交叉配血不合170例原因分析及临床输血策略

Analysis of 170 cases with cross-matching incompatibility and the strategy of blood transfusion

目的探讨交叉配血不合原因以及相应的处理方法,以指导临床安全有效合理用血。方法对2014-01~2016-12在该院收治需行输血治疗的170例交叉配血不合患者进行回顾性分析,总结输血前交叉配血不合原因,归纳处理方法。结果 170例疑难交叉配血标本中,不规则抗体88例(51.76%),自身抗体62例(36.47%),ABO亚型14例(8.24%),蛋白凝集4例(2.35%),药物原因2例(1.18%)。不规则抗体中,Rh系统32例(联合抗体3例),MNSs系统19例,Lewis系统6例,Kidd系统和Diego系统各占1例,多种抗体7例,未能检出抗体特异性16例,抗体阳性未鉴定抗体特异性6例。ABO亚型14例中有稀有血型类孟买3例。采取配合性输注各种血液成分,患者均及时得到有效救治。结论交叉配血不合主要是由同种不规则抗体,其次是自身抗体等原因引起。根据交叉配血不合的具体原因采取相应措施,指导临床确定输血方案,选择合适的血液进行输注,保障输血的安全有效。

Objective To discuss the causes of the cross-matching incompatibility and the relevant managing methods. Methods We retrospectively analyzed the data of 170 patients with cross-matching incompatibility whoneeded blood transfusion from the blood bank in our hospital from January 2014 to December 2016, and summarized the causes of cross-matching incompatibility before blood transfusion. Results In the 170 patients with cross-matc- hing incompatibility, there were 88 cases with irregular antibody （51.76%）, 62 cases with auto-antibodies （36.47%）, 14 cases with ABO subtype（8.24% ）, 4 cases with protein aggregation（2. 35% ） and 2 cases with drug reason（ 1.18% ）. In the cases with irregular antibodies, there were 32 cases with Rh system（ including 3 cases with joint antibodies） , 19 cases with MNSs system, 6 cases with Lewis system, 1 case with Kidd, 1 case with Diego sys- tem, 7 cases with multiple antibodies. 16 cases failed to detect the antibodies, and 6 cases with unidentified antibod- ies. Conclusion The main cause of cross-matching incompatibility is the same irregular antibodies, followed by au- toantibodies. Clinical blood transfusion schemes should be determined by the types and specific causes of the cross- matching incompatibility.