摘要
目的了解输血后直接抗球蛋白试验由阴性转阳性患者的成分血输注效果。方法通过回顾性分析,在输血科输血信息管理系统中选取本院2019年1月~10月收治入院并做直接抗球蛋白试验(DAT)、不规则抗体筛查(简称抗筛)均为阴性的215名住院手术输血患者,在其输血后复做DAT和抗筛,DAT阳性者(复检阳性组)再做抗体分类及凝聚胺法交叉配血(简称交叉配血);抗筛阳性者再做不规则抗体鉴定;将这类患者按围手术期红细胞输血量≤4 U[(150±10%)mL/U]组、>4~8 U组和>8 U组,以输血后DAT阴性者设为对照组,对比输血后DAT转阳性者的输注效果。结果本组DAT阴性手术输血患者输注红细胞后转阳率8.84%(19/215);19例DAT复检阳性的类型:IgG型占84.21%(16/19),IgG+C3型占15.79%(3/19);19名DAT转阳性患者的抗筛复检:阳性占10.53%(2/19)、阴性占89.47%(17/19),2名抗筛阳性者抗体鉴定分别为-E及-M;交叉配血:主、次侧均不合占5.26%(1/19),主侧不合占5.26%(1/19),次侧不合占10.52(2/19),主、次侧均相合78.95%(15/19)。Hb、RBC、Hct值:复检阳性组中红细胞输血量(U)≤4、>4~8的2个亚组与对照组输血后有效提高(P<0.05);只有输血量>8 U亚组输血前后无明显变化(P>0.05)。结论直抗试验DAT阴性患者输注红细胞后转阳性可不仅提示患者产生了抗体或者发生了输血反应,而且DAT阳性类型还能够指导临床选择适当的成分血制剂,确保输血安全有效。
Objective To analyze the effect of blood component transfusion when the results of direct antiglobulin test(DAT)changed from negative to positive after blood transfusion.Methods The data of 215 surgical blood recipients,who were admitted in our hospital from January to October 2019 and presented negative results for both DAT and irregular antibody screening(Anti-screening),were collected via Ruimei Laboratory Management System.DAT and Anti-screening were performed again after blood transfusion,and DAT positive patients(re-test positive group)were then subject to antibody classification and polybrene cross-matching(referred to as cross-matching),and Anti-screening positive patients were tested for irregular antibodies.Patients were stratified by perioperative RBCs transfusion volume as≤4 U(150±10%mL/U),>4 to 8 U and>8 U,and DAT-negative patients after blood transfusion were set as the controls,and the transfusion effect of DATpositive patients after blood transfusion was compared with them.Results 8.84%(19/215)of DAT-negative patients turned positive after RBCs transfusion,among which IgG type accounted for 84.21%(16/19)and IgG+C315.79%(3/19);two patients(anti-E and-M,10.53%)were positive in anti-screening re-test and the rest were negative(89.47%,17/19).As for cross matching,incompatibility of both primary and secondary side,primary side and secondary side accounted for 5.26%(1/19),5.26%(1/19)and 10.52(2/19),respectively,while 78.95%(15/19)showed compatibility of both primary and secondary side.The Hb,RBC and Hct values of the re-test positive group,received RBC transfusion volume(U)≤4 and>4~8,were effectively elevated compared with the controls(P<0.05),while no significant changes of the parameters were noticed when blood transfusion volume>8 U(P>0.05).Conclusion The conversion of DAT negative results to positive after RBC transfusion indicates the patient has developed antibodies or the incidence of blood transfusion reaction,which can provide references for the clinical choice of appropriate blood components to ensure the safety and effectiveness of blood transfusion.
作者
陈诚
姚祺敏
胡晓燕
张琦
夏荣
CHEN Cheng;YAO Qimin;HU Xiaoyan;ZHANG Qi;XIA Rong(Department of Transfusion,Affiliated Huashan Hospital of Fudan University,Shanghai 200040,China)
出处
《中国输血杂志》
CAS
2021年第8期854-857,共4页
Chinese Journal of Blood Transfusion
基金
上海市公共卫生体系建设三年行动计划(2020年~2022年)重点学科建设项目(GWV-10.1-XK23)
中国输血协会威高科研基金重点项目(CSBT-MWG-2019-01)。
关键词
直接抗球蛋白试验
阴性转阳性
不规则抗体筛查
输血效果
输血量
direct antiglobulin test(DAT)
negative to positive
irregular antibody screening
blood transfusion effect
blood transfusion volume
作者简介
通信作者:夏荣(1966.03-),男,医学博士,教授,主任医师,博士研究生导师,主要从事临床输血及血液免疫学研究,电话:021-52888331,Email:xiarongcn@126.com。
