A1Bw亚型中多重抗体漏检的临床研究

Clinical study on missed detection of multiple antibodies in A1Bw subtype

目的分析1例A1Bw亚型样本的血清学和分子生物学特征及交叉配血不合原因。方法采用试管法对该样本进行ABO血型血清学检测、吸收放散试验、唾液血型物质检测、酸化血清试验、ABO基因第1~7外显子扩增产物基因测序。以“ABO亚型”和“不规则抗-B/抗-A抗体”为关键词,对中国知网数据库2020年1月至2023年8月发表的文献进行文献检索。结果该样本血清学表型为cisAB/A或ABx,同时血清中产生同种抗-Lea、抗-E抗体伴不规则抗-B抗体。ABO基因序列分析结果显示,ABO*A1.02/B.01杂合,且第7外显子发生c.721C/T基因突变,最终该血型判定为ABO*A1.02/BW.03基因型。文献检索结果显示,共检索到文献42篇,排除分子技术、肿瘤疾病等文献,最终纳入18篇文献。该文主要从亚型中不规则抗体检测的角度出发,重点叙述多重抗体漏检分析,总结当存在ABO血型以外的不规则抗体时,亚型中的不规则抗-B/抗-A抗体的检测流程。结论血清学试验结合分子生物学方法可更准确鉴定ABO亚型,正确鉴定亚型中不规则抗体是保障输血安全的前提。

Objective To analyze the serological and molecular characteristics of a case of A1Bw subtype and the cause of cross-matching incompatibility.Methods The samples were subjected to serological test of ABO blood type,absorption and elution test,saliva blood type substance detection,acidified serum test,gene sequencing of ABO gene exons 1-7 amplification products.“ABO subtype”and“irregular anti-B/anti-A antibody”were used as keywords to search the literature published in China National Knowledge Infrastructure database from January 2020 to August 2023.Results The serological phenotype of this specimen was cisAB/A or ABx and allo-anti-Lea,and anti-E and irregular anti-B antibodies were produced in the serum.The results of ABO gene sequencing showed that the patient was heterozygous for ABO*A1.02/B.01 and had a mutation in exon 7 of c.721C/T gene,which finally determined the ABO*A1.02/BW.03 genotype.The results of literature retrieval showed that a total of 42 literatures were retrieved,excluding molecular techniques and tumor diseases,and a total of 18 literatures were finally included.From the perspective of irregular antibody detection in subtypes,this paper focuses on the analysis of multiple antibody missed detection,and summarizes the detection process of irregular anti-B/anti-A antibodies in subtypes when irregular antibodies other than ABO blood type exist.Conclusion Serological test combined with molecular biological methods can more accurately identify ABO subtypes.Correct identification of irregular antibodies in ABO subtypes is a prerequisite for blood transfusion safety.