直接抗人球蛋白试验阳性患者血型鉴定及交叉配血试验分析
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摘要
目的分析直接抗人球蛋白试验(DAT)阳性患者血型鉴定及交叉配血试验结果,为临床输血提供一定的参考。方法 2017年6月至2018年6月我院确诊的54例自身免疫性溶血性贫血(AIHA)、DAT阳性患者,行DAT、交叉配血试验(凝聚胺法)、冷抗体吸收试验、磷酸氯喹放散试验及自身抗体吸收试验,观察DAT阳性凝集、DAT分型、血型鉴定、交叉配血检测及处理结果。结果 DAT阳性患者中W+～2+凝集98. 15%; DAT分型中Ig G、C3d占50. 00%,单Ig G型占29. 63%,单C3d型占20. 37%; ABO血型正反定型不符占79. 63%,自身红细胞、血清凝集占61. 11%;经冷抗体吸收试验、磷酸氯喹放散试验后确定血型:A型Rh阳性13例,B型Rh阳性12例,O型Rh阳性9例,AB型Rh 9例; 54例DAT阳性患者中显示配血不合44例,其中主、次侧均显示阳性反应22例,主侧阳性反应、次侧阴性反应14例,主侧阴性反应、次侧阳性反应8例;配血不合原因:冷抗体因素17例,冷凝集素效价1:256以上8例,冷凝集素效价1:128 19例;行冷抗体吸收试验、磷酸氯喹放散试验、自身抗体吸收试验后显示交叉配血相合36例,交叉配血不合8例。结论冷抗体吸收试验、磷酸氯喹放散试验或自身抗体吸收试验应用有利于DAT阳性患者血型鉴定,提高交叉配血相合率。
Objective To provide the references for clinical blood transfusion through analyzing the results of blood grouping and cross-matching test of 54 patients with positive results of direct anti-human globulin test( DAT).Methods Fifty-four DAT positive patients with autoimmune hemolytic anemia( AIHA) diagnosed in our hospital were enrolled in the study.The DAT,cross-matching test( polybrene method),cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test were performed.The detection and treatment results of DAT positive agglutination,DAT classification,blood grouping and cross-matching test were observed.Results In the DAT positive patients,W+ ～ 2+ agglutination accounted for 98. 15%.In the DAT classification,Ig G and C3 d accounted for 50. 00% in which single Ig G type accounted for 29. 63% and single C3 d type accounted for 20. 37%.Unconformable ABO group typing and reverse typing accounted for 79. 63%.Autologous erythrocyte and serum agglutination accounted for 61. 11%.The cold resistant body absorption test and chloroquine phosphate elution test showed that the blood type was A Rh positive type in 13 cases,B Rh positive type in 12 cases,O Rh positive type in 9 cases and AB Rh type in 9 cases.Among the 54 DAT positive patients,there were 44 cases with unconformable blood matching,including positive reactions on both the primary side and the secondary side of 22 cases each.There were positive reactions on the primary side and negative reactions on the secondary side in 14 cases,and negative reactions on the primary side and positive reactions on the secondary side in 8 cases.The causes of unconformable blood matching included cold antibody factors( n = 17),cold agglutinin titer higher than 1: 256( n = 8) and cold agglutinin titer of 1: 128( n = 19).The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test showed 36 cases with cross-matching compatibility and 8 cases with incompatibility.Conclusion The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test are beneficial to the blood grouping of DAT positive patients,which can improve the compatibility of cross matching.
Objective To provide the references for clinical blood transfusion through analyzing the results of blood grouping and cross-matching test of 54 patients with positive results of direct anti-human globulin test( DAT).Methods Fifty-four DAT positive patients with autoimmune hemolytic anemia( AIHA) diagnosed in our hospital were enrolled in the study.The DAT,cross-matching test( polybrene method),cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test were performed.The detection and treatment results of DAT positive agglutination,DAT classification,blood grouping and cross-matching test were observed.Results In the DAT positive patients,W+ ～ 2+ agglutination accounted for 98. 15%.In the DAT classification,Ig G and C3 d accounted for 50. 00% in which single Ig G type accounted for 29. 63% and single C3 d type accounted for 20. 37%.Unconformable ABO group typing and reverse typing accounted for 79. 63%.Autologous erythrocyte and serum agglutination accounted for 61. 11%.The cold resistant body absorption test and chloroquine phosphate elution test showed that the blood type was A Rh positive type in 13 cases,B Rh positive type in 12 cases,O Rh positive type in 9 cases and AB Rh type in 9 cases.Among the 54 DAT positive patients,there were 44 cases with unconformable blood matching,including positive reactions on both the primary side and the secondary side of 22 cases each.There were positive reactions on the primary side and negative reactions on the secondary side in 14 cases,and negative reactions on the primary side and positive reactions on the secondary side in 8 cases.The causes of unconformable blood matching included cold antibody factors( n = 17),cold agglutinin titer higher than 1: 256( n = 8) and cold agglutinin titer of 1: 128( n = 19).The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test showed 36 cases with cross-matching compatibility and 8 cases with incompatibility.Conclusion The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test are beneficial to the blood grouping of DAT positive patients,which can improve the compatibility of cross matching.
引文
[1]李长琴,赵晓姬,马永能,等.21例抗人球蛋白试验阳性病例分析[J].国际检验医学杂志,2014,35(7):829-830.
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[5]陆乐,吴玲玲,姚晓娟,等.直接抗人球蛋白试验阳性病人ABO、Rh疑难血型鉴定和交叉配血试验74例分析[J].安徽医药,2017,21(2):277-280.
[6]阳福桂,刘芳,戚志萍,等.直接抗人球蛋白试验在临床贫血及输血患者中的应用[J].临床输血与检验,2015,17(6):498-500.
[7]王晓平,杨君青.直接抗人球蛋白试验阳性在贫血患者的分布特征及临床意义[J].河北医药,2016,38(18):2796-2798.
[8]李美霖,车进,麻静敏,等.献血者直接抗人球蛋白试验阳性结果分析[J].山西医药杂志,2015,44(17):2066-2067.
[9]别立莉,陈赞,耿一心,等.直接抗人球蛋白试验阳性患者的血清学特性和抗体鉴定[J].新乡医学院学报,2017,34(3):206-208.
[10]Nathalang O,Sriwanitchrak P,Tubrod J,et al.Antibody elutions in Thai patients with a positive direct antiglobulin test[J].Blood Transfus,2011,9(3):306-310.
[11]Sesham R,Lewin E,Enchill B,et al.G490(P)Coombs positive autoimmune haemolytic anaemia complicating post streptococcal glomerulonephritis(a very rare occurrence)[J]. Archives of Disease in Childhood,2015,100(3):A209-A210.
[12]胡江,方乐.盐水介质法、凝聚胺法及微柱凝胶法在新生儿输血安全中的应用价值对比[J].中国医药导刊,2015,17(9):895-896.
[13]高阳,芦璐,王德景,等.凝聚胺法与微柱凝胶法在临床输血中的应用研究[J].国际输血及血液学杂志,2016,39(6):476-479.
[14]王芳,毛伟,黄霞,等.Rh抗体在凝聚胺方法漏检的分析[J].检验医学与临床,2009,6(20):1748-1749
[2]刘琼,刘蜜.血清学诊断ABO新生儿溶血病的实验研究[J].湖南师范大学学报(医学版),2016,13(6):17-20.
[3]李建刚,赵家宁,徐华,等.直接抗人球蛋白试验阳性患者交叉配血方法探讨[J].现代检验医学杂志,2015,30(4):130-132.
[4]许飞,张建伟,吴强,等.2010~2013年常州地区交叉配血试验不合原因分析[J].临床输血与检验,2015,17(4):371-372.
[5]陆乐,吴玲玲,姚晓娟,等.直接抗人球蛋白试验阳性病人ABO、Rh疑难血型鉴定和交叉配血试验74例分析[J].安徽医药,2017,21(2):277-280.
[6]阳福桂,刘芳,戚志萍,等.直接抗人球蛋白试验在临床贫血及输血患者中的应用[J].临床输血与检验,2015,17(6):498-500.
[7]王晓平,杨君青.直接抗人球蛋白试验阳性在贫血患者的分布特征及临床意义[J].河北医药,2016,38(18):2796-2798.
[8]李美霖,车进,麻静敏,等.献血者直接抗人球蛋白试验阳性结果分析[J].山西医药杂志,2015,44(17):2066-2067.
[9]别立莉,陈赞,耿一心,等.直接抗人球蛋白试验阳性患者的血清学特性和抗体鉴定[J].新乡医学院学报,2017,34(3):206-208.
[10]Nathalang O,Sriwanitchrak P,Tubrod J,et al.Antibody elutions in Thai patients with a positive direct antiglobulin test[J].Blood Transfus,2011,9(3):306-310.
[11]Sesham R,Lewin E,Enchill B,et al.G490(P)Coombs positive autoimmune haemolytic anaemia complicating post streptococcal glomerulonephritis(a very rare occurrence)[J]. Archives of Disease in Childhood,2015,100(3):A209-A210.
[12]胡江,方乐.盐水介质法、凝聚胺法及微柱凝胶法在新生儿输血安全中的应用价值对比[J].中国医药导刊,2015,17(9):895-896.
[13]高阳,芦璐,王德景,等.凝聚胺法与微柱凝胶法在临床输血中的应用研究[J].国际输血及血液学杂志,2016,39(6):476-479.
[14]王芳,毛伟,黄霞,等.Rh抗体在凝聚胺方法漏检的分析[J].检验医学与临床,2009,6(20):1748-1749
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