自身免疫性溶血性贫血患者抗-LW抗体和自身抗-D抗体鉴定及输血策略  

Identification and transfusion strategies of anti-LW antibody and autoantibodies with anti-D in patients with autoimmune hemolytic anemia

作　　者：张静[1] 王素玲[1] 乔芳[1] 赵佳[1] 胡光磊[1] 王振雷[1] ZHANG Jing;WANG Suling;QIAO Fang;ZHAO Jia;HU Guanglei;WANG Zhenlei(Hebei Blood Center,Shijiazhuang,050071,China)

机构地区：[1]河北省血液中心,石家庄050017

出　　处：《临床血液学杂志》2022年第10期748-751,共4页Journal of Clinical Hematology

摘　　要：目的:对自身免疫性溶血性贫血(AIHA)患者的不规则抗体进行鉴定分析,为其制定输血策略,指导临床科学合理用血。方法:在河北省血液中心进行疑难交叉配血的AIHA患者2例,分别采用试管法和微柱凝胶法对其进行ABO血型和Rh血型鉴定、直接抗球蛋白试验(DAT)、抗体筛查试验及交叉配血试验,采用二硫苏糖醇(DTT)处理和未经处理的谱细胞鉴定患者血浆抗体特异性。结果:2例患者均为RhD抗原阳性,DAT及抗体筛查试验阳性,其中1号患者血浆与DTT未处理谱细胞反应呈抗-D特异性,与DTT处理后谱细胞反应结果呈全阴性;2号标本血浆与DTT处理及未处理谱细胞反应均呈阴性。2例患者与同型RhD阴性红细胞均呈交叉配血相合状态。结论:1号患者体内的不规则抗体为抗-LW抗体,2号患者抗体为自身抗-D抗体,此类AIHA患者均可输注同型RhD阴性悬浮红细胞。Objective: To identify and analyze irregular antibodies in patients with autoimmune hemolytic anemia(AIHA), in order to make the blood transfusion strategy and guide clinical scientific and rational blood use. Methods: A total of 2 cases with autoimmune hemolytic anemia who took difficult cross matching in our center were carried on ABO positive and negative stereotyping and Rh group typing, direct anti-human globulin test(DAT), antibody screening and cross match test by test tube and microcolumn gel method, respectively. The antibodies in serum of patients were identified by dithiothreitol(DTT) treated and untreated panel cells. Results: The two patients were both positive for RhD antigen, DAT and antibody screening test. Among them, the plasma of patient 1 showed anti-D-specific reaction with untreated DTT panel cells, and all negative reaction with treated DTT panel cells. The plasma of patient 2 showed negative reaction with both DTT treatment and untreated panel cells. Both patients were compatible with their RhD negative blood of the same type. Conclusion: The antibody in patient 1 and patient 2 was anti-LW antibody and autoanti-D antibody, respectively. Such AIHA patients could be transfused with the same type of RhD negative suspended red blood cells.

关 键 词：自身免疫性溶血性贫血 自身抗-D抗体 抗-LW抗体 抗体鉴定 输血策略 

分 类 号：R556[医药卫生—血液循环系统疾病]