特殊情况紧急抢救输血的回顾性分析

目的观察交叉配血试验不合或/和抗体筛查阳性时紧急抢救输血推荐方案的临床应用及效果分析。方法对输血前交叉配血试验不合或/和抗体筛查阳性且生命危急的患者,启动《推荐方案》中输血方案进行抢救,密切观察患者输血过程中有无输血不良反应发生,比较输血前与输血后1 d、7 d,Hb、Hct、TBIL、DBIL、IBIL的变化,对应用紧急输血方案临床疗效进行评价。结果 10例交叉配血试验不合和抗体筛查阳性患者需抢救输血,男性3例,女性7例,均为Rh(D)阳性患者;其中3名患者输注同型交叉配血阴性供者红细胞;4名患者输注非同型[均为O型Rh(D)阳性]且交叉配血试验阴性的供者红细胞;还有3名患者未筛选出交叉配血试验阴性的血源,为抢救生命应急选择与患者同型且交叉配血试验凝集程度最弱(±或1+)的供者红细胞输注;10名患者中3名非同型输注AB型血浆;10例患者输注后,血红蛋白、红细胞压积明显提高,均无溶血及其它输血不良反应发生。结论交叉配血试验不合或/和抗体筛查阳性患者紧急抢救输血选择与患者ABO血型同型且交叉配血试验阴性的供者红细胞输注、选择O型且交叉配血试验阴性的供者红细胞输注及直接选择AB型血浆输注是安全有效的,应当推广。     

抗-E患者输血导致产生抗-c1例

临床资料 患者,男,68岁,肾功能障碍,因肾性贫血长期输血,在经治医院交叉配血不合,送本站进一步检查,抗体筛选阳性,经鉴定证实为抗-E,每次交叉配血选择E抗原阴性的血液输注。输注8U红细胞后,再次要求输血,抗体筛选时发现联合抗体经鉴定为抗-E、抗-c,现报道如下。     

大面积烧伤患者反复输血输液抗感染治疗对输血血清学的影响

目的回顾性探讨与分析大面积烧伤患者多次输血输液抗感染治疗对交叉配血的影响,并制订适宜的检测策略和交叉配血方案。方法选取本院烧伤科住院的大面积烧伤患者(烧伤面积大于85%以上)111例,入院后经大量输血输液抗感染治疗,当患者再次需要输血做交叉配血时,主次侧出现交叉配血不合现象。为此,应用吸收放散技术对大面积烧伤患者的红细胞和血清进行检测,并且利用谱细胞来鉴定抗体特异性。结果 111例大面积烧伤患者中,共检出同种抗体48例,占43.2%,红细胞直接抗人球蛋白试验阳性占23.4%(26/111),蛋白异常凝集占20.7%(23/111),药物性抗体占12.6%(14/111)。结论长期大量输注头抱类抗生素,反复多次输注悬浮红细胞、去白红细胞悬液、白蛋白、冰冻血浆和冷沉淀后,会导致机体产生免疫反应,使患者体内产生血型同种抗体、药物性抗体、自身抗体及红细胞被致敏等,这些现象是影响大面积烧伤患者交叉配血不合的主要因素。     

模拟电子交叉配血的临床应用分析

目的探讨电子交叉配血技术在我国临床输血中的可行性与安全性。方法采用全自动血型仪和试管法对患者和献血者进行血型鉴定和抗体筛查。患者和献血者2次血型鉴定结果一致及抗筛试验结果阴性,与传统血清学交叉配血法相符,模拟进行红细胞悬液出库。结果电子交叉配血法与传统血清学交叉配血法结果相符的4435 U红细胞悬液模拟出库给2 330名患者输注,未观察到ABO/RhD血型不合的输血不良反应。电子交叉配血法与传统血清学交叉配血法结果不相符,未模拟出库红细胞悬液65 U。主要原因为患者不规则抗体筛查漏检抗-Mur;患者直接抗球蛋白C3试验阳性需输注洗涤红细胞,患者直接抗球蛋白IgG试验阳性;献血者直接抗球蛋白Ig G试验阳性。结论在完善血型不规则抗体筛查试剂抗原谱和增加患者、献血者直接抗球蛋白试验的基础上,电子交叉配血技术在我国临床输血中具有可行性与安全性。为了临床输血安全,对不符合电子交叉配血条件的应采用血清学交叉配血作为补充。     

抗-E抗体致配血不合5例分析

多次、大量输血及妊娠均可使机体产生红细胞不规则抗体,引起不良输血反应、血型鉴定困难及交叉配血不合。我们于200901／200906通过抗体筛选试验和交叉配血检出5例抗-E抗体,筛选无相应抗原的红细胞输注,无一例发生溶血性输血反应,报告如下。     

多次输血产生抗-E、抗-c联合抗-Wra抗体致疑难配血一例

正临床患者在输血前进行不规则抗体筛查试验,不规则抗体是引起临床配血不合的主要原因。对于不规则抗体筛查阳性患者,需进行进一步的抗体鉴定,确定抗体特异性,然后选择相应抗原阴性的献血者红细胞进行输注,保障临床输血安全。本实验室发现一例抗-E、抗-c联合抗-Wra抗体导致配血不合,现报道如下。材料与方法1 标本来源患者何某,女,71岁,临床诊断T-细胞大颗粒淋巴细胞白血病,上呼吸道感染,重度贫血入院,Hb 24 g/L,     

抗球蛋白试验在疑难交叉配血过程中的重要性分析

目的通过对患者输血前血样进行抗球蛋白试验检查,查找导致临床患者配血不合的原因,配合性输注,确保临床输血安全。方法通过不规则抗体筛选试验,检测患者血清中抗体性质。结果 61例交叉配血不合患者抗球蛋白试验结果显示,由温、冷性自身免疫性抗体及冷凝集素影响配血不合30例;ABO血型系统以外不规则抗体同种免疫性抗体31例,由Rh血型系统同种免疫性抗体导致配血不合占大多数,其中与抗-E抗体有关的患者17例,占由同种免疫性抗体引起配血不合的54.84%。结论患者体内产生的ABO血型系统以外不规则同种免疫性抗体或者温、冷性自身免疫性抗体及冷凝集素等几种因素的影响,是造成临床交叉配血不合的主要原因,Rh血型抗原的复杂性和多态性应引起临床的重视,Rh血型同型输注可降低输血不良反应的发生率。     

抗-H抗体引起血型鉴定困难3例报告

抗-H抗体属于IgM型冷抗体，临床鉴定血型时，常可引起正反定型不符，造成定型困难。在反定型鉴定血型时发现的抗-H抗体中，3例患者经血型血清学检测，抗体在37℃、室温、4℃均有活性，分析抗体性质为IgM，提示紧急时刻给AB型患者输血，不能盲目输注O型红细胞，最好输注同型血。如果没有同型时，需输O型红细胞，先用盐水离心法配血，主侧配血相合时方可发出，再用不完全法检测。防止患者有抗-H抗体存在，引起输血不良反应。     

避免抗-Dia抗体漏检的临床分析与处理

目的鉴定1例不规则抗体导致的交叉配血不合。方法通过选择合适的抗体筛查细胞和谱细胞进行抗体鉴定检测不规则抗体,通过血清学及分子生物学手段检测红细胞表型。结果患者血清中同时存在IgG抗-E和IgG抗-Di~a抗体。抗-E抗体、抗-Di~a抗体效价分别是4和16。结论患者血清中的抗-E、抗-Di~a抗体是导致交叉配血不合的原因。合理选择抗体筛查细胞和谱细胞对输血前患者进行不规则抗体筛查和鉴定,是避免发生迟发型免疫性溶血性输血反应的重要保障。     

静脉输注丙种球蛋白对非新生儿溶血患儿交叉配血的影响

目的 研究非溶血患儿静脉输注丙种球蛋白（intravenous immunoglobulin, IVIG）后对交叉配血的影响,探究最佳输血策略。方法 对2020年1月—2022年12月我科收到的12例抗体筛选阴性、交叉配血不合的非ABO溶血患儿标本进行分析,使用试管法进行血型鉴定,使用微柱凝胶法进行抗体筛查、交叉配血、直接抗人球蛋白试验、游离血浆及放散液中抗-A和抗-B检测。结果 IVIG患儿,6例A型、2例AB型患儿血浆中检测到抗-A,3例B型患儿血浆中检测出抗-B,1例AB型患儿血浆中检测出抗-A和抗-B,所有患儿直接抗人球蛋白试验阳性,且均出现不同程度溶血表现,并与同型悬浮红细胞交叉配血不合、与O型洗涤红细胞配血相合。结论 IVIG会导致部分非ABO溶血患儿出现交叉配血不合、轻微溶血症状,宜选择O型洗涤红细胞输注。     

临床患者血浆中β- 内酰胺类药物＆抗体致输血无效及对供者红细胞亲和力的研究

目的 分析临床患者血浆中β- 内酰胺类药物＆抗体对供者红细胞的亲和力,探究药源性溶血性贫血及输血无效的临床特点。方法 选择2021 年11 月～ 2022 年4 月期间临床送检的4 例有β- 内酰胺类药物用药史的临床患者,检测ABO 与Rh 血型,直接抗球蛋白试验（direct antiglobulin test ,DAT）、不规则抗体鉴定（identification of irregularantibodies,IAT）与β- 内酰胺类药物抗体及效价,对DAT 阳性的患者红细胞进行酸放散并检测放散液中β- 内酰胺类药物抗体。选择ABO 和Rh 同型的供者红细胞与患者血浆在37℃无菌条件下体外致敏,监测β- 内酰胺类药物＆抗体在0 ,24,48 和72 h 与供者红细胞的亲和力,并观察加入补体后的溶血程度。结果 4 例患者血浆中均存在β- 内酰胺类药物抗体,停药前输血无效,停药后输血效果良好。患者1:A 型,RhCCDee,DAT 阳性（3+W）,IAT 阴性,血浆中存在头孢哌酮药物抗体（效价:1∶64）、阿莫西林药物抗体（效价:1∶16）,放散液中存在头孢哌酮药物抗体。患者2:A 型,RhCcDee,DAT 阳性（4+W）,IAT 阴性,血浆中存在头孢哌酮药物抗体（效价:1∶128）,放散液中存在头孢哌酮药物抗体。患者3:A 型,RhCcDee,DAT 阳性（4+）,IAT 阳性,鉴定为抗 E 抗体,血浆中存在阿莫西林药物抗体（效价:1∶16）、亚胺培南药物抗体（效价:1∶64）、头孢哌酮药物抗体（效价:1∶128）,放散液中存在亚胺培南、头孢哌酮药物抗体。患者4:A 型,RhCCDee ,DAT 阳性（1+）,IAT 阳性,鉴定为抗-E.c 抗体,血浆中存在阿莫西林药物抗体（效价:1∶32）,放散液中未检测到药物抗体。4 例患者血浆与供者红细胞体外致敏24 h 后DAT均为阳性,48 和72 h 内逐渐增强,加入补体后均可引起红细胞溶解。结论 头孢哌酮、阿莫西林和亚胺培南三种β-内酰胺类药物＆抗体可迅速结合到供者红细胞表面并随时间延长而增强,有补体存在的条件下可在24 ～ 72 h 内破坏供者红细胞引起溶血,导致输血无效。     

745例患者疑难交叉配血检测结果分析

目的：回顾性分析本地区导致临床输血交叉配血不相合产生的原因,为预防溶血性输血反应,保障临床输血安全,拯救病人提供有效依据。方法：对2006-2013年番禺、南沙两区各医院因交叉配血困难而送检的标本745例检测结果进行血型鉴定、不规则抗体筛选和鉴定、交叉配血。结果：ABO血型不合引起的交叉配血不相合15例、血浆蛋白异常引起的交叉配血不相合33例,血型不规则抗体引起的151例。其中ABO血型不合引起配血不相合的A亚型12例,B亚型3例;不规则抗体引起配血不相合分别是：自身抗体57例,药物抗体7例,同种特异性抗体87例．分别为：抗-E31例、抗-cE12例、抗-c5例、抗-Ce1例、抗-M10例、抗-Mur9例、抗-E伴抗-Mur3例、抗-Le^a 5例、抗～Le^b 3例、抗-P16例、抗-Jk^b 2例。结论：本地区导致交叉配血不相合的原因主要是同种不规则抗体,异常血浆蛋白次之,最后是ABO亚型。同种不规则抗体以1Kh血型系统的抗体为主,抗-E比例最多;建议交叉配血试验不配合时,应考虑ABO血型定型是否错误,排除异常血清蛋白影响,开展不规则抗体筛选和鉴定,建立Rh系统数据库,选择相合的血液输注,预防免疫性输血反应,保障临床输血安全。     

Severe anaphylactic reactions following transfusions of platelets to a patient with anti-Ch

The high-frequency Chido (Ch) antigen, found predominantly in plasma, is a determinant of the C4d fragment of the C4 molecule and is acquired by red cells during in vivo complement activation. Antibodies are made by Ch- people who lack C4S. It has often been reported that anti-Ch (and anti-Rg) do not cause hemolytic transfusion reactions. Reported here is a case of a transfusion reaction caused by anti-Ch. The antibody did not cause red cell destruction, but did cause a life-threatening anaphylactic reaction during transfusion of plasma proteins in pooled platelets. The antibody was of the IgG4 subclass and might have caused a short-term, sensitizing anaphylactic response. This case, and one previously reported in which a patient with anti-Rg experienced a severe reaction to fresh-frozen plasma and a plasma derivative, illustrates that these antibodies can cause severe, life-threatening reactions in patients who receive plasma-containing components.     

ABO-incompatible bone marrow transplantation: preparation by plasma exchange and in vivo antibody absorption

The threat of fatal hemolytic transfusion reaction has been a major deterrent to the use of ABO-incompatible bone marrow donors. An eighteen year old type O male with acute leukemia was prepared to receive type A HLA identical marrow using large volume plasma exchange prior to and following cyclophosphamide administration. Saline agglutinating anti-A antibody was initially present at a titer of 1:128. The initial antiglobulin titer of dithiothreitol (DTT) treated serum was 1:64. Initially the T 1/2 of 51Cr labeled type A red blood cells was less than five minutes. The first plasma exchange removed large quantities of anti-A antibody but 51Cr survival of type A red blood cells was unchanged. A second plasma exchange after an interval of three days, increased the T 1/2 of 51Cr labeled cells to 20 minutes. Saline agglutinating anti-A was not present at a titer of 1:8 and the antiglobulin titer of DTT treated serum was 1:4. Reaction to subsequent transfusion of type A red blood cells (5 units) was limited to a single febrile episode during the first unit. Survival of 51Cr labeled red blood cells increased to T 1/2 equal to 21 hours. These data indicate that plasma exchange and infusion of ABO incompatible red blood cells effectively reduce antibody concentration and prolong survival of ABO incompatible erythrocytes. It is suggested that the prolongation of 51Cr survival of ABO-incompatible red blood cells to a point that extravascular destruction is predominant be used to establish the safety of ABO-incompatible marrow infusion.     

临床输血不良反应情况分析及预防措施探讨

目的: 回顾输血后发生不良反应的病例,分析其发生原因与特点,探讨有效降低输血不良反应发生的措施。方法: 回顾分析2011年至2015年间发生输血不良反应的病例,对输注各种血液成分后患者发生输血不良反应的情况进行统计分析。结果: 5年内共有17 592人次输注血液制品,其中发生输血不良反应58例次,发生率为0.33%。输注单采血小板者的输血不良反应发生率最高,为1.02%;其次是输注血浆制品,为0.49%;输注悬浮红细胞则相对较低,为0.18%。输注不同血液成分间的输血不良反应发生率差异有统计学意义（χ²=26.1,P<0.01)。输血不良反应中,以过敏反应构成比较高,为63.8%,主要以输注血浆制品、单采血小板者多见;而发热反应构成比为36.2%,以输注悬浮红细胞者常见。我院输血不良反应逐年有所下降。结论: 加强输血管理,严格把握输血指征,减少不必要的输血,特别要避免血浆与红细胞配套使用,降低输血不良反应的发生率,确保输血安全。     

Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation

The management of hemotherapy in 31 cases of ABO- or Rh-incompatible bone marrow transplantation is described. Our experience confirms that ABO or Rh incompatibility does not adversely affect engraftment, patient survival, or incidence of graft-versus-host disease. Eighteen recipients with ABO antibodies against the donors' red cells (major incompatibility) were managed by different combinations of plasma exchange, transfusion of incompatible donor type red cells, and removal of donor-type red cells from the bone marrow before transplant. The only serious complication was delayed hemolysis in seven of nine patients who received incompatible red cell transfusions before transplant. Thirteen patients received bone marrow containing ABO antibodies against their red cells (minor incompatibility). Five were managed by centrifuging the bone marrow to remove plasma and reduce the amount of antibody. This did not cause substantial loss of stem cell activity (60-100% of original marrow), and no patients had complications related to the marrow transfusion. In contrast, two of seven patients who received uncentrifuged bone experienced hemolysis. Two of four Rh positive recipients who received marrow from an Rh negative donor developed anti-D, possibly due to Rh positive blood components transfused after transplantation. None of eight Rh negative patients who received an Rh positive transplant has developed anti-D. Blood components should be selected to avoid transfusion of incompatible red cells and to avoid transfusion of a large amount of incompatible plasma. This may necessitate use of plasma components of a different ABO type than the red cell components.     

异基因造血干细胞移植后并发自身免疫性溶血性贫血患者产生类抗体血清学检测方法及输血策略

目的探讨异基因造血干细胞移植（AHSCT）后免疫介导的自身免疫性溶血性贫血（AIHA）患者交叉配血不合的原因,血浆中不规则抗体筛选试验阳性时,不规则抗体鉴定的血清学检测方法的选择,处理措施及输血策略。 方法一例AHSCT后的3岁男性患儿因重度贫血为改善贫血症状需输注红细胞入住四川省人民医院。通过盐水试管法确定了患儿ABO、Rh血型后进行交叉配血试验发现患儿与多个同型供者血液不相合,考虑到患儿贫血严重,于是采用直接抗球蛋白试验来判断红细胞是否被致敏;通过盐水介质试管法、微柱抗球蛋白法和聚凝胺法进行ABO血型系统以外的不规则抗体筛选试验以确定血浆中有无不规则抗体;根据不规则抗体筛选试验结果选择聚凝胺法来确定抗体的特异性;通过盐水介质试管法、经典抗球蛋白法和聚凝胺法进行交叉配血实验,结合抗体鉴定的结果,综合分析选择合适的供者红细胞输注。 结果本例患儿ABO血型为AB型,Rh分型为CCDee,ABO血型已转变为供者血型。直接抗球蛋白试验强阳性,红细胞被抗体致敏。血浆中检出了不规则抗体,红细胞上放散下来的致敏抗体与血清中检出的不规则抗体均为类抗-Ce自身抗体。选择了避开类抗-Ce抗体的Ce抗原阴性的AB型红细胞输注后血色素升高,3 d后复查血常规Hb为79 g/L,输血有效。 结论任何类型的AHSCT后都有可能发展成AIHA,也就是血浆中可能存在某种自身抗体（类抗体）而破坏自身红细胞,若能够明确患者血清中存在的类抗体,即可避开这种抗体而筛选红细胞无相应抗原的供者,也就避免发生溶血性输血反应以安全输血。     

Phenotyping autologous red cells within 1 day after allogeneic blood transfusion by using immunomagnetic isolation of reticulocytes

BACKGROUND: When a transfused patient develops multiple or weak blood group antibodies, posttransfusion phenotyping is useful in antibody identification. To perform a correct phenotyping after transfusion, isolation of autologous red cells is necessary. However, mature autologous red cells are impossible to separate from their donor counterparts. Since the proportion of autologous reticulocytes compared to donor reticulocytes increases rapidly after transfusion, selective isolation of reticulocytes provides autologous cells for antigen typing. STUDY DESIGN AND METHODS: Extensive phenotyping was performed on red cells from 10 surgical patients before transfusion and on red cells and reticulocytes after the transfusion of 5 or more red cell units. Reticulocytes were isolated by using an antibody against the human transferrin receptor coupled to magnetic beads. RESULTS: The data showed nearly full agreement between pretransfusion phenotyping of red cells and posttransfusion typing of reticulocytes. Correct phenotyping of transferred patients could be obtained 8 to 10 hours after transfusion using isolated reticulocytes. CONCLUSION: This method is helpful in selecting compatible blood when patients have developed antibodies and have an urgent need for further transfusions.     

IMMUNOHEMATOLOGY: Identification and evaluation of false‐negative antibody screens

Background: Non‐ABO alloantibodies are frequently implicated in hemolytic transfusion reactions and are a leading cause of transfusion‐related mortality. Detection of clinically significant non‐ABO alloantibodies is reliant on an antibody screen, which is prone to clerical, technical, and reagent error. Data on the frequency of false‐negative antibody screens due to the occurrence of these errors are scarce, and the true incidence of false‐negative antibody screens in everyday practice is unknown. STUDY DESIGN AND METHODS: Monitoring for false‐negative antibody screens is routinely performed in our institution. All cases of false‐negative antibody screens involving clinically significant antibodies were identified through review of the blood bank quality assurance records from 2004 to 2007. The clinical impact was recorded in each case. RESULTS: Twenty‐one cases of false‐negative antibody screens due to clinically significant antibodies were detected. Sources of error included testing error (12 cases), reagent red blood cell (RBC) failure (one case), and reagent limitations (one case). The cause of error was inconclusive in seven cases. Nine patients were found to have received antigen‐incompatible blood as a consequence of these errors, resulting in a single nonfatal hemolytic transfusion reaction. CONCLUSIONS: The identification and investigation of false‐negative antibody screens is a valuable quality assurance measure which can serve to monitor staff performance, identify cases of reagent RBC failure, and identify patients who have received antigen‐incompatible blood at risk for hemolytic transfusion reactions.     

低频率抗Mur抗体引起溶血性输血反应的调查研究

目的研究抗Mur抗体血型血清学特征，调查其在输血医学中临床意义。方法对2例患者的血清，与已知血型的试剂红细胞和4个已知Mur抗原，在盐水介质、低离子间接抗球蛋白介质，分析鉴定出其抗体的特异性。结果这2例患者与已知血型的试剂红细胞在多种反应介质中的反应结果显示患者血清中含有抗Mur抗体，患者血清与4个已知Mur抗原的反应证实该例抗体只与Mur抗原反应。结论该例同种抗体为特异性抗Mur抗体，在临床会引起溶血性输血反应。在东方人群中Mihenberger血型抗体常规筛选鉴定值得探讨。