温自身抗体干扰抗体鉴定的应对策略  

How to eliminate the interference of warm autoantibodies with antibody identification

作　　者：旷开其[1] 刘思圆 张宁洁 卜艳红 桂嵘 晏永和 KUANG Kaiqi;LIU Siyuan;ZHANG Ningjie;BU Yanhong;GUI Rong;YAN Yonghe(Changsha Blood Center,Changsha 410001,China;The Second Xiangya Hospital,Central South University;The Third Xiangya Hospital,Central South University)

机构地区：[1]长沙血液中心,湖南长沙410001 [2]中南大学湘雅二医院 [3]中南大学湘雅三医院

出　　处：《中国输血杂志》2021年第8期809-812,共4页Chinese Journal of Blood Transfusion

基　　金：湖南省卫生计生委科研基金课题(B2017203)。

摘　　要：目的探讨排除温自身抗体干扰的血清学方法应用于输血前相容性试验的效果。方法收集10例温自身抗体影响抗体筛查和抗体鉴定患者的血液标本(全血、血清各3 mL/例),用微热放散法、氯喹放散法或二硫苏糖醇和木瓜酶(ZZAP)试剂处理自身或同种异体红细胞,用处理后的红细胞吸收患者血浆中的自身抗体,并用吸收后的患者血浆及患者红细胞放散液行抗球蛋白法或聚凝胺法抗体鉴定,以确定自身抗体/同种抗体是否具有特异性。为存在同种抗体或特异性自身抗体的拟输血患者选用ABO/Rh同型且不含相应抗原的红细胞血液成分输注,并评估输血疗效。结果10例因原发性或继发性自身免疫性疾病导致产生的温自身抗体影响同种抗体筛查、鉴定的标本,经自身/异体吸收后均排除温自身抗体对标本同种抗体鉴定的影响,检出IgG同种特异性抗体3例(抗-e、抗-Jka、抗Wra)、特异性自身抗体1例(抗-Ce);10名患者中有6人接受输血治疗,其中4名有特异性抗体的患者输注不含相应抗原的成分血。6例分别输注悬浮红细胞2 U后,均为24 h Hb增加值>10 g/L,且均未发生溶血性输血反应,输血后贫血症状均有所改善。结论输血患者存在温自身抗体影响同种抗体鉴定时,采用合适的放散法和自体/异体吸收法可排除该种自身抗体的影响,准确鉴定抗体种类和性质,从而有针对性地给患者输血并确保疗效。Objective To investigate the effect of serological methods for eliminating the interference of warm autoantibodies with the compatibility test before blood transfusion.Methods The blood samples(whole blood and serum,3 mL/each)of 10 cases of warm autoantibodies interfering with antibody screening and identification were collected.Autogenous or allogeneic red blood cells(RBCs)were treated with microthermal(45℃),chloroquine,or ZZAP(dithiothreitol and papain)reagents,and then were used to absorb the autoantibodies in patients′plasma.The plasma after absorption and RBC elution were used for antibody identification by anti-human globulin method or Polybrene method to determine the specificity of the autoantibody/alloantibody.Blood transfusion with ABO/Rh homotypic RBCs without corresponding antigens was performed in patients with alloantibodies or specific autoantibodies,and the efficacy of blood transfusion was evaluated.Results The interferenc of warm autoantibodies with antibody screening and identification due to primary or secondary autoimmune diseases were eliminated after absorption,and IgG isospecific antibodies(anti-E,anti-Jka,anti-Wra)in 3 cases and specific autoantibodies(anti-Ce)in 1 case were yielded.6 of the 10 patients received blood transfusion,and 4 with specific antibodies avoided exposure to corresponding antigens.After transfusion of 2U suspended RBCs,the increase of hemoglobin at 24h in all 6 patients was greater than 10 g/L,and no hemolytic transfusion reaction occurred.Anemia symptoms were improved after transfusion.Conclusion Appropriate elution methods and autologous/allogeneic absorption methods can eliminate the interference of warm autoantibodies with the identification of alloantibodies,therefore can accurately identify the types and properties of antibodies,thus providing targeted and effective blood transfusion.

关 键 词：温自身抗体 红细胞血型 抗体鉴定 同种抗体 特异性自身抗体 自身免疫性溶血性贫血 

分 类 号：R457.11[医药卫生—治疗学] R556.62[医药卫生—临床医学]