桂北地区Rh血型系统分布及Rh分型配合性输注的临床应用价值

Distribution of Rh blood group system in Northern Guangxi and clinical application value of Rh typing combined with transfusion

目的探讨桂北地区人群Rh血型系统C、E、c、e抗原和表型分布情况,分析RhC、E、c、e表型配合性输注的疗效,为临床Rh表型配合性输注提供参考依据。方法选取2021年9月至2022年4月该院9645例血液标本作为研究对象,其中RhD阳性标本9610例,RhD阴性标本35例。检测并分析9610例RhD阳性标本RhC、E、c、e抗原和表型分布情况。另选取2021年7月至2023年7月该院收治的有输血史或妊娠史的210例输血患者进行配血观察研究。在ABO和RhD同型的基础上,将210例输血患者分为RhC、E、c、e配合性输注组(观察组,105例)和非配合性输注组(对照组,105例)。两组输注去白细胞红细胞悬液2 U,检测两组输血前后白细胞计数(WBC)、血小板计数(PLT)、血红蛋白(Hb)水平和红细胞压积(HCT),记录两组输注后红细胞输注有效率、不规则抗体阳性率及不良反应发生率。结果桂北地区RhD阳性抗原阳性率为99.64%(9610/9645)。9610例RhD阳性血型主要抗原C、c、E、e的分布频率分别为94.09%(9042/9610)、41.43%(3981/9610)、33.04%(3176/9610)、96.44%(9268/9610)。9610例RhD阳性标本中,有9种形式,其表型及分布频率分别为CCDee(57.76%,5551/9610)、CcDEe(26.56%,2552/9610)、CcDee(8.76%,842/9610)、ccDEE(3.34%,321/9610)、ccDEe(2.14%,206/9610)、CCDEe(0.79%,76/9610)、ccDee(0.43%,41/9610)、CcDEE(0.20%,19/9610)、CCDEE(0.02%,2/9610)。两组输血前Hb水平、HCT、WBC及PLT比较,差异均无统计学意义(P>0.05)。两组输血后Hb水平、HCT均高于输血前,观察组输血后WBC低于输血前,差异均有统计学意义(P<0.05)。观察组输血后Hb水平、HCT均高于对照组,差异均有统计学意义(P<0.05)。输血后两组红细胞输注有效率、不规则抗体阳性率及不良反应发生率比较,差异均有统计学意义(P<0.05)。结论桂北地区人群Rh表型为CCDee和CcDEe占优势,表型CCDEE最少。有妊娠史或需反复输血患者,在ABO和RhD同型基础上,优选Rh表型配合性血制品进行输注,可减少Rh系统抗体的产生,降低输血不良反应的发生率,提高患者红细胞输注效果,保障输血的安全性和治疗效果。

Objective To investigate the distribution of C,E,c,e antigens and phenotypes of Rh blood group system in Northern Guangxi,and to analyze the efficacy of RhC,E,c,e phenotype matching transfusion,so as to provide reference for clinical Rh phenotype matching transfusion.Methods A total of 9645 blood samples from September 2021 to April 2022 were selected as the research objects,including 9610 RhD-positive samples and 35 RhD-negative samples.The distribution of RhC,E,c and e antigens and phenotypes in 9610 RhD positive samples were detected and analyzed.In addition,210 transfusion patients with a history of blood transfusion or pregnancy admitted to the hospital from July 2021 to July 2023 were selected for blood matching observation study.A total of 210 patients with blood transfusion were divided into RhC,E,c,e cooperative transfusion group(observation group,105 cases)and non-cooperative transfusion group(control group,105 cases)on the basis of ABO and RhD isotype.On two groups of infusion to white and red blood cell suspension 2 U,detection of blood transfusion in the two groups before and after blood transfusion leucocyte count(WBC),platelet count(PLT),hemoglobin(Hb)level and erythrocyte deposited(HCT).Records of the two groups after infusion of red blood cells infusion efficient,irregular antibody positive rate and incidence of adverse reactions.Results The positive rate of RhD antigen in northern Guangxi was 99.64%(9610/9645).Among 9610 cases of RhD-positive,the distribution frequencies of main antigens C,c,E and e in RhD positive blood group were 94.09%(9042/9610),41.43%(3981/9610),33.04%(3176/9610)and 96.44%(9268/9610)respectively.Among the 9610 RhD-positive samples,there were 9 types,and the phenotypes and distribution frequencies were CCDee(57.76%,5551/9610),CcDEe(26.56%,2552/9610),CcDee(8.76%,5552/9610),ccdee(8.76%,842/9610),ccDEE(3.34%,321/9610),ccDEe(2.14%,206/9610),CCDEe(0.79%,76/9610),ccDee(0.43%,41/9610),CcDEE(0.20%,19/9610)and CCDEE(0.02%,2/9610).There was no significant difference in Hb level,HCT,WBC,and PLT before blood transfusion between the two groups(P>0.05).The Hb level and HCT of the two groups after blood transfusion were higher than those before blood transfusion,and the WBC of the observation group after blood transfusion was lower than that before blood transfusion,and the differences were statistically significant(P<0.05).The Hb level and HCT in the observation group after blood transfusion were higher than those in the control group,and the differences were statistically significant(P<0.05).There were significant differences in the effective rate of red blood cell transfusion,the positive rate of irregular antibodies,and the incidence of adverse reactions between the two groups after blood transfusion(P<0.05).Conclusion CCDee and CcDEe are the predominant Rh phenotypes in North Guangxi,and CCDEE is the least phenotype.For patients who have a history of pregnancy or require repeated blood transfusion,Rh phenotype matching blood products are preferred for transfusion on the basis of ABO and RhD isotype,which can reduce the production of Rh system antibodies,reduce the incidence of adverse reactions of blood transfusion,improve the effect of red blood cell transfusion,and ensure the safety and efficacy of blood transfusion.