混合抗体型自身抗体干扰同种抗体鉴定研究  

How autoantibodies interfere with the identification of alloantibodies

作　　者：朱婷文 黄蓉[2] 刘凤霞[2] 李玉娇[1] 颜芝[1] 桂嵘[2] ZHU Tingwen;HUANG Rong;LIU Fengxia;LI Yujiao;YAN Zhi;GUI Rong(Department of Blood Transfusion,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Blood Transfusion,the Third Xiangya Hospital of Central South University)

机构地区：[1]新疆医科大学第一附属医院输血科,新疆乌鲁木齐830054 [2]中南大学湘雅三医院输血科

出　　处：《中国输血杂志》2021年第8期813-817,共5页Chinese Journal of Blood Transfusion

摘　　要：目的探讨准确鉴定混合型自身免疫性溶血性贫血(AIHA)患者同种抗体/自身抗体特异性的技术方法,为献血者血液成分选择提供指导。方法根据直接抗人球蛋白分型试验筛选混合型AIHA患者血液标本,用稀释法或吸附法等方法处理患者血浆/清后行同种/自身抗体特异性鉴定,红细胞经放散后行同种/自身抗体特异性鉴定。根据抗体鉴定结果选择合适表型的红细胞输注,观察输血不良反应的发生率及输注疗效。结果16例患者中有14例患者血清/放散液中检出同种抗体/自身抗体特异性的。10例患者在住院期间有输血,均选择与患者ABO同型/RhD同型或相容且避开针对同种抗体/自身抗体特异性抗原的红细胞输注,均未发生溶血性输血反应,且输血后贫血症状有所改善。结论选择合适的方法可以消除混合型AIHA患者的自身抗体对同种抗体鉴定的影响,从而选择合适的献血者血液对此类患者进行输血治疗,可有效避免溶血性输血不良反应的发生。Objective To explore a method to accurately identify the specificity of alloantibodies or autoantibodies in autoimmune hemolytic anemia(AIHA)patients with both warm and cold antibodies,so as to provide guidance for the selection of blood components.Methods Blood samples of AIHA patients with both warm and cold antibodies were screened by the direct antiglobulin testing(DAT).The plasma of patients were treated with dilution or adsorption method and the erythrocyte was dispersed for specificity identification of alloantibodies or autoantibodies.According to the results of antibody identification,appropriate phenotype of red blood cells(RBCs)were transfused to patients,and the incidence of adverse reactions and efficacy of transfusion were observed.Results Alloantibodies or specific autoantibodies were detected in serum or elution in 14 of the 16 patients.10 patients underwent blood transfusion during hospitalization,and all of them received RBCs with the same or compatible ABO/Rh(D)type as the patients and without any reaction to the alloantibodies and specific warm autoantibodies.No hemolytic reaction occurred,and anemia symptoms were improved after blood transfusion.Conclusion The selection of appropriate methods could eliminate the influence of autoantibodies on the identification of alloantibodies in AIHA patients with both warm and cold antibodies.Therefore,the selection of blood from compatible donors for transfusion could effectively avoid the occurrence of hemolytic reaction.

关 键 词：混合型自身免疫性溶血性贫血 同种抗体 特异性自身抗体 输血反应 

分 类 号：R457.11[医药卫生—治疗学]