies.Conclusion The direct antibody positivity with direct Coombs test is one of the factors influencing the anemiaof patients. Anti-globulin test and typing test are crucial for the diagnosis of anemia,and in the patients with blood transfusion,a false positive test should be exluded to ensure the efficient transfusion.

关 键 词：直接抗人球蛋白试验 贫血 输血 

分 类 号：R446.11[医药卫生—诊断学] R556[医药卫生—临床医学]