摘要
目的探讨类抗-D和类抗-C抗体致婴儿自身免疫性溶血性贫血(AIHA)的诊治,并且进行相关文献复习。方法选择2017年7月31日,四川大学华西第二医院收治的1例生后60 d的AIHA女性患儿为研究对象。采用微柱凝胶法检测患儿的血浆抗体和红细胞抗原,对患儿血浆标本进行吸收放散试验,并对血浆及放散液中的不规则抗体进行鉴定。对本例患儿的临床病例资料进行回顾性分析,总结其实验室检查结果、临床特征及诊治经过。本研究对AIHA相关文献进行复习时,设定检索策略为:以"类同种抗体""mimicking antibody"为中、英文关键词,分别对万方知识服务平台、中国知网(CNKI)数据库和PubMed数据库,建库至2020年6月,收录的类同类抗体所致AIHA相关文献进行检索。根据文献复习,总结此类抗体的实验室检测方法,以及此类抗体所致AIHA患者的诊断、治疗和预后。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果本例患儿于生后53 d出现全身皮肤黄染。患儿生后60 d入院检查:①ABO血型为B型,Rh血型表型为CcDEe型。②红细胞标本的直接抗人球蛋白试验(DAT)、抗体筛查结果均呈阳性,血清及自身红细胞放散液中均检出抗-D和抗-C特异性抗体,血清标本与B/ccdee去白细胞红细胞交叉配血主侧相合。③结合实验室检查结果及临床症状,本例患儿被确诊为类抗-D和类抗-C抗体致AIHA。患儿接受相容性去白细胞悬浮红细胞1 U输血后,其血红蛋白(Hb)值升高至88 g/L,此后逐渐下降至56 g/L,改用激素治疗后,Hb值上升至61 g/L,贫血症状缓解。④符合本研究检索及筛选策略的文献为8篇,纳入研究的本病患儿为8例,其抗体鉴定结果中,Rh血型系统的类同种抗体为5例,Kidd血型系统的类抗-Jkb合并类抗-Jk3抗体为1例,MNS血型系统的类抗-S抗体为1例,Kell血型系统的类抗-Kpb抗体为1例,患者接受的治疗方案主�
Objective To investigate identification and therapeutic effect of autoimmune hemolytic anemia(AIHA)caused by mimicking anti-D plus anti-C autoantibodies,and to review related literature.Methods On July 31,2017,a 60-day-old female infant with AIHA was selected as research subject.The microcolumn gel method was used to detect this infant′s plasma antibodies and red blood cell antigens,absorption and elution test was performed on infant′s plasma,and irregular antibodies in serum and diffuser was identified.Clinical data of this infant was analyzed retrospectively,and her laboratory detection characteristics and treatment effects were summarized."Mimicking antibody"in Chinese and English were respectively used as key words in order to retrieve literature from China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform and PubMed Database from establishment of database to June 2020.The relevant literature of minicking antibody caused AIHA would be searched.Through literature review,laboratory testing,diagnosis,treatment and prognosis of AIHA caused by mimicking antibodies were summarized.The procedure followed in this study were in accordance with the requirements of the World Medical Association Declaration of Helsinki in 2013.Results①This infant was with a history of xanthochromia on the 53rd day after birth.The infant′s ABO blood group was B group,and phenotype of Rh blood group was CcDEe group,respectively.②Immunological serological testing results showed that both the direct anti-human globulin test(DAT)and antibody screening were positive,antibody with anti-D and anti-C properties were detected in specimens of serum and diffuser.The cross-match with the B/ccdee red blood cells was matched in main side.③Combined with laboratory test results and clinical symptoms,this infant was finally diagnosed as AIHA caused by mimicking anti-D plus anti-C antibodies.The hemoglobin(Hb)value increased to 88 g/L after 1 U red blood cells transfusion,and then it decreased to 56 g/L.Finally,the
作者
杨丽艳
冯川莉
陈剑
Yang Liyan;Feng Chuanli;Chen Jian(Department of Laboratory Medicine,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《国际输血及血液学杂志》
CAS
2022年第1期62-73,共12页
International Journal of Blood Transfusion and Hematology
关键词
同种抗体
自身抗体
贫血
溶血性
自身免疫性
输血
激素疗法
Isoantibodies
Autoantibodies
Anemia,hemolytic,autoimmune
Blood transfusion
Hormone therapy
