罕见抗LW抗体自身免疫性溶血性贫血合并新生儿溶血病患者的输血策略  

Transfusion Strategy for Rare Anti-LW Antibody Autoimmune Hemolytic Anemia Patients with Neonatal Hemolytic Disease

作　　者：田冬冬 赵鼎 李志浩 李巍[1] 杨佳丽 张笑盼 郑留闯 TIAN Dong-Dong;ZHAO Ding;LI Zhi-Hao;LI Wei;YANG Jia-Li;ZHANG Xiao-Pan;ZHENG Liu-Chuang(Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,Henan Province,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院,河南郑州450018

出　　处：《中国实验血液学杂志》2021年第6期1935-1939,共5页Journal of Experimental Hematology

摘　　要：目的:分析自身免疫性溶血性贫血合并新生儿溶血病患者不规则抗体筛选试验阳性及交叉配血不相合的原因,准确鉴定患者抗体类型,为其选择合理的输血方案。方法:选取一例患儿,使用试管法和微柱凝胶卡分别进行血型正反定型、Rh分型、直接抗人球蛋白试验、游离试验、放散试验和交叉配血试验;分别用经二硫苏糖醇(DTT)处理和未经处理的谱细胞与患者血浆反应,鉴定患者不规则抗体。结果:该患儿血型为B型RhD阳性、不规则抗体筛查阳性,其母亲血型为O型RhD阳性、不规则抗筛阴性,患者血浆中检出的抗-LW为自身抗体,同时存在ABO新生儿溶血病(ABO-HDN)。选择O型RhD阳性洗涤红细胞和B型RhD阴性红细胞均输注有效。结论:患儿体内不规则抗体为抗-LW抗体,排除ABO-HDN后输注同型RhD阴性悬浮红细胞效果较好。Objective: To analyze the causes of positive irregular antibody screening test and incompatibility of cross matching in one patient with autoimmune hemolytic anemia complicated with neonatal hemolytic disease,and to accurately identify the type of antibodies in patients,and to select a reasonable strategy for blood transfusion. Methods:One children was enrolled,blood group positive and reverse typing,Rh typing,direct anti-human globulin test,free test,dispersal test and cross matching test were carried out by test tube method and microcolumn gel card;irregular antibodies were identified by the reaction of DTT treatment and untreated panel cells with patients’ plasma. Results: The blood group of the patient was RhD positive B and irregular antibody screening positive,while the blood group of the mother was RhD positive O and irregular anti-screening negative,the result showed that the anti-LW detected in the plasma of the patient was autoantibody and ABO neonatal hemolytic disease( ABO-HDN) was present. Both O type RhD positive washing RBCs and B type RhD negative RBCs were transfused effectively. Conclusion: Irregular antibodies in patients are anti-LW antibodies,and transfusion of homotype RhD negative suspended erythrocytes after the exclusion of ABO-HDN shows a better effect.

关 键 词：自身免疫性溶血性贫血 抗体鉴定 抗-LW抗体 新生儿溶血病 输血策略 

分 类 号：R457.1[医药卫生—治疗学] R446.6[医药卫生—临床医学]