摘要
目的报告1例高效价抗-M抗体引起的交叉配血不合患者,探讨高效价抗-M抗体对交叉配血的影响及其在急诊输血流程中的处置策略。方法复旦大学附属中山医院厦门医院于2022年2月7日收治1例交叉配血不合的急诊手术患者,检测ABO血型、Rh血型和MN血型,进行不规则抗体筛查与鉴定、抗体效价和交叉配血试验。结果患者为54岁男性,因“突发胸背痛3 d”入院,诊断为主动脉弓动脉瘤先兆破裂,需行急诊手术。患者血型鉴定结果为O、CcDee、NN型,不规则抗体筛查试验结果阳性;检测抗体特异性,发现患者体内存在高效价抗-M抗体,免疫球蛋白M(IgM)型抗-M抗体效价为1︰1024,且在37℃条件下有活性,干扰交叉配血。患者术中输注O、CcDee、NN型去白细胞悬浮红细胞2 U,输注有效且无输血不良反应。结论急诊患者输血前有必要进行不规则抗体筛查并鉴定抗体特异性,进而在配血时规避对应的抗原,避免发生溶血性输血反应。对该病例的治疗探讨了对抗-M抗体患者在急诊输血流程中的处置策略,确保急诊患者输血安全。
Objective To report a case of cross matching incompatibility caused by high titer anti-M antibody and to explore the influence of high titer anti-M antibody on cross matching and its treatment strategy in the emergency blood transfusion process.Methods A case of incompatibility with cross matching blood in emergency operation was admitted in Zhongshan Hospital,Fudan University(Xiamen Branch)on February 7,2022.ABO,Rh and MN blood type identification tests,irregular antibody screening test,antibody identification,antibody titer test and cross matching test were performed.Results The patient,a 54-year-old male,was hospitalized due to"sudden chest and back pain for 3 days".He was diagnosed as threatened rupture of aortic arch aneurysm and needed emergency surgery.The results of blood type identification were O,CcDee,NN type and positive for irregular antibody screening test.After the specific identification of antibody,there was a high titer anti-M antibody in the patient's plasma.The titer of IgM anti-M antibody was 1︰1024 and it was active at 37℃,which interfered with cross matching.Intraoperative infusion of 2 U leucocyte suspension erythrocyte with O,CcDee and N type was effective and no adverse blood transfusion reactions were observed.Conclusions It is necessary to conduct irregular antibodies screening and identify their specificity before transfusion in emergency patients,so as to avoid the corresponding antigens for blood matching and avoid hemolytic blood transfusion reaction.The treatment strategy of anti-M antibody patients in emergency blood transfusion process was discussed in the treatment of this case to ensure the safety of emergency blood transfusion.
作者
王翠碧
陈玮媛
熊磊群
张萍萍
雷棽
吕小英
Wang Cuibi;Chen Weiyuan;Xiong Leiqun;Zhang Pingping;Lei Shen;Lyu Xiaoying(Department of Blood Transfusion,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361015,Fujian,China)
出处
《实用检验医师杂志》
2022年第2期208-211,共4页
Chinese Journal of Clinical Pathologist
基金
复旦大学附属中山医院厦门医院孵化课题(2020ZSXMYJ02)。
关键词
抗-M抗体
MNS血型
交叉配血
急诊输血
Anti-M antibody
MNS blood type
Blood cross matching
Emergency blood transfusion
