淄博地区ABO血型系统以外不规则抗体的筛查及分析
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摘要
目的观察淄博地区ABO血型系统以外不规则抗体筛查结果 ,分析不规则抗体血型构成情况,探讨红细胞表面抗原分布规律,为安全输血治疗工作的开展提供条件。方法采用分层整群抽样回顾性分析的方法,抽取淄博地区2013年6月～2018年9月接受输血的1 720例患者,仔细阅览患者的临床资料,记录不规则抗体阳性检查结果 ,对比不同性别、不同妊娠情况及有无输血史者阳性筛查结果差异,观察不规则抗体阳性血液标本抗体分型规律。结果 1 720例接受输血治疗患者中检出16例不规则抗体为阳性者,阳性率为0.93%;其中不同性别及女性既往有无妊娠史比较,差异无统计学意义(P> 0.05);既往接受输血治疗者阳性率高于无输血治疗者,差异有统计学意义(P <0.05)。经盐水法检出含有IgM型不规则抗体共2例,分别为抗-M、抗-c;经微柱凝胶法与抗人球蛋白法检出全部结果中,有43.75%为Rh系统,分别包括5例抗-E、1例抗-D、1例抗-c,提示Rh系统抗原内RhE、D、c抗原性较强,经免疫刺激后产生不规则抗体风险较大;其次分别为Kell与MNSs系统。结论红细胞表面除ABO血型系统抗原外,Rh系统、Kell系统等血型系统也广泛存在,在一定程度上将影响输血治疗,输血可能会刺激患者不规则抗体,产生输血免疫反应,对治疗效果产生负面影响,临床应做好输血前一系列除ABO血型系统外不规则抗体的筛查与鉴定,为安全的输血治疗提供技术保障。
Objective To observe the screening results of irregular antibody outside of ABO blood group system in Zibo area,to analyze the composition of irregular antibody blood type,to explore the distribution law of red blood cell surface antigen,and to provide conditions for the development of safe blood transfusion. Methods The stratified cluster sampling retrospective analysis was adopted. 1720 patients who received blood transfusion from June 2013 to September 2018 in Zibo region were selected as the subjects. The clinical data of patients were carefully reviewed,and the results of irregular antibody positive test were recorded. The differences in positive screening results in patients with different gender,different pregnancy conditions and the history of blood transfusion were compared. The antibody typing pattern of irregular antibody positive blood samples was observed. Results Among the 1 720 patients who received blood transfusion therapy,16 cases of positive irregular antibodies were detected,and the positive rate was 0.93%;There was no statistical difference in the gender,women with or without pregnancy history(P > 0.05);The positive rate in patients with previous transfusion therapy was higher than that in patients without blood transfusion therapy(P < 0.05);2 cases of IgM-type irregular antibody were detected by saline method,anti-M and anti-c,respectively;Among the results of microcolumn gel method and anti-human globulin test,43.75% were Rh system,including 5 cases of anti-E,1 case of anti-D and 1 case of anti-c,suggesting that RhE,D,and c were more antigenic in Rh system antigen,and the risk of producing irregular antibodies after immune stimulation was greater;Followed by Kell and MNSs system. Conclusion In addition to ABO blood group system antigens,Kell system and other blood type systems are also widely existed in Rh system,which will affect the blood transfusion treatment to a certain extent. Blood transfusion may stimulate irregular antibodies and produce transfusion immune response,which has a negative impact on treatment effects. Clinically,a series of screening and identification of irregular antibodies outside of ABO blood group system before transfusion should be carried out,so as to provide technical support for safe blood transfusion therapy.
Objective To observe the screening results of irregular antibody outside of ABO blood group system in Zibo area,to analyze the composition of irregular antibody blood type,to explore the distribution law of red blood cell surface antigen,and to provide conditions for the development of safe blood transfusion. Methods The stratified cluster sampling retrospective analysis was adopted. 1720 patients who received blood transfusion from June 2013 to September 2018 in Zibo region were selected as the subjects. The clinical data of patients were carefully reviewed,and the results of irregular antibody positive test were recorded. The differences in positive screening results in patients with different gender,different pregnancy conditions and the history of blood transfusion were compared. The antibody typing pattern of irregular antibody positive blood samples was observed. Results Among the 1 720 patients who received blood transfusion therapy,16 cases of positive irregular antibodies were detected,and the positive rate was 0.93%;There was no statistical difference in the gender,women with or without pregnancy history(P > 0.05);The positive rate in patients with previous transfusion therapy was higher than that in patients without blood transfusion therapy(P < 0.05);2 cases of IgM-type irregular antibody were detected by saline method,anti-M and anti-c,respectively;Among the results of microcolumn gel method and anti-human globulin test,43.75% were Rh system,including 5 cases of anti-E,1 case of anti-D and 1 case of anti-c,suggesting that RhE,D,and c were more antigenic in Rh system antigen,and the risk of producing irregular antibodies after immune stimulation was greater;Followed by Kell and MNSs system. Conclusion In addition to ABO blood group system antigens,Kell system and other blood type systems are also widely existed in Rh system,which will affect the blood transfusion treatment to a certain extent. Blood transfusion may stimulate irregular antibodies and produce transfusion immune response,which has a negative impact on treatment effects. Clinically,a series of screening and identification of irregular antibodies outside of ABO blood group system before transfusion should be carried out,so as to provide technical support for safe blood transfusion therapy.
引文
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[15]徐弘,孔玉洁,宋宁,等.筛选试剂红细胞的血型基因分型方法建立和应用[J].中国输血杂志,2017,30(10):1146-1149.
[16]焦琴,李娜,杨世明,等.163例Rh血型系统以外不规则抗体的检测及其临床意义[J].细胞与分子免疫学杂志,2018,34(2):160-162.
[17]吴迪.9013例输血者不规则抗体筛查结果及意义[J].首都医科大学学报,2017,38(5):753-757.
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[19]刘恋霞.24743例拟输血患者不规则抗体筛查结果及分析[J].世界中西医结合杂志,2017,12(11):1532-1534.
[20]葛艳玲,刘英.RhE抗原检测及同型输注在临床输血中的意义[J].临床血液学杂志:输血与检验,2018,31(2):137-138.
[21]张勇萍,杜娟,杨世明,等.4397例孕产妇ABO和RhD血型检测及不规则抗体的分析[J].细胞与分子免疫学杂志,2016,32(5):680-682.
[22]王淑平,陈慧芬,李志强.孕妇ABO血型系统以外不规则抗体致新生儿溶血病10例[J].临床输血与检验,2017,19(4):340-342.
[23]李丹,张勇萍,杨世明,等.35例MNS血型抗体特异性及对ABO血型鉴定与交叉配血的影响[J].细胞与分子免疫学杂志,2016,32(12):1687-1689.
[24]吴军军,祝文坚,甘恒.梧州地区Rh阴性无偿献血者CcEe抗原分型及不规则抗体筛查分析[J].医学检验与临床,2016,27(9):68-70.
[25]王兰芳,蔡娟.孕妇产前血型不规则抗体检测1450例临床分析[J].蚌埠医学院学报,2011,36(1):69-70.
[2]刘培贤,贾洪娟,刘志鹏,等.Rh血型系统抗原检测对临床安全合理输血的重要性分析[J].世界中西医结合杂志,2017,12(10):1415-1417.
[3]王晓华,刘衍春,李兴华,等.《中国输血杂志》2006-2015年红细胞血型参比文献回顾性分析[J].中国输血杂志,2017,30(4):408-410.
[4]López-Díaz PE,Ruiz-Olivera MDR,Hernández-Osorio LA,et al.Irregular antibodies in no hemolytic autoimmune diseases are able to induce erythrophagocytosis[J].Immunol Res,2017,65(1):410-418.
[5]郑妍,王文婷,杨世明,等.拟输血患者血型不规则抗体检测结果的回顾性分析[J].细胞与分子免疫学杂志,2017,33(9):1275-1277.
[6]陈利红,杨浩莹,李玖平.卡式微柱凝胶技术在血型鉴定及输血前红细胞不规则抗体检验中的作用[J].检验医学与临床,2018,15(5):700-702.
[7]Roback JD,Grossman BJ,Harris T.Technical Manual[M].AABB:Seventeenth Edition,2011:897.
[8]苗伶俐,刘晓莺.交叉配血不合80例原因分析及体会[J].西南国防医药,2016,26(6):630-632.
[9]曲淑君.5379例患者ABO血型分布及不规则抗体检测结果分析[J].检验医学与临床,2017,14(8):1172-1173.
[10]陈文伟,庄丑菊.不规则抗体筛查对临床输血的价值研究[J].山西医药杂志,2017,46(12):1487-1488.
[11]Li H,Xu HM,Zhang Y,et al.Analysis of patients'irregular antibody screening and identification results before blood transfusion[J].J Exper Hematol,2015,23(3):861-865.
[12]孙国栋,尹志柱,刘景汉,等.不规则抗体筛查阳性患者紧急抢救输血20例分析[J].临床输血与检验,2017,19(2):123-125.
[13]Mallhi RS,Dimri U,Jayamanna DRSA,et al.Presence of irregular antibody(anti-c)in a multitransfused cardiac surgery patient[J].Indian J Hematol,2015,31(3):385.
[14]Lubu sˇk y'M.The importance of irregular red cell antibodies screening and blood group antigens assessment in pregnant women[J].CeskáGynekol,2015,80(3):236.
[15]徐弘,孔玉洁,宋宁,等.筛选试剂红细胞的血型基因分型方法建立和应用[J].中国输血杂志,2017,30(10):1146-1149.
[16]焦琴,李娜,杨世明,等.163例Rh血型系统以外不规则抗体的检测及其临床意义[J].细胞与分子免疫学杂志,2018,34(2):160-162.
[17]吴迪.9013例输血者不规则抗体筛查结果及意义[J].首都医科大学学报,2017,38(5):753-757.
[18]唐玉杰,施丽,唐生明.广西中北部地区不规则抗体筛选分析[J].临床输血与检验,2017,19(2):132-135.
[19]刘恋霞.24743例拟输血患者不规则抗体筛查结果及分析[J].世界中西医结合杂志,2017,12(11):1532-1534.
[20]葛艳玲,刘英.RhE抗原检测及同型输注在临床输血中的意义[J].临床血液学杂志:输血与检验,2018,31(2):137-138.
[21]张勇萍,杜娟,杨世明,等.4397例孕产妇ABO和RhD血型检测及不规则抗体的分析[J].细胞与分子免疫学杂志,2016,32(5):680-682.
[22]王淑平,陈慧芬,李志强.孕妇ABO血型系统以外不规则抗体致新生儿溶血病10例[J].临床输血与检验,2017,19(4):340-342.
[23]李丹,张勇萍,杨世明,等.35例MNS血型抗体特异性及对ABO血型鉴定与交叉配血的影响[J].细胞与分子免疫学杂志,2016,32(12):1687-1689.
[24]吴军军,祝文坚,甘恒.梧州地区Rh阴性无偿献血者CcEe抗原分型及不规则抗体筛查分析[J].医学检验与临床,2016,27(9):68-70.
[25]王兰芳,蔡娟.孕妇产前血型不规则抗体检测1450例临床分析[J].蚌埠医学院学报,2011,36(1):69-70.