深圳地区1770例疑难交叉配血标本解决方案的回顾性研究  

Solutions to cross-matching incompatibility in clinical:retrospective study of 1770 cases in Shenzhen

作　　者：苏宇清[1] 梁延连[1] 刘笑阳 吴凡[1] 彭龙 梁爽 邓志辉[1] SU Yuqing;LIANG Yanlian;LIU Xiaoyang;WU Fan;PENG Long;LIANG Shuang;DENG Zhihui(Shenzhen Blood Center,Shenzhen 518035,China;Department of Clinical Laboratory,Dalian Medical University)

机构地区：[1]深圳市血液中心,广东深圳518035 [2]大连医科大学检验医学院

出　　处：《中国输血杂志》2021年第12期1339-1342,共4页Chinese Journal of Blood Transfusion

基　　金：深圳市医疗卫生三名工程(SZSM201811092);深圳市输血医学重点学科(SZXK070);广东省医学基金(B2020179,B2021093)。

摘　　要：目的总结并探讨深圳地区最近10年临床疑难交叉配血(标本)不合原因,为提高输血疗效提供解决方案。方法收集2011年~2020年深圳地区医疗机构送本中心做疑难血型鉴定的1770例临床标本,分析其交叉配血不合的原因,确定患者血浆中意外抗体的类型,通过分类变量的统计学方法对抗体做总体率评估。以同型输血结合相容性相输的原则来提高输血的安全性。结果1)1770例疑难配血标本来源于956名患者,其中2011年~2015年疑难配血患者人均配血次数为1.32(307/232);自2016年始,疑难配血患者人均配血次数由2016年的1.27(103/81)上升至2018年的2.23(286/128),并在之后2年保持稳定。2)在956名其交叉配血不合患者中,由自身抗体或/和同种抗体阳性的比例为90.38%(864/956),包括42.26%(404/956)自身抗体合并同种抗体阳性、20.71%(198/956)单纯自身抗体阳性、27.41%(262/956)单纯同种抗体阳性;检出特异性同种抗体20种,分属于8个血型系统,其中Rh血型的55种抗体的频率达到70.82%(551/778)[抗-E(37.15%)>抗-c(20.95%)抗-C(5.27%)=抗-e(5.27%)>抗-D(2.19%);其后依次为MNS[11.40%(112/778)]、Kidd[5.66%(44/778)]、Leiws[3.21%(25/778)]、Duffy[1.80%(14/778)]、Diego[1.03%(8/778)]、P1[0.39%(3/778)]、H[0.26%(2/778)]血型系统的同种抗体。3)年龄<20岁的多次输血患者中有86%(37/43)为地中海贫血患者,均检测到自身抗体或红细胞同种抗体1~4种。结论临床交叉配血不合的原因主要是由输血或妊娠免疫导致的同种抗体、自身免疫性疾病如自身免疫性溶血性贫血引发的自身抗体干扰配血所致;临床医疗机构如遇交叉配血不合,应立即送至具有检测能力的血型参比实验室鉴定和配血,这对于保障临床安全用血与提高疗效至关重要。Objective To analyze the blood samples sent by hospitals in Shenzhen to solve ABO cross-match incompatibility during 2011 to 2020,so as to find corresponding solutions to improve the efficacy of blood transfusion.Methods The clinical data of 1770 cases of cross-match incompatibility in our laboratory from January 2011 to December 2020 were collected and reviewed.The causes of cross-match incompatibility were analyzed,the types of unexpected antibodies were determined.The overall incidence of antibodies was evaluated by statistical method of classified variables.The safety of blood transfusion was safeguarded by ABO homotype plus cross-matching compatibility.Results 1)The 1770 samples,presenting cross-matching incompatibility,involved 956 patients.The average number of cross-matching per patient from 2011 to 2015 was 1.32(307/232),which increased from 1.27(103/81)in 2016 to 2.23(286/128)in 2018,and remained stable in 2019 and 2020.2)Among 956 patients,auto-and/or allo-antibody in plasma were yielded in 90.38%(864/956),including auto-antibody plus alloantibody in 42.26%(404/956),solo auto-antibody in 20.71%(198/956)and solo allo-antibody in 27.41%(262/956).Up to 20 kinds of specific allo-antibodies were detected,belonging to 8 blood groups.Among them,70.82%(551/778)were Rh blood group,such as anti-E(37.15%)>anti-c(20.95%)>anti-C(5.27%)=anti-e(5.27%)>anti-D(2.19%),followed by MNS[11.40%(112/778)],Kidd[5.66%(44/778)],Leiws[3.21%(25/778)],Duffy[1.80%(14/778)],Diego[1.03%(8/778)],P1[0.39%(3/778)]and H[0.26%(2/778)].3)86%(37/43)of multiple transfusion recipients,aged below 20 years old,were thalassemia,and 1-4 kinds of allo-and/or auto-antibody were yielded.Conclusion The cross-matching incompatibility were mainly caused by allo-and/or auto-antibodies,which may be induced by blood transfusion,pregnancy or autoimmune diseases such as autoimmune hemolytic anemia.Those suspicious blood samples in clinical should be sent to blood group reference laboratory for further determination,in order to ensure the safety and efficacy

关 键 词：疑难配血 同种抗体 自身抗体 血型抗体频率 安全输血 

分 类 号：R457.11[医药卫生—治疗学]