一例意外抗体阳性患者造血干细胞移植后抗体监测结果分析  

Analysis of Antibody Monitoring Results after Hematopoietic Stem Cell Transplantation in a Patient with Unexpected Antibody Positivity

作　　者：付丽辉[1] 马春娅[1] 罗圆圆[1] 沈伟[2] 向东[2] 于洋[1] FU Lihui;MA Chunya;LUO Yuanyuan;SHEN Wei;XIANG Dong;YU Yang(Department of Transfusion Medicine,The First Medical Center of PLA General Hospital,Beijing 100853;Shanghai Blood Center,Shanghai 200051)

机构地区：[1]解放军总医院第一医学中心输血医学科,北京100853 [2]上海市血液中心,上海200051

出　　处：《临床输血与检验》2025年第2期169-174,共6页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的研究抗-E意外抗体阳性患者在脐带血造血干细胞移植E阳性抗原后血清学变化特点、实验室检测方法及输血策略。方法采用血清学常规方法进行ABO、Rh血型鉴定及意外抗体筛查试验,使用PEG增强技术及酸放散试验进行意外抗体鉴定;应用流式细胞术进行细胞分群检测,分析血型抗原转换及抗体转归规律。结果患者移植前血型为AB型,Rh分型为CCDee,存在抗-E意外抗体。非亲缘脐带血造血干细胞供者为B型,Rh分型为ccDEE,亲缘半相合外周血造血干细胞供者为AB型,Rh分型为CcDEe。患者处于血型转型期,意外抗体筛查结果为阴性,但通过PEG增强试验及红细胞酸放散试验均检出IgG抗-E抗体。结论对于移植前存在同种抗体的患者,在移植转型期,建议采用PEG增强抗人球蛋白试验等手段作为常规血清学检测的补充,监测同种抗体水平的变化,预防溶血反应,避免红细胞输注无效。Objective To study the serological changes,laboratory detection methods,and transfusion strategies for patients with positive anti-E unexpected antibodies after umbilical cord blood hematopoietic stem cell transplantation with E-positive antigens.Methods ABO and Rh blood typing and unexpected antibody screening tests were performed using conventional serological methods.Unexpected antibody identification was conducted using PEG enhancement technology and acid elution test.Cell population detection was carried out using flow cytometry to analyze the patterns of blood group antigen conversion and antibody resolution.Results The patient had pretransplant blood type AB,Rh type CCDee,with anti-E unexpected antibodies.Unrelated cord blood HSC donor was type B,Rh classification was ccDEE,related hemicompatible peripheral blood HSC donor was type AB,and Rh classification was CcDEe.The patient was in blood group transition and the unexpected antibody screening result was negative,but IgG anti-E antibody was detected by PEG enhancement test and erythrocyte acid release test.Conclusion For patients with similar antibodies before transplantation,PEG enhanced anti-human globulin test is recommended as a supplement to routine serological tests,monitor the changes of alloantibody levels,prevent hemolytic reaction and avoid red cell transfusion refractoriness.

关 键 词：抗-E抗体 非亲缘脐带血造血干细胞移植 Rh血型转型 流式细胞术 

分 类 号：R457.1[医药卫生—治疗学] R457.7[医药卫生—临床医学]