血液病所致ABO血型抗原减弱分析和处理对策  

Analysis and treatment of blood diseases caused-weakenA BOantigen

作　　者：李云燕 赵国胜[3] 刘凤霞[3] 屈琳[1] LI Yunyan;ZHAO Guosheng;LIU Fengxia;QU Lin(Department of Clinical Laboratory,Third Xiangya Hospital,Central South University,Changsha 410013,China;921st Hospital of the Joint Service and Security Force of the Chinese People's Liberation Army,Changsha 410003,China;Department of Blood Transfusion,the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院检验科,长沙410013 [2]中国人民解放军联勤保障部队第九二一医院,长沙410003 [3]中南大学湘雅三医院输血科,长沙410013

出　　处：《湖南师范大学学报（医学版）》2023年第4期83-86,101,共5页Journal of Hunan Normal University(Medical Sciences)

基　　金：湖南省自然科学基金面上项目(2022JJ30900)。

摘　　要：目的:探讨血液病所致患者ABO血型抗原减弱的主要原因和血型血清学鉴定方法.方法:采用全自动血型分析仪对临床待检标本进行ABO血型血清学初步鉴定,对ABO血型正定型凝集强度<3+和反定型<2+的患者血标本,再采用经典试管法进行ABO正反定型、唾液实验、吸收放散试验、亲和力实验等血型血清学实验进行鉴定.此外,通过PCR-SSP基因分型检测试剂盒对样本进行基因分型;通过对ABO基因1-7号外显子进行测序以确认基因突变位点.结果:在67例血液病所致ABO血型抗原减弱患者中,包含白血病30例(44.7%)、血液系统疾病待查26例(38.9%)、骨髓增生异常综合征9例(13.4%)、非霍奇金淋巴瘤1例(1.5%)、慢性骨髓炎1例(1.5%);其中A抗原减弱者43例(64.2%)、B抗原减弱者23例(34.3%)、AB抗原减弱者1例(1.5%);H抗原增强者2例(2.98%).PCR-SSP基因分型以及ABO基因1-7号外显子进行测序分析发现了一些新的突变位点,包括7号外显子的607G>A,734C>T,6号外显子的259G>T,261delG,5号外显子的239G>A,以及1号外显子的18insTTGCA.结论:白血病是导致ABO血型抗原减弱的主要原因;综合分析临床资料和采用血型血清学方法,可与ABO亚型进行区分,正确鉴定出ABO血型,确保临床输血安全.Objective To explore the main causes of ABO blood group antigen reduction in patients with diseases and the method of blood group serological identification.Methods ABO blood group serological identification was performed on clinical specimens to be tested by automatic blood group analyzer.Blood samples of patients with positive and negative ABO type agglutination intensity<3+and negative ABO type agglutination intensity<2+were identified by classical test tube method,such as ABO positive and negative stereotyping,saliva test,absorption and release test,affinity test and other blood group serological tests.the samples were genotyped by PCR-SSP genotyping assay kit;and exons 1-7 of the ABO gene were sequenced to confirm the mutation sites.Results Among 67 patients with ABO blood group antigen weakened due to disease,there were 30 patients with leukemia(44.7%),26 patients with hematological diseases(38.9%),9 patients with myelodyspllastic syndrome(MDS)(13.4%),1 patient with non-Hodgkin lymphoma(1.5%),and 1 patient with chronic osteomyelitis(1.5%).43 cases(64.2%)with A antigen weakened,23 cases(34.3%)with B antigen weakened,and 1 case(1.5%)with AB antigen weakened.There were 2 cases(2.98%)with enhanced H antigen,and the other intensities were unchanged.PCR-SSP genotyping and sequencing of exons 1-7 of theABOgene identified some new mutation sites,including 607G>A,734C>T in exon 7,259G>T,261delG in exon 6,239G>A in exon 5,and 18insTTCCA in exon 1.Conclusion Leukemia is the main cause ofABOblood group antigen weakening.By comprehensive analysis of clinical data and using blood group serology,ABO blood group can be distinguished from ABO subtype and correctly identified to ensure the safety of clinical transfusion.

关 键 词：ABO血型 抗原减弱 血液病 基因突变 

分 类 号：R446.62[医药卫生—诊断学]