抗-M、抗-Jk^(a)序贯产生致2次迟发性溶血性输血反应及应对策略  

Sequential generation of anti-M and anti-Jk^(a)leads to two delayed hemolytic transfusion adverse reactions and corresponding strategies

作　　者：龙红惠 牛迎迎 王丹婷 黄春妍[1,2] LONG Honghui;NIU Yingying;WANG Danting;HUANG Chunyan(Department of Transfusion Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Transfusion Medicine,West China Tianfu Hospital,Sichuan University)

机构地区：[1]四川大学华西医院输血科,四川成都610041 [2]四川大学华西天府医院输血科

出　　处：《中国输血杂志》2024年第5期501-505,共5页Chinese Journal of Blood Transfusion

摘　　要：目的 通过追踪1例因输血后回忆反应连续产生意外抗体导致迟发性溶血性输血反应的患者,探讨有输血史、妊娠史患者群体的输血管理措施及应对策略。方法 对1例连续发生迟发性溶血反应患者进行ABO、Rh、MN及Kidd血型鉴定、直接抗人球蛋白试验、意外抗体筛查及抗体鉴定,鉴定后用相应红细胞检测其抗体效价,同时筛选合适的红细胞供患者后续治疗使用。结果 患者血型为B型RhD(+)、CCDee,第1次输血前抗筛阴性,交叉配血相合,输血后d8患者血红蛋白降至57 g/L,抗筛阳性,抗体鉴定结果为抗-M,患者输入的血液表型为M+N+,实验室结果表明患者发生了迟发性溶血。患者在输入M抗原阴性血液后,实验室检查结果仍提示有迟发性血清学输血反应发生,抗体鉴定显示患者产生了新的抗-Jka,而输入的红细胞表型为M-N+、Jk(a+b-)。此后选择B型、RhD(+)、M-N+、Jk(a-b+)的红细胞输注有效。结论 患者输血后初次检测出的同种抗体大多数会在几年内消失,当患者再次输血,则可能发生迟发性溶血反应,为已产生同种抗体输血患者建立输血管理档案、制作卡片供患者保存,在下次需要输血时告知医生和输血科人员,可大大减少迟发性溶血性输血反应的发生。Objective To make transfusion management strategies for patients with history of blood transfusion and/or pregnancy by following up a patient with delayed hemolytic transfusion reactions(DHTR)caused by unexpected antibody produced after blood transfusion.Methods ABO,Rh,MN and Kidd blood group test,direct antiglobulin test,unexpected antibody screening,antibody identification,antibody titer detection,and cross-matching test were performed on a patient with DHTR.Meanwhile,suitable red blood cells were screened for subsequent treatment.Results The patient′s blood group was B,RhD(+)and CCDee,the antibody screening test and the cross-matching test were negative before the first transfusion.After eight days,hemoglobin of the patient decreased to 57 g/L and the laboratory results indicated delayed hemolysis,the antibody screening was positive,and the antibody identification result was anti-M,as RBCs of the patient received typed as M+N+.After the patient received M antigen negative RBCs,the laboratory test results still indicated delayed serologic transfusion reaction.A new antibody arose and was identified as anti-Jk^(a)while RBCs transfused were M-N+and Jk(a+b-).Afterwards,it was effective for the patient to receive B,RhD(+),M-N+and Jk(a-b+)RBCs.Conclusion Most of the homologous antibodies produced by patients after blood transfusion will disappear within a few years.When patients undergo another transfusion,DHTR may occur because of anamnestic reaction.Establishing a transfusion management document and creating a card for patients who have already produced RBC alloantibodies can greatly reduce the occurrence of DHTR by informing doctors and staff when the next transfusion is needed.

关 键 词：迟发性溶血性输血反应 回忆反应 应对策略 

分 类 号：R457.13[医药卫生—治疗学] S852.43[医药卫生—临床医学]