意外抗体对ABO血型鉴定的干扰

目的：分析意外抗体在ABO血型鉴定中的干扰作用,为ABO疑难血型鉴定提供思路和对策。方法：对全自动血型仪检测的ABO血型正反定不合的样本结合盐水试管法、抗体筛查及鉴定结果以及病史资料综合分析。结果：26例引起正反定不合的抗体中IgM18例,IgG8例,分别是抗-M10例、抗-Lea2例、抗-N1例、抗-P12例、抗-JKa1例、抗-D2例、抗-E2例、抗-C1例、抗-c1例、抗-Fya1例、自身抗体3例。结论：IgM和IgG两类意外抗体均能引起ABO血型正反定不合,反定细胞应该选用常见意外抗体对应抗原表位缺失的红细胞。     

类孟买血型的鉴定和家系调查1例

本文采用血型血清学方法对本血液中心。型献血者进行稀有血型筛选,约筛18100人中发现1例类孟买血型。该红细胞与筛选用抗-H反应为阴性,与强的抗-H反应为弱凝集。血型为O,D,I,Le（a-b＋）型。抗体筛选结果：献血者血清与自身、新生儿、和成人红细胞在室温下反应均为0;在4℃下反应分别为W＋、0、1＋。抗体鉴定结果：血清中存在弱的抗-H和抗-I抗体。红细胞抗原检查结果：吸收放散试验证实红细胞上存在H和A抗原,但A抗原不与抗-A、抗-B和抗-AB凝集。     

无偿献血者不规则抗体检测分析

目的:回顾性分析近一年来徐州地区无偿献血者不规则抗体的发生频率及分布特点,探讨无偿献血者不规则抗体筛查的必要性,确保输血的安全性和有效性。方法:RhD阳性献血者主要应用ABO反定型红细胞,通过盐水法检测不规则抗体,血型室进一步鉴定抗体特异性;RhD阴性献血者全部进行抗体筛查及鉴定。结果:RhD阳性献血者共检出血型同种不规则抗体47例(0.04%),其中确认特异性抗体27例(57.4%),冷抗体(未能确定特异性)19例(40.4%);不规则抗体(未能确定特异性)1例(2.1%)。免疫球蛋白类别为IgM抗体占95.7%(45/47),IgG抗体占4.3%(2/47),其中女32例,男15例,男女检出率差异有统计意义。RhD阴性献血者血清不规则抗体检出率为3.0%(22/729),其中抗-D 10例(45.5%),抗-M 3例(13.6%),抗-P1 1例(4.5%),冷抗体(未能确定特异性)6例(27.3%),不规则抗体(未能确定特异性)2例(9.1%);免疫球蛋白类别为IgM抗体占45.4%(10/22),IgG抗体占54.6%(12/22),其中女19例,男3例,男女检出率差异有统计学意义。结论:本研究为是否进行献血者抗体筛选提供了决策依据,对于RhD阴性献血者有必要进行不规则抗体筛选。     

不规则抗体筛查在输血安全中的临床应用

目的:通过对临床输血患者红细胞血型不规则抗体的检测结果和分布特点,保障临床输血安全。方法:采用微柱凝胶法对2018-01—2018-07收治的21例临床输血患者进行不规则抗体筛查,对抗体筛查阳性标本采用盐水法、凝聚胺法、抗球蛋白法进行抗体特异性鉴定。结果:21例临床患者不规则抗体阳性者,其中男8例,女13例;女性患者不规则抗体检出率显著高于男性。21例不规则抗体阳性患者中,自身抗体1例,同种抗体+自身抗体1例,同种抗体19例。检出的同种抗体中抗-DC 1例,抗-E 2例,抗-Ec 6例,抗-c 1例,抗-Ce 1例,抗-M2例,抗-P11例,抗-Lea2例,抗-JKa1例,未确定特异性抗体2例。有妊娠史/输血史者≥3次的检出率明显高于无妊娠史和输血史者。结论:对有多次妊娠史和反复输血的临床患者在输血前应进行不规则抗体筛选,及时发现有临床意义的抗体,可有效避免临床患者免疫性溶血反应的发生,提高临床患者输血的安全性、有效性。     

不规则抗体筛查在输血安全中的临床应用

目的:通过对临床输血患者红细胞血型不规则抗体的检测结果和分布特点,保障临床输血安全。方法:采用微柱凝胶法对2018-01—2018-07收治的21例临床输血患者进行不规则抗体筛查,对抗体筛查阳性标本采用盐水法、凝聚胺法、抗球蛋白法进行抗体特异性鉴定。结果:21例临床患者不规则抗体阳性者,其中男8例,女13例;女性患者不规则抗体检出率显著高于男性。21例不规则抗体阳性患者中,自身抗体1例,同种抗体+自身抗体1例,同种抗体19例。检出的同种抗体中抗-DC 1例,抗-E 2例,抗-Ec 6例,抗-c 1例,抗-Ce 1例,抗-M2例,抗-P11例,抗-Lea2例,抗-JKa1例,未确定特异性抗体2例。有妊娠史/输血史者≥3次的检出率明显高于无妊娠史和输血史者。结论:对有多次妊娠史和反复输血的临床患者在输血前应进行不规则抗体筛选,及时发现有临床意义的抗体,可有效避免临床患者免疫性溶血反应的发生,提高临床患者输血的安全性、有效性。     

新生儿不规则抗体检测的临床意义

目的：检测新生儿红细胞血型不规则抗体,探讨不规则抗体与新生儿溶血病的关系。方法：对521例新生儿溶血病待确诊患儿通过微柱凝胶卡进行直接抗人球白试验、游离抗体测定、放散试验,不规则抗筛选阳性标本进一步进行不规则抗体鉴定,同时进行不规则抗筛选阳性患儿母亲血型鉴定及不规则抗体筛选、鉴定。结果：检测出抗-D 4例,抗-E 3例,抗-c1,抗-M 1例。结论：应重视孕妇IgG类红细胞血型不规则抗体筛查;根据不规则抗体的特性,可为患儿选择无相应抗原的血液进行综合治疗和换血。     

低频抗-Mur抗体鉴定及血型特征研究

目的:通过对1例冰冻保存的抗筛阴性、交叉配血不合的献血者标本进行检测分析,了解低频血型抗体类型和血型特征。方法:采用不同厂家的抗体筛选细胞对冰冻保存标本和新采集标本进行抗体检测和鉴定,并检测抗体效价;采用多种血型血清学方法检测抗-Mur抗体与Mur抗原的红细胞凝集反应特征。结果:该献血者标本与具有Mur抗原的筛选细胞血清凝集反应阳性,与其余筛选细胞反应均为阴性;抗体鉴定结果为IgG抗-Mur抗体;冰冻保存标本和新采集标本的抗体效价均为16;Mur抗原抗体在酶介质中不凝集。结论:导致抗筛阴性、交叉配血不合的不规则抗体为IgG抗-Mur抗体,IgG抗-Mur抗体冰冻保存效价比较稳定且可在人体内较长时间稳定存在,Mur抗原抗体反应符合MN血型抗原抗体血型血清学凝集反应特征。     

献血者检出IgM、IgG性质抗-M抗体1例报告

献血者为女性,48岁,首次无偿献血,育有一子。ABO血型鉴定正定型为AB型,反定型为O型。红细胞血型鉴定、抗球蛋白试验、抗体筛选及鉴定均按文献方法进行。红细胞血型鉴定结果见表1。献血者ABO血型为AB型,MN血型为NN型。血浆抗体筛选采用上海血液中心生产的(1、2、3)号筛选细胞进行,盐水法1、2号筛选细胞阳性;二巯基乙醇灭活献血者血浆中IgM性质抗-M盐水     

红细胞输注效果不佳与回忆反应的分析研究

目的:了解红细胞输注效果不佳的原因,为临床输血效果评价提供参考。方法:对11例红细胞输注效果不佳患者在输血前、输血后第3、7和12天分别进行直接抗球蛋白试验、抗体筛查和血常规检测以及抗体特异性检测。结果:11例红细胞输注效果不佳患者在输血前抗体筛选等检测均为阴性结果,在输血后第7天开始都出现了血红蛋白和红细胞数先升后降的现象,直接抗球蛋白试验试验的结果均为阳性或可疑,抗体筛查在第12天所有患者都出现抗筛阳性或者可疑。结论:11例红细胞输注效果不佳的原因符合"回忆反应"的特征。提示对于有输血史或多次妊娠史的患者,即使抗体筛选等检测结果为阴性,也应考虑"回忆反应"发生的可能,有必要对此类患者输入Rh抗原(D/C/c/E/e)相合的血液,保证临床输血安全有效。     

引起溶血性输血反应3例低频率抗-Mur抗体特征探析

目的研究抗．Mur抗体血清学特征,探索其在输血医学中临床意义。方法对3例患者的血清,与已知血型的试剂红细胞,在盐水、木瓜酶、凝聚胺、抗球蛋白介质中反应,鉴定抗体的特异性。结果该3例患者与已知血型的试剂红细胞在盐水、凝聚胺、抗球蛋白介质中反应结果显示患者血清中含有抗-Mur抗体。结论该3例同种抗体抗-Mur引起溶血性输血反应,为避免抗体筛查中漏检抗-Mur。确保输血安全,建议在抗体筛选细胞中增加Mur抗原细胞。     

IH-1000全自动血型仪在交叉配血中的应用

目的:评价IH-1000全自动血型仪在交叉配血中的准确性。方法:采用IH-1000全自动血型仪对1 200例患者样本进行交叉配血,并与传统的抗人球蛋白配血法、聚凝胺配血法进行对照试验。结果:①100份抗体筛查阴性的标本,3种不同交叉配血方法的试验结果完全相符;②1 082份抗体筛查阴性的标本,交叉配血试验结果为:全自动血型仪法30例次侧不相容,抗人球蛋白试管法25例次侧不相容,差异无统计学意义(P0.05);③18份抗体筛查阳性标本,交叉配血试验结果为:全自动血型仪法18例不相容,聚凝胺法16例不相容,抗人球蛋白试管法17例不相容,差异无统计学意义(P0.05)。结论:IH-1000血型仪用于交叉配血检测,结果可靠,可永久保存,操作规范化、标准化,降低了人为错误的发生率。     

The P blood group system in pigeon breeders and pigeon breeder's disease.

A blood group P1-like antigen has been found in gram-negative bacilli isolated from pigeon droppings, in pigeon serum, and on pigeon red blood cells. As a probable resident of the environment of the pigeon loft, the antigen stimulated formation of anti-P1 antibody in eight of 11 pigeon breeders who belonged to the P2 blood group. Only one of 11 random hospitalized patients with the P2 blood phenotype had a detectable titer of anti-P1 antibody (P less than 0.01). The titer of anti-P1 antibody was not significantly different in symptomatic vs asymptomatic breeders. The presence or absence of anti-P1 antibody could not be correlated with any band of immunoprecipitates formed between pigeon breeder's serum and crude extract of pigeon droppings. The P antigen was identified in pigeon-dropping extracts of breeders with the P2 blood phenotype by inhibition of hemagglutination. We conclude that anti-P1 antibodies appear to be a component of the immunologic response to avian antigens of pigeon breeders but are probably unrelated to the pathogenesis of pigeon breeder's disease.     

Anti-ribosomal P protein antibody induces Th1 responses by enhancing the production of IL-12 in activated monocytes

Autoantibodies to ribosomal P proteins (anti-P) are detected in 12–16% of patients with systemic lupus erythematosus (SLE), and have been found to be associated with some manifestations, including lupus psychosis, nephritis and hepatitis. We have recently disclosed that anti-P react with activated human peripheral blood monocytes, and enhance their production of tumor necrosis factor-α and interleukin (IL)-6. It is also possible that anti-P might regulate other monocyte functions, including the regulation of T helper (Th) responses. The current study was therefore undertaken to explore the effects of anti-P on the induction of Th1 responses. Peripheral blood mononuclear cells (PBMC) from healthy donors were cultured with affinity-purified anti-P or control IgG. Highly purified monocytes were cultured with interferon (IFN)-γ in the presence of anti-P or normal IgG. Anti-P significantly enhanced the production of IFN-γ by PBMC. Of note, anti-IL-12 monoclonal antibodies almost completely abrogated the anti-P-mediated upregulation of the IFN-γ production of PBMC. Accordingly, anti-P significantly enhanced the production of IL-12 by activated monocytes. These results indicate that anti-P induce Th1 responses by upregulating the production of IL-12 by activated monocytes. The data therefore suggest that anti-P play an important role in the pathogenesis of SLE through the promotion of Th1 responses.     

1∶49枸橼酸钠抗凝剂在临床输血检验中的应用

目的:研究1∶49枸橼酸钠抗凝剂在血型鉴定、抗体筛查、临床交叉配血和输血传染性指标检测中的应用。方法:配制不同浓度的枸橼酸钠比例,确定最大抗凝比例,取68例标本分别用EDTA-K2、肝素钠和1∶49枸橼酸钠抗凝,分别用来鉴定血型和做抗体筛查,最后用聚凝胺法及微柱凝胶卡式法交叉配血检测不同抗凝剂对交叉配血的结果的影响。同时,取乙肝表面抗原(HBsAg)、丙肝抗体(HCV)、艾滋病抗体(HIV)、梅毒抗体(TP)各30例阳性标本,采用化学发光方法进行检测,观察1∶49枸橼酸钠抗凝管对检测HBsAg、HCV、HIV、TP的影响。结果:1∶49的枸橼酸钠抗凝管能达到抗凝效果,对血型鉴定、抗体筛查、交叉配血结果没有影响,与不抗凝采血管对HBsAg、HCV、HIV、TP阳性标本进行检测比较,2种采血管对结果的影响差异无统计学意义(P0.05)。结论:1∶49枸橼酸钠抗凝剂能提高临床交叉配血、输血前检查相关传染性指标检测的快速性和准确性。     

Immunological Identification of Blood Group Pk Antigen on Normal Human Erythrocytes and Isolation of Anti-Pk with Different Affinity

The P1 and Pk blood group glycolipid antigens have the common terminal disaccharide, Gal(alpha, 1-4)Gal, but previous studies indicated that anti-P1 from P2 individuals does not cross-react with Pk antigen. In this paper, the specificities of anti-P1 and anti-Pk were analyzed carefully by complement fixation and hemagglutination techniques and the following results were obtained: (1) Anti-P1 from P2 serum was not absorbed with the Pk glycolipid (CTH), but this antigen absorbed all anti-P1 and anti-Pk (anti-P1Pk) antibodies from the sera of four p individuals. Most of the anti-P1Pk antibodies were IgG, but the anti-p1 from the P2 individual was IgM. (2) The Pk antigen on normal P2 erythrocytes was not 'cryptic'. It was reactive with p serum from which the anti-P antibodies were removed by absorption with the P glycolipid (globoside). This was not appreciated previously because, in order to make anti-Pk reagents, p sera (anti-P1PPk) were absorbed with P1 cells which contain CTH. (3) The anti-P1Pk antibodies in p sera were separated by partial absorption with P1 erythrocytes and elution from the absorbing cells, into two fractions that differ markedly in their affinity for alpha-methyl-D-galactoside and the oligosaccharides prepared from CTH.     

类B抗原致血型鉴定困难2例

<正>我站最近发现1例孕妇及1例献血员其红细胞上有类B抗原造成血型鉴定困难,报告如下。1病例资料例1孕妇,29岁,第2胎,孕20周,自述无流产及输血史。因常规产前检查就诊我市妇幼保健院,临床未能确定其ABO血型,故来鉴定。经调查孕妇9年前第1次妊娠时检测为AB型血,然而其丈夫为O型血,女儿为O型血,其女儿与母亲的AB型不符合遗传规律。     

Anti-ribosomal P protein antibody in human systemic lupus erythematosus up-regulates the expression of proinflammatory cytokines by human peripheral blood monocytes

OBJECTIVE: Autoantibodies to ribosomal P proteins (anti-P antibodies) are detected in 12-16% of patients with systemic lupus erythematosus (SLE) and have been found to be associated with some manifestations of the disease, including lupus psychosis and hepatitis. Recent studies have disclosed that anti-P antibodies react with activated T cells but not with B cells, suggesting possible direct effects of anti-P antibodies on immune regulation. The present study was designed to explore the presence of the epitope recognized by anti-P antibodies on human peripheral blood monocytes. METHODS: Highly purified peripheral blood monocytes obtained from healthy donors were cultured with or without interferon-gamma (IFNgamma) in the presence of either anti-P antibodies purified by affinity chromatography from the sera of patients with SLE or control IgG. RESULTS: Flow cytometry analysis disclosed that fresh (day 0) monocytes did not express the ribosomal P epitope, whereas expression of the ribosomal P epitope was induced on annexin V-negative monocytes after activation through plastic adherence for 48 hours. More important, anti-P antibodies (compared with normal IgG or IgG from SLE patients devoid of anti-P antibodies) enhanced the production of tumor necrosis factor alpha (TNFalpha) and interleukin-6 (IL-6) by activated monocytes. Accordingly, anti-P antibodies also up-regulated the expression of TNFalpha and IL-6 messenger RNA in activated monocytes. Of note, F(ab')(2) fragments of anti-P antibodies, which do not result in Fcgamma receptor (FcgammaR) crosslinking, also effectively up-regulated the expression of TNFalpha and IL-6. CONCLUSION: These results indicate that human peripheral blood monocytes express the ribosomal P epitope upon activation, irrespective of induction of apoptosis. Moreover, the data suggest that anti-P antibodies might modify a variety of inflammatory responses through up-regulation of the expression of proinflammatory cytokines in monocytes, in a manner that does not involve FcgammaR crosslinking.     

玻璃珠柱凝集法与传统试管法检测ABO／Rh（D）血型的应用评价

目的：探讨玻璃珠柱凝集法在临床应用中鉴定血型的准确性。方法：用全自动血型及配血分析系统和传统试管法分别对我院住院患者22919例抗凝样本进行血型鉴定并比较检测结果的符合率。结果：两种方法的检测结果一致,全自动血型及配血分析系统鉴定血型的准确率达到100％,鉴定结果中Rh（D）阴性为70例,阴性率为0．3％,且鉴定出1例弱D。结论：全自动血型及配血分析系统将血型鉴定从加样到判读整个过程实现了标准化和自动化,能消除许多人为因素造成的错误判定,为安全输血提供了保障。     

Differential regulation of IgG subclasses and IgE antimalarial antibody responses in complicated and uncomplicated Plasmodium falciparum malaria

The aim of this study was to assess the immunoglobulin (Ig)-subclass distribution of antimalarial antibody responses in 110 and 169 Thai patients with complicated and uncomplicated Plasmodium falciparum malaria, respectively. Antimalarial plasma IgG subclasses and IgE antibody levels against a crude malaria blood stages, and antigen preparation were determined using enzyme-linked immunosorbent assay (ELISA). On admission, the levels of anti-P. falciparum IgG1, IgG2 and IgG3 were significantly lower in patients with complicated malaria than uncomplicated malaria (IgG1, P < 0.0001; IgG2, P < 0.0001; IgG3, P < 0.0001). The levels of antimalarial IgE were slightly lower, but not statistically significant (P = 0.389) in the complicated malaria. After adjusting all antibody levels and age, anti-P. falciparum IgG3 levels remained significantly associated with complicated malaria. None of the other antibody concentrations showed statistically significant associations with complicated malaria. The anti-P. falciparum IgG3 levels were related to the IgG1 as well as IgG2 levels. A correlation between anti-P. falciparum IgG2 and IgE was observed in the complicated malaria group, and this may indicate their roles in the severity of disease. Our data suggest that anti-P. falciparum IgG3 is associated with a reduced risk of complicated malaria and that antimalarial Ig-subclasses are differently regulated in patients with complicated and uncomplicated malaria.     

Cross reaction of antibodies to a glycine/alanine repeat sequence of Epstein-Barr virus nuclear antigen-1 with collagen, cytokeratin, and actin.

P62 is a synthetic peptide which corresponds to the glycine/alanine repeat sequence of Epstein-Barr virus nuclear antigen-1. It is the main epitope recognised by anti-rheumatoid arthritis nuclear antigen antibodies. It was shown previously that anti-P62 antibodies were raised fourfold in patients with rheumatoid arthritis compared with controls. To examine the possibility that this increase was due to cross reactive autoantibodies binding to P62, anti-P62 antibodies from serum samples taken from 10 patients with rheumatoid arthritis and five healthy controls were purified by affinity chromatography. Immunoglobulin G anti-P62 antibodies purified from four of 10 serum samples from patients with rheumatoid arthritis also reacted with human epidermal keratin, denatured collagen type II and actin, but not with influenza antigens, as determined by enzyme linked immunosorbent assay (ELISA). Anti-P62 antibodies in serum samples from healthy controls and patients with rheumatoid arthritis reacted with epidermal keratin by immunoblotting. It is suggested that antibodies to the glycine/alanine repeat sequence of Epstein-Barr nuclear antigen-1 recognise homologous epitopes on keratin, actin, and collagen. It is also possible that molecular mimicry between a major epitope on the Epstein-Barr virus and several autoantigens might contribute to the breakdown of tolerance and autoimmunity in patients with rheumatoid arthritis.