肺炎链球菌导致T多凝集红细胞的确认及血浆置换策略  

Severe Streptococcus pneumoniae-associated red blood cell T-polyagglutination and plasma exchange strategy

作　　者：刘德龙[1] 吴思梦[1] 范诗晴 谢文举 赵晓琳 王秋实[1] LIU Delong;WU Simeng;FAN Shiqing;XIE Wenju;ZHAO Xiaolin;WANG Qiushi(Department of Blood Transfusion,Shengjing Hospital of China Medical University)

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004

出　　处：《中国输血杂志》2022年第7期728-731,共4页Chinese Journal of Blood Transfusion

基　　金：辽宁省科技厅课题(2021JH2/10300045)。

摘　　要：目的 明确T多凝集鉴定方法,并选择配合的冰冻血浆用于血浆置换。方法 通过红细胞与植物血凝素、成人血清和脐带血血清反应结果,加入凝聚胺后是否会红细胞聚集,以及MN抗原表达确定是否存在T多凝集。对确定存在T多凝集的患者,采取盐水介质次侧配血方法选择不含抗-T或者效价低的冰冻血浆进行血浆置换。结果 3例肺炎链球菌肺炎患儿确定出现T多凝集,表现为MN抗原一过性消失,与花生凝集素和大豆凝集素阳性反应,红细胞与成人血清阳性反应,与脐带血血清阴性反应,且在加入凝聚胺试剂后红细胞不出现聚集。结论 严重感染患者可能合并红细胞T多凝集,成人血浆中抗-T含量不同,选择不含有抗-T或者低效价抗-T的冰冻血浆用于血浆置换可以快速缓解患者病情,同时可以避免溶血性输血反应。Objective To identify and propose blood transfusion suggestions for 3 children suspected to have red blood cell T polyagglutination.Methods According to the RBC reactions with phytohemagglutinin,adult serum and cord blood serum,aggregation test with polybrene reagent and MN antigen phenotype test were carried out on 3 children to confirm the presence of T polyagglutination.The donor serum with negative or weak reactions was selected by minor cross matching for the 3 children who needed therapeutic plasma exchange(TPE).Results Three cases of RBC T polyagglutination were caused by bacterial infection,with transient appearance of MN antigen;the samples were reactive to peanut agglutinin,soybean agglutinin,adult serum but nonreactive to cord blood serum,and didn′t aggregate after adding polybrene reagent.After receiving timely TPE,the T polyagglutination gradually disappeared.Conclusion Some bacteria,such as Streptococcus pneumoniae,may cause polyagglutination of red blood cells.The patients with suspected T polyagglutination should be diagnosed in time.For T polyagglutination patients,the minor matched plasma should be used for avoiding the random plasma with anti-T antibody transfusion.

关 键 词：多凝集红细胞 T多凝集 输血 血浆置换 肺炎链球菌 溶血尿素症 

分 类 号：R457.11[医药卫生—治疗学]