摘要
背景:造血干细胞移植是目前临床治愈血液系统恶性肿瘤、先天性遗传性疾病以及自身免疫性疾病的重要手段,ABO血型不合的异基因造血干细胞移植并不影响造血干细胞的植活,但ABO血型不合在移植后血型转换期输血时应该制定何种输血策略值得研究。目的:研究ABO血型不合的异基因造血干细胞移植后血型转换期血型抗原抗体的变化及输血时血液的选择策略。方法:应用血型鉴定、抗体检测、抗体效价测定、交叉配血等方法,对24例ABO血型不合的异基因造血干细胞移植患者,在血型转换期进行血型抗原抗体的监测和输血前相容性检测,并与同期30例血型相合的异基因造血干细胞移植患者进行比较,选择适合的血液。结果与结论:24例ABO血型不合患者于移植后全部获得造血重建,但在红系恢复时间上,主要血型不合组和主次要均不合组的时间均有延长,差异均有显著性意义(P<0.05)。根据血型转换期监测的ABO抗原和相应抗体发生的变化,主要ABO血型不合移植者在血型转换期均输注了患者型红细胞;次要血型不合者根据抗原减弱的情况,从输患者型过渡到输供者型红细胞;主次要均不合的患者,从首先输注O型洗涤红细胞再过渡到输注供者型红细胞,24例患者均未发生任何溶血性输血反应。因此ABO血型不合的异基因造血干细胞移植后的输血策略,应根据患者血型转变情况及抗体效价动态变化,权衡所选血型对造血重建的影响,选择合适的血液成分输血,可避免溶血性输血反应且不影响干细胞植活及血型转换时间,保证患者移植安全。
BACKGROUND: Hematopoietic stem cell transplantation is an important means for clinical cure of hematologic malignancies, congenital hereditary diseases and autoimmune diseases. Although ABO-incompatibility has no effects on the survival of transplanted hematopoietic stem cells, the transfusion strategy to ABO-incompatible grafts in allogeneic hematopoietic stem cell transplantation is worth studying.OBJECTIVE: To explore the antigen-antibody changes during blood conversion after ABO-incompatible hematopoietic stem cell transplantation as well as transfusion strategies.METHODS: Blood grouping, antibody detection, antibody titer determination, cross-match test were employed for antigen-antibody monitoring during blood conversion and pre-transfusion compatibility detection in 24 cases undergoing ABO-incompatible allogeneic hematopoietic stem cell transplantation. Another 30 cases undergoing ABO-compatible allogeneic hematopoietic stem cell transplantation were enrolled as controls to select the appropriate blood.RESULTS AND CONCLUSION: All of the 24 ABO-incompatible patients developed the hematopoietic reconstitution after transplantation, but both major and major-minor ABO incompatibility were different from ABO compatibility in the time of erythrocytic recovery(P < 0.05). According to the changes of ABO antigen and antibody during the blood conversion, the patients of major ABO incompatibility were selected the red blood cells of their own type, the patients of minor ABO incompatibility were selected the red blood cells of the blood group from patients to donors gradually, and the patients of major-minor ABO incompatibility were selected the red blood cells from O-type blood to donor’s type gradually.None of the 24 recipients presented hemolytic reaction during transplantation and after transfusion. Therefore, the transfusion strategy to ABO-incompatible grafts in allogeneic hematopoietic stem cell transplantation is dynamically varied according to the changes of patient’s ABO antigen and antibody, and evaluat
出处
《中国组织工程研究》
CAS
北大核心
2015年第6期913-917,共5页
Chinese Journal of Tissue Engineering Research
基金
沈阳市科学技术计划项目(F-10-149-9-35
F10-206-1-00)~~
