ABO次要错配肺移植患者过客淋巴细胞综合征致交叉配血不合分析——附1例报告  

Blood transfusion strategy for passenger lymphocyte syndrome after solid organ transplantation

作　　者：闫慧[1] 蒋姝婷[1] 杨子怡[1] 谢静静 YAN Hui;JIANG Shuting;YANG Ziyi;XIE Jingjing(Department of Blood Transfusion,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院输血科,河南郑州450003

出　　处：《中国输血杂志》2022年第5期569-571,共3页Chinese Journal of Blood Transfusion

摘　　要：目的 分析ABO次要错配肺移植患者移植术后与同型献血者交叉配血不相合原因及治疗措施。方法 1例ABO次要错配肺移植患者(O供A)术后13d出现血红蛋白持续下降,与同型献血者配血主侧不相合,通过复查受者血型、直接抗球蛋白试验、不规则抗体筛查、谱细胞及自身红细胞放散试验分析其主侧配血不合原因。结果 复查受者血型,反定型与A_(1)红细胞试剂凝集强度为±,4℃孵育增强法凝集强度为1+;不规则抗体筛查及10系谱细胞均阴性,自身对照阳性,排除ABO以外的不规则抗体影响。直接抗球蛋白试验阳性,放散试验阳性,经检测放散出抗-A,结合患者血红蛋白持续下降、总胆红素升高等检查结果,临床确诊发生了过客淋巴细胞综合征。经输注O型洗涤红细胞6 U后,贫血症状得到纠正,未发生不良反应。结论 ABO非同型实体器官移植后,可能会发生过客淋巴细胞综合征,多数溶血症状不明显,容易忽视,临床应持续监测受体移植后直接抗球蛋白试验、血红蛋白、总胆红素等指标,早期发现及时治疗,避免引起重大不良后果。Objective To analyze the causes and treatments for the incompatible crossmatching between a patient, who underwent the minor ABO mismatches lung transplantation, and the blood donor with ABO-compatible blood.Methods A patient, who underwent the minor ABO mismatches(donor group O;recipient group A) lung transplantation developed a continuous decrease in Hb for 13 days after surgery, The blood sample of the patient presented major crossmatching incompatibility with the blood donors and the causes of it were analyzed by the recipient′s blood type reviewing, direct antiglobulin test, antibody screening and erythrocyte elution.Results The patient’s serum reacted with A_(1) erythrocyte reagent with agglutination strength at ±,and enhanced to 1+ at 4℃ after 10 min incubation.Antibodies were not detected by 10-cell panel and the effects of unexpected antibodies were excluded.The results of direct antiglobulin test and elution test were positive, and eluted anti-A antibody was detected.Combined with the patient′s continuous decline in Hb and elevated total bilirubin, passenger lymphocyte syndrome(PLS) was clinically diagnosed.After the transfusion of 6 U of O-type washed RBCs, the symptoms of anemia were improved and no adverse reactions occurred. Conclusion PLS may occur after an ABO mismatched solid organ transplantation.Most of the hemolytic symptoms are not obvious and easy to ignore, therefore clinical indicators of direct antiglobulin test results, Hb and total bilirubin should be continuously monitored after transplantation for early detection and timely treatment of PLS to avoid major adverse consequences.

关 键 词：肺移植 过客淋巴细胞综合征 交叉配血 

分 类 号：R392.4[医药卫生—免疫学] S857.134[医药卫生—基础医学]