自身抗-B伴冷凝集素患者输血前检测及输血治疗——附1例报告  

Pre-transfusion detection and transfusion therapy of a patient with autoanti-B and cold agglutinin:a case report

作　　者：杨林玉 陈立 李忠俊 YANG Linyu;CHEN LI;LI Zhongjun(The Second Affiliated Hospital of the Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学附属第二医院输血科,重庆400037

出　　处：《中国输血杂志》2025年第1期122-125,共4页Chinese Journal of Blood Transfusion

基　　金：陆军军医大学临床医学科研人才培养计划(2018XLC2015);重庆市教委科学技术研究计划重大项目(KJZD-M202312802)。

摘　　要：目的对1例自身抗-B伴冷凝集素患者行血清学鉴定及输血疗效评估。方法37℃生理盐水洗涤患者红细胞并用巯基试剂处理,采用试管法、微柱凝胶法检测ABO血型抗原。用O型红细胞4℃吸收EDTA抗凝血浆去除冷凝集素,再用B型红细胞4℃吸收放散检测相关血型抗体,利用输血前后血红蛋白变化评估患者输血效果,并持续监测其ABO血型。结果血清学实验正定型检出B抗原,O型红细胞吸收放散检出冷凝集素,B型红细胞吸收放散检出患者血清中含有IgM抗-B。输注3 U O型洗涤红细胞无不良反应且输注有效。2月后随访患者,血型鉴定正反一致,均为B型。结论结合患者既往血型鉴定结果,本次血清学鉴定及后续追踪综合分析,患者ABO血型为B型,但存在一过性高效价冷凝集素和B抗原特异性自身抗体。Objective To identify the ABO blood group of a patient with rare B antigen-specific autoantibody with cold agglutinin,and evaluate the effect of blood transfusion.Methods Red blood cells of patient were washed with 37℃physiological saline and treated with sulfhydryl reagent.ABO blood group antigen was detected by tube method and microcolumn gel method.After the cold agglutinin was removed by EDTA anticoagulant plasma absorbed by type O red blood cells at 4℃,the related blood group antibodies were detected by type B red blood cells absorbing and releasing liquid at 4℃.The blood transfusion effect of patients was evaluated by the changes of hemoglobin before and after transfusion,and their ABO blood group was continuously monitored.Results B antigen was detected in the positive setting of serological experiment,cold agglutinin was detected by absorption and elution of type O red blood cells,and anti-B antibody was detected by absorption and elution of type B red blood cells.That is,there was specific autoantibody against B antigen,and the antibody property was IgM.No adverse reactions occurred during the infusion of 3 U type O washed red blood cells and the infusion was effective.The patient was continuously followed for two months,and the forward and reverse blood group identification were consistent,both of which were type B.Conclusion According to the previous blood group identification results,serological identification and follow-up comprehensive analysis,the ABO blood group of the patient is type B,but there are transient high titer cold agglutinin and B antigen-specific autoantibodies.

关 键 词：ABO血型鉴定 自身抗体 冷凝集素 抗体鉴定 

分 类 号：R457.11[医药卫生—治疗学]