摘要
目的对1例ABw亚型患者进行A型血浆置换后血型血清学变化以及是否发生溶血反应进行回顾性调查。方法使用微柱凝胶技术、微柱玻璃珠技术、盐水试管法、吸收放散等血型血清学方法及分子生物学方式进行ABO血型鉴定和基因分型,对患者血浆置换前后实验室检查结果进行分析。结果该患者于行2000 mL A型血浆置换后转入本院,d 2检测正反定型相符;d 3检测反定B细胞凝集强度为±~1+,正反定型不符。经试管法、人源抗-B吸收放散试验确认存在B抗原,分子生物学鉴定为ABw03型。患者用A型血浆进行血浆置换后,血红蛋白、血小板计数均一过性下降,肌酐一过性轻度上升,谷丙转氨酶、谷草转氨酶持续下降,总胆红素和间接胆红素一过性下降后上升,提示存在轻微的溶血性输血反应。结论ABO亚型患者含弱A或B抗原,输注大量血浆可能引起溶血性输血反应。应严格按照ABO血型正反定型标准判断血型结果,对弱凝集采取额外实验室检查并结合分子生物学技术进行正确的判断和处理,可以减少ABO亚型的漏检,减少输血反应的发生。
Objective To investigate the serological changes of blood type and whether hemolytic reactions occurred in a patient with ABw subtype after type A therapeutic plasma exchange(TPE)retrospectively.Methods The ABO blood group identification and genotyping was carried out by microcolumn gel method,microcolumn glass bead method,saline tube method and absorption-elution test,and the laboratory results before and after plasma exchange TPE were analyzed.Results The patient underwent 2000 mL type A plasma exchange TPE at an external in other hospitals and was transferred to our hospital.On the second day of hospitalization,the test showed consistency between forward and reverse blood typing.On the third day,the detection showed that Bc was±~1+,and discrepancy was found between forward and reverse typing.The presence of B antigen was confirmed through tube method and human anti-B absorption-elution test,and was identified as ABw03 by molecular biological method.After type A plasma exchange TPE,Hb and Plt both temporarily decreased,creatinine slightly increased,ALT and AST continued to decrease,while TBIL,DBIL and IBIL showed a temporary decrease followed by an increase,indicating a slight hemolytic reaction.Conclusion Infusion of large volume of plasma may cause hemolytic reactions when ABO subtype patients contain weak A or B antigens.The blood type should be strictly identified according to the ABO blood type forward and reverse typing standards.Additional laboratory tests combined with molecular biology techniques are required for weak agglutination,which can reduce the missed detection of ABO subtypes and reduce the occurrence of transfusion reactions.
作者
何燕京
高畅
王秋实
HE Yanjing;GAO Chang;WANG Qiushi(Department of Blood Transfusion,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国输血杂志》
CAS
2024年第5期506-510,共5页
Chinese Journal of Blood Transfusion
基金
辽宁省科技厅项目(2021JH2/10300045)。
关键词
溶血性输血反应
微柱凝胶卡
ABO亚型
漏检
hemolytic transfusion reaction
microcolumn gel card
ABO subtype
missed detection
