摘要
目的分析红细胞直抗阳性的原因及配血的处理方法,旨在寻求安全、有效的输血对策。方法应用血清学方法对直抗阳性标本进行分型,对血清、放散液进行抗体鉴定或用药物处理的红细胞检测药物抗体,结合病史、用药史等分析原因,选择相容的血液进行输注。结果249例红细胞直抗阳性中,213例由患者自身原因造成,红细胞放散液和谱细胞或药物处理的红细胞无凝集反应。36例红细胞放散液和谱细胞或药物处理的红细胞有凝集反应,其中自身免疫性溶血性贫血(AIHA)自身抗体21例,胎母血型不合新生儿溶血病(HDN)5例,药物抗体4例,冷抗体4例,免疫性溶血反应同种抗体2例。结论针对大多数患者红细胞直抗阳性导致的配血不合,其放散液不具反应性,由患者自身原因引起,可输注相容性去白细胞悬浮红细胞;红细胞直抗阳性且放散液和谱细胞或药物处理的红细胞有凝集反应,主要原因是自身抗体、同种抗体和药物抗体,自身抗体配血选择ABO、RH同型的多个血液进行盲配,取凝集较弱的输注洗涤红细胞;同种抗体配血选择无相应抗原的血液相容性输注去白细胞悬浮红细胞;药物抗体临床停止使用对应药品,输相容性同型洗涤红细胞。
Objective To analyze the causes of red blood cell direct antibody positive and the treatment methods of blood matching,in order to seek safe and effective blood transfusion countermeasures.Methods Serological methods were used to classify the direct antibody positive specimens,serum and elution liquid were used for antibody identification or drug-treated red blood cells were used to detect drug antibodies.Combined with medical history,medication history and other reasons,compatible blood was selected for infusion.Results Among 249 cases of red blood cell direct antibody positive,213 cases were caused by the patient’s own reasons,and there was no agglutination reaction between red blood cell release liquid and red blood cells treated with spectrum cells or drugs.Agglutination reaction was observed in 36 cases of red blood cell release liquid and spectrum cells or drug treated red blood cells,including 21 cases of autoimmune hemolytic anemia(AIHA)autoantibodies,5 cases of hemolytic disease of newborn(HDN),4 cases of drug antibodies,4cases of cold antibodies,and 2 cases of immune hemolytic reaction of the same antibody.Conclusion For most patients with blood matching incompatibility caused by direct red blood cell antibody positive,their elution liquid is not reactive,which is caused by the patient’s own reason,and the compatible leucocyte-free suspended red blood cells can be transfused;red blood cell direct antibody positive and elution liquid and spectrum cells or drug treatment of red blood cells have agglutination reaction,mainly due to autoantibodies,alloantibodies and drug antibodies.Autoantibody matching blood selects ABO and RH homotype of multiple blood for blind matching,and takes the transfusion of washing red blood cells with weak agglutination;blood compatibility without corresponding antigen was selected for allogeneic antibody matching,and leukocyte-free suspended red blood cells were infused.The clinical use of corresponding drugs for drug antibodies was stopped,and compatible homotypic washed r
作者
田华
杨维旭
TIAN Hua;YANG Weixu(Baoji People's Hospital,Baoji 721000;Baoji High-Tech Hospital,Baoji 721013,China)
出处
《临床医学研究与实践》
2023年第6期101-104,共4页
Clinical Research and Practice
