A亚型患者血型鉴定流程及输血策略研究

Blood Type Identification and Corresponding Transfusion Strategy of Patients With A Subtype

目的如何对血型正反定不相符的患者进行ABO血型鉴定,探讨适合此类亚型患者的红细胞和血小板的输注策略,提高输血疗效。方法以本院2018年12月收治的1例血型正反定型不一致的患者为例,用抗-A、抗-A1、抗-B、抗-AB和抗-H单抗检测红细胞ABH抗原;筛查血清中不规则抗体,红细胞吸收放散试验和唾液ABH血型物质检测证实红细胞上弱表达的ABO抗原,应用分子生物学进行直接测序分析。进行家系调查,并采用血清学方法为患者筛选适宜输注的红细胞和血小板。结果根据血清学、分子生物学方法的结果确定该患者为A2亚型,基因型A205/O01;不规则抗体筛查为阴性,血浆中存在抗-A1。结论血型血清学联合分子生物学方法有助于ABO亚型血型的准确鉴定;ABO亚型血型个体输血时应采取特殊输血策略,以避免输血不良反应的发生。

Objective To identify possible causes and resolution strategies for ABO typing discrepancies and selet the blood components suitable for transfusion to improve the transfusion effect.Methods A patient with inconsistent results of forward in our hospital in December 2018 and reverse ABO grouping was determined for erythrocyte ABH antigen by anti-A,anti-A1,anti-B,anti-AB and anti-H.Screen serum irregular antibodies.The presence of weak A or B antigen on the RBCs was confirmed by adsorption-elution tests and salivas agglutination inhibition test.Molecular biology was applied to direct sequencing analysis.At the same time,family investigation was conducted.Blood group serological method was used to screen transfusion-ready suspended red blood cells and platelets for the patient.Results According to the results of serological and molecular biological methods,the patient was identified as A2 subtype.The genotype was A205/O01,and the irregular antibody screening was negative,but anti-A1 existed in plasma.Conclusion The combination of blood group serology and molecular biology can help identify ABO subtype.Special blood transfusion strategies are required in the blood transfusion of ABO subtype blood group to avoid the adverse reactions.