抗-Ⅰ引起配血不合的处理及治疗38例  

Crossmatch incompatibility caused by anti-I antibody: 38 cases, containing 1 rare case of adult i blood group producing anti-Ⅰ

作　　者：曹微微[1] 李碧娟[1] 李宁[1] CAO Weiwei;LI Bijuan;LI Ning(Department of Blood Transfusion,Xiangya Hospital,Central South University,Changsha,410008,China)

机构地区：[1]中南大学湘雅医院输血科,湖南长沙410008

出　　处：《中国输血杂志》2021年第1期36-39,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨血型抗体抗-Ⅰ对于血型鉴定以及临床输血安全的影响并了解自身冷抗体抗-Ⅰ及同种抗体抗-Ⅰ的差异及其处理方法。方法选取2016年1月~2019年7月中南大学湘雅医院38例抗-Ⅰ阳性患者作为研究对象,其中包括1例罕见成人i血型产生同种抗-Ⅰ。采用抗人球蛋白法及盐水试管法进行不规则抗体的筛查和鉴定,并对临床输血效果进行评价。结果 38例抗-Ⅰ包括自身抗-Ⅰ37例及同种抗-Ⅰ1例,其中抗-Ⅰ34例,抗-Ⅰ合并同种抗体4例。4℃条件下,29例抗Ⅰ效价在32~512之间,2例抗Ⅰ效价>1 024。37例产生自身冷抗体患者红细胞经37℃生理盐水洗涤及血清经4℃冷吸收处理后,血型鉴定正反定型一致,交叉配血相合。输血后的效果评估除一例输注后Hb上升不明显,其余37例均有效。成人i血型患者红细胞经上述相同方法处理后,血型鉴定正反定型一致为B型;反定型增加脐血ABO型红细胞确认i血型。该例成人i型患者体内所产生的天然IgM同种抗-Ⅰ效价为256,输血原则为自身输血。结论产生低温反应性抗-Ⅰ患者输血治疗应采用加温缓慢输注,并密切关注患者状态。产生同种-I成人i血型患者输血原则为自身输血,若患者大量失血缺乏i型血液,首选年龄大的I血型供血者;还可做血浆置换,暂时性移除抗-Ⅰ。Objective To investigate treatments of discrepancy presented in blood typing and cross-matching test caused by anti-I antibody and the difference between autoanti-I antibody and alloanti-I antibody. Methods 38 cases of I-positive antibody in our hospital from January 2016 to July 2019 were selected as the research subjects. The irregular antibodies screening and identification were performed by adopting the anti-human globulin and saline test tube method,and the blood transfusion effect was evaluated. Results 37 cases of autoanti-I antibody and 1 case of alloanti-I antibody, with specificity produced by an individual with a rare i blood group, were identified. 34 cases contained I-positive antibody and 4 contained I-positive antibody combined with alloantibodies. At 4 ℃, most of the anti-I titers were between 32 and 512, 2 cases were more than 1 024. After the RBCs were washed with 37℃ normal saline and cold absorbed at 4℃, the cross-matching tests were matched and 37 cases of blood transfusion were all effective except for one case. After performing the same treatment on i adult red blood cells and adding I antigen-negative cord blood cells, the result was correct to be B type. The titer of IgM alloanti-I antibody in this adult was 256, and autotransfusion was preferred.Conclusion Patients with anti-I antibody, reactive at low temperature, should be treated with warm and slow transfusion under close monitoring. Autotransfusion is, in principle, beneficial to adult i blood group patients producing alloanti-I antibody. If i blood patients suffered from massive blood loss without suitable blood resource available, the elderly i blood donors were preferred, and plasmapheresis may also be an alternative to remove anti-I temporarily.

关 键 词：冷自身抗体 同种抗体 抗-Ⅰ 成人i血型 

分 类 号：R457.11[医药卫生—治疗学]