自身免疫性溶血性贫血(AIHA)患者意外抗体类型与输血疗效相关性分析  

Correlation between unexpected antibody types and transfusion efficacy in patients with autoimmune hemolytic anemia(AIHA)

作　　者：黎淑贞 蓝文莉 马伟文 谢敬文 温吉桃 LI Shuzhen;LAN Wenli;MA Weiwen;XIE Jingwen;WEN Jitao(Panyu Central Blood Station,Guangzhou 511400,China)

机构地区：[1]广州市番禺区中心血站,广东广州511400

出　　处：《中国输血杂志》2024年第5期598-601,共4页Chinese Journal of Blood Transfusion

基　　金：番禺区科技计划项目(预立项目:2021-Z04-076)。

摘　　要：目的分析广州地区AIHA患者抗体类型并跟踪输血疗效,为AIHA患者临床输血治疗策略提供参考依据。方法在2021年1月—2023年10月本地区医院输血科(血库)送检至本站的96份疑难交叉配血标本分析鉴定出25份AIHA患者标本,再对其进行血型鉴定、Rh系统的抗原表型分型、抗体筛查及交叉配血,分析AIHA患者抗体类型与输血疗效的相关性。结果25份AIHA患者标本中,ABO正反定型相符17份,8份正反定型不符。主侧配血不相合19(19/25,76%)份,其中直接Coombs试验阳性+自身抗体阳性+无特异性抗体阳性18(18/19,94.7%)份;自身抗体+同种抗体阳性1(1/19,5.3%)份。主侧配血相合6(6/25,24%)份,其中自身抗体阳性3(3/6,50%)份;自身抗体+同种抗体阳性3(3/6,50%)份。25名AIHA患者中20名患者有输血治疗并能追踪到输血疗效,5名患者没有输血治疗或转院而无法追踪。输血有效11(11/20,55%)例;输血部分有效6(6/20,30%)例;输血无效3(3/20,15%)例。配血不合病例中,输血有效或部分有效17(17/20,85%)例。结论AIHA患者的输血疗效与交叉配血结果并无直接联系,在调节干预自身免疫内环境并排除同种意外抗体导致的配血不相合前提下,配血不合的AIHA患者在充分权衡利弊的情况下,必要时可输血,选择ABO、Rh系统抗原同型血液,可提高输血安全性和有效率。Objective To analyze the antibody types of autoimmune hemolytic anemia(AIHA)patients in Panyu district,Guangzhou and track the therapeutic effect of blood transfusion,so as to provide reference for clinical transfusion treatment strategy of AIHA patients.Methods From January 2021 to October 2023,96 ambiguous cross-matching blood samples from Blood Transfusion Departments of local hospitals sent to Panyu Central Blood Station were analyzed,and 25 samples of AIHA patients were identified.Then blood group identification,Rh system antigen phenotyping,antibody screening and cross-matching were further performed to analyze the correlation between antibody types and transfusion efficacy in AIHA patients.Results Among the 25 samples of AIHA patients,17 showed consistency between forward and reverse blood grouping and 8 showed discrepancy.There were 19(19/25,76%)samples incompatible in cross match on the major side,of which 18(18/19,94.7%)were positive for direct Coombs test,autoantibodies and non-specific antibodies,and 1(1/19,5.3%)was positive for autoantibody and alloantibody.There were 6(6/25,24%)samples compatible in cross match on the major side,of which 3(3/6,50%)were positive for autoantibodies,3(3/6,50%)were positive for autoantibody and alloantibody.Of the 25 AIHA patients,20 received blood transfusion treatment and could be traced,and 5 patients did not receive blood transfusion treatment or transferred to other hospitals and could not be traced.Blood transfusion was effective in 11(11/20,55%)cases,partially effective in 6(6/20,30%)cases,and ineffective in 3(3/20,15%)cases.Among the ABO blood group incompatibility samples,transfusion was effective or partially effective in 17(17/20,85%)cases.Conclusion The transfusion efficacy of AIHA patients is not directly related to the results of cross-matching.Under the premise of regulating the autoimmune environment and eliminating the ABO blood group incompatibility caused by unexpected alloantibodies,AIHA patients with incompatible cross-matching can be transfused whe

关 键 词：自身免疫性溶血性贫血 意外抗体 交叉配血 输血疗效 广州地区 

分 类 号：R457.11[医药卫生—治疗学] R556.62[医药卫生—临床医学]