NEC患儿T抗原暴露导致红细胞多凝集现象的鉴定及输血策略  

Children with NEC:Report of Red Blood Cell Polyagglutination by T-antigen Exposure

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(Hebei Blood Center,Shijiazhuang,Hebei 050017)

机构地区：[1]河北省血液中心,河北石家庄050000

出　　处：《临床输血与检验》2023年第4期494-497,共4页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的探讨坏死性小肠结肠炎(necrotising enterocolitis,NEC)患儿发生T抗原暴露导致红细胞多凝集现象的鉴定方法,为其制定输血策略,为指导临床为患儿科学、合理用血提供参考依据。方法在本中心进行疑难交叉配血的2例NEC患儿,采用试管法对其进行ABO血型和Rh血型鉴定、直接抗人球蛋白试验(direct antiglobulin test,DAT)、抗体筛查试验及交叉配血试验,采用3例ABO同型献血者血浆,3例AB型献血者血浆,3例同型脐血血浆等方法发现其出现红细胞多凝集现象,并用花生凝集素、MN血型抗体鉴定试剂及凝聚胺方法鉴定其多凝集现象。结果两例患儿红细胞抗体筛查实验阴性;DAT实验阴性;交叉配血实验主侧阴性;次侧盐水法阳性,抗人球蛋白实验阳性;患儿红细胞与献血者同型血浆、AB型血浆呈阳性反应,与同型脐血血浆呈阴性反应;与花生凝集素均呈阳性反应患儿MN血型抗原均为阴性,患儿红细胞加入凝聚胺试剂不出现预期凝集现象。结论NEC患儿出现多凝集红细胞现象表现为DAT实验阴性,但是次侧交叉配血不相合现象。此时应采用多种方法鉴定其红细胞发生多凝集现象,准确识别患儿红细胞多凝集现象,选择合适的血液产品,避免延误患儿输血治疗。Objective To discuss the identification method of polyagglutination of red blood cells by T-antigen exposure in children with necrotizing enterocolitis(NEC)to formulate transfusion strategies to provide reference for clinical guidance and scientific and rational use of blood in children.Methods ABO and Rh blood group identification,direct antiglobulin test(DAT),antibody screening test and cross-matching test were performed in 2 NEC children with difficult cross-matching difficulty in our center.Erythrocyte polyagglutination was found in 3 ABO donor plasma,3 AB donor plasma and 3 umbilical cord blood plasma.The polyagglutination was further identified by Peanut Agglutinin,MN Blood Group Reagent and Polybrene test.Results The erythrocyte antibody screening test,DAT and major cross-matching test were negative in 2 cases.The minor cross-matching test using saline and anti-human globulin test were positive.The red blood cells of the children were positive with plasma from donor of the same blood type and AB plasma,and negative with cord blood plasma of the same blood type.MN blood group antigen was negative in children who were positive with Peanut Agglutinin.No expected agglutination was observed with Polybrene test.Conclusion NEC children with polyagglutinated erythrocytes showed negative DAT tests and positive minor cross-matching tests.At this time,multiple methods should be used to identify the phenomenon of erythrocyte polyagglutination to choose appropriate blood products to avoid delayed transfusion.

关 键 词：坏死性小肠结肠炎 T抗原暴露 多凝集红细胞 交叉配血 输血策略 

分 类 号：R457[医药卫生—治疗学]