聚乙二醇在低效价抗体漏检导致迟发性溶血性输血反应中的应用  

Application of PEG in delayed hemolytic transfusion reaction caused by low valent antibody misdetection

作　　者：陈敏洁 邹昕 马思飞 张建伟[1,2] 杨红梅 CHEN Minjie;ZOU Xin;MA Sifei;ZHANG Jianwei;YANG Hongmei(Changzhou Central Blood Station,Changzhou,213000,China;Changzhou Key Laboratory of Clinical Blood Transfusion in Jiangsu Province)

机构地区：[1]江苏省常州市中心血站,江苏常州213000 [2]江苏省常州市临床输血重点专科实验室

出　　处：《临床血液学杂志》2024年第10期737-741,745,共6页Journal of Clinical Hematology

基　　金：常州市科技局项目(No:CJ20220240);江苏省英科新创基金项目(No:JSYK2023018);江苏省爱康基金项目(No:JSAK2022011);常州市中心血站站级课题(No:XZ202303)。

摘　　要：目的:探讨聚乙二醇(PEG)在低效价血型抗体引起迟发性溶血性输血反应(delayed hmeolytic transfusion reaction, DHTR)中的应用,为输血反应提供有效诊断依据。方法:联合运用三种介质(盐水、凝聚胺、抗人球蛋白)结合多套谱细胞进行抗体特异性鉴定,酸放散试验及PEG抗人球蛋白法辅助低效价抗体的检出。结果:患者直接抗人球蛋白试验阳性,抗体鉴定结果为抗-Cw和抗-Dia,同型输注后输血效果仍然不佳,怀疑漏检抗体。利用PEG抗人球蛋白法增强试验再次抗体鉴定,血清中检出低效价抗-Ec抗体。结合患者多次输血效果不佳,胆红素和乳酸脱氢酶进行性升高判断患者为DHTR。结论:血清中低效价抗体易漏检,利用PEG抗人球蛋白法可更好地检出低效价抗体,且部分患者输血反应症状不明显,应将多种血清学检测结合患者临床症状与表现,以辅助DHTR鉴定,从而保证患者输血安全。Objective: To explore the application of PEG in delayed hemolytic transfusion reactions(DHTR) caused by low titer blood group antibodies, and provide effective diagnostic basis for transfusion reactions. Methods: Antibody specific identification was detected using a combination of three media(saline, polyamine, and anti human globulin card) combined with multiple spectrum cells, and low potency antibodies were detected assisting by acid release and PEG anti human globulin assay. Results: The patient's direct anti human globulin test was positive, and the antibody identification results were anti-C~w and anti-Di~a. The transfusion effect after the same type transfusion was still poor, and it was suspected that there were still missed antibodies. The PEG anti human globulin enhancement test was used for further antibody identification, and low titer anti-Ec antibodies were detected in the serum. Based on the poor results of multiple blood transfusions and the progressive increase of bilirubin and lactate dehydrogenase, it was determined that the patient had a delayed hemolytic transfusion reaction. Conclusion: Low titer antibodies in serum may be prone to missed detection. The PEG anti human globulin method can better detect low titer antibodies, and some patients may not have obvious transfusion reaction symptoms. Multiple serological tests should be combined with patient clinical symptoms and manifestations to assist in DHTR identification and ensure patient transfusion safety.

关 键 词：聚乙二醇 低效价 迟发性溶血性输血反应 抗-Dia 抗-Ec 

分 类 号：R457.1[医药卫生—治疗学]