摘要
目的分析Duffy血型系统意外抗体分布特点并探讨患者输血策略。方法收集2012年1月至2022年12月西部战区总医院患者意外抗体筛查和鉴定资料,检测Duffy血型患者系统意外抗体标本的红细胞Duffy表型,通过疾病史、妊娠史、输血史等分析抗体产生原因,并探讨输血策略。结果351957例患者标本中检出2128例(0.6%)意外抗体,Duffy血型意外抗体34例(0.0097%),其中抗-Fy^(b)26例(76.5%),抗-Fy^(a)3例(8.8%),抗-Fy^(b)+抗-E 3例(8.8%),抗-Fy^(b)+抗-Le a 1例(2.9%),抗-Fy^(b)+抗-E+抗-c 1例(2.9%),免疫球蛋白G(IgG)抗体33例(97.1%),IgG+IgM抗体1例(2.9%),主要为妊娠或输血免疫刺激产生。34例Duffy血型意外抗体患者中2例输注自体血液(4 U),6例输注异体血液,共输注ABO、Rh血型相同,Duffy抗体相应抗原阴性悬浮红细胞36.5 U,均无输血不良反应,33例患者好转出院,1例患者因多器官功能衰竭放弃治疗。结论Duffy血型系统意外抗体较罕见,可导致溶血性输血反应和新生儿溶血病,主要因妊娠或输血免疫刺激产生,抗-Fy^(a)检出率远低于抗-Fy^(b),应采用多种方法保障患者临床输血安全。
Objective To analyze the distribution characteristics of unexpected antibodies in Duffy blood group system and to explore the blood transfusion strategy of patients.Methods The screening and identification data of accidental antibodies in patients from January 2012 to December 2022 in the General Hospital of Western Theater Command PLA were collected.The Duffy phenotype of red blood cells in patients with Duffy blood group was detected.The causes of antibodies were analyzed by disease history,pregnancy history and blood transfusion history,and the blood transfusion strategy was discussed.Results Accidental antibodies were detected in 2128(0.6%)of 351957 patients,and in 34 cases(0.0097%)of Duffy blood group accidental antibodies,including 26 cases(76.5%)of anti-Fy^(b),three cases(8.8%)of anti-Fy^(a),three cases(8.8%)of anti-Fy^(b)+anti-E,1 case(2.9%)of anti-Fy^(b)+anti-Le a,one case(2.9%)of anti-Fy^(b)+anti-E+anti-c,33 cases(97.1%)of immunoglobulin G(IgG)antibody,and one case(2.9%)of IgG+IgM antibody.It is mainly produced by immune stimulation of pregnancy or blood transfusion.Among the 34 patients with unexpected antibody of Duffy blood group,two patients were infused with autologous blood(4 U),six patients were infused with allogeneic blood,and the same ABO and Rh blood groups were transfused.The corresponding antigen-negative suspended red blood cells of Duffy antibody were 36.5 U,and there were no adverse reactions of blood transfusion.33 patients were improved and discharged,and one patient gave up treatment due to multiple organ failure.Conclusion Unexpected antibodies of Duffy blood group system are rare,which can lead to hemolytic transfusion reaction and hemolytic disease of the newborn,mainly due to pregnancy or immune stimulation of blood transfusion.The detection rate of anti-Fy^(a)is much lower than that of anti-Fy^(b).Various methods should be used to ensure the safety of clinical blood transfusion.
作者
杨俊龙
黎欢
张利
白艳丽
YANG Junlong;LI Huan;ZHANG Li;BAI Yanli(Department of Blood Transfusion,Xi′an International Medical Center Hospital,Xi′an,Shaanxi 710100,China;Department of Blood Transfusion,the General Hospital of Western Theater Command PLA,Chengdu,Sichuan 610083,China)
出处
《现代医药卫生》
2024年第11期1829-1832,1839,共5页
Journal of Modern Medicine & Health
基金
四川省科学技术厅科技计划项目(2019YFS0273)。
