1例肿瘤患者交叉配血相合输血后发生溶血反应的原因分析暨文献复习  

Causes of Hemolytic Reaction after Cross-Matched Compatible Blood Transfusion in a Tumor Patient:Analysis and Literature Review

作　　者：封彦楠 张珂[1] Feng Yannan;Zhang Ke(Department of Blood Transfusion,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省肿瘤医院·研究所·四川省肿瘤临床医学研究中心,四川省癌症防治中心,电子科技大学附属肿瘤医院输血科,成都610041

出　　处：《肿瘤预防与治疗》2025年第1期61-68,共8页Journal of Cancer Control And Treatment

基　　金：电子科技大学肿瘤医工研究院肿瘤医工创新基金重点项目(编号:ZYGX2021YGCX007)。

摘　　要：目的:分析1例肿瘤患者交叉配血相合输血后发生溶血反应的可能原因,结合文献复习,对未来同类病例输血和治疗方案的制定提供指导和帮助。方法:患者诊断为宫颈鳞癌IVB期2周期化疗后放疗中,合并严重感染、肝功能损伤。首次输血前检出抗-Wra抗体联合ABO以外其他抗体,特异性待定。输注Wra抗原阴性且交叉配血相合的红细胞。第2次红细胞输注后,Hb持续下降,发生危及生命的溶血反应。结果:通过各项检测指标的分析,怀疑感染诱发冷凝集素综合征,漏检高效价冷抗体导致输血后发生溶血反应,且输血加重了自身免疫性溶血性贫血的症状。结论:肿瘤患者治疗过程中易发生感染,从而诱发冷抗体的产生。交叉配血试验需警惕冷自身抗体的干扰,针对产生冷抗体的患者,若必须输血须保温慢输,同时加强自我管理,日常保暖尤为重要。Objective:To analyze the possible causes of hemolytic transfusion reaction after cross-matched compatible blood transfusion in a tumor patient,and provide guidance and help in the development of blood transfusion and treatment protocols for similar cases in the future with literature review.Methods:The patient was diagnosed as stage IVB cervical squamous cell carcinoma after 2 cycles of chemotherapy and radiotherapy,complicated by severe infections and liver function injuries.Anti-Wra antibodies in combination with antibodies other than ABO were detected before the first transfusion,and the specificity was pending.The patient was infused with Wra antigen-negative and cross-matched compatible red blood cells(RBC).After the second transfusion of RBC,hemoglobin continuously decreased and a life-threatening hemolytic reaction occurred.Results:Through the analysis of various test indicators,it was suspected that the infection induced cold agglutinin syndrome,and the missed detection of high-titer cold antibodies ledtohemolysissreactionafter transfusion.Additionally,blood transfusion exacerbates the symptoms of autoimmune hemolytic anemia.Conclusion:Tumor patients are prone to infections during treatment,which can induce cold antibodies.It should be cautious of the interference of cold autoantibodies during the cross-matched tests.For patients with cold antibodies,if blood transfusion is necessary,it should be kept warm and slow.At the same time,self-management should be strengthened,and keeping warm is particularly important.

关 键 词：自身免疫性溶血性贫血 冷抗体 输血 肿瘤 

分 类 号：R457.1[医药卫生—治疗学] R730.5[医药卫生—临床医学]