罕见Rh，Kidd血型系统复合抗体引起速发性溶血性输血反应的调查研究

Study on the Acute Hemolytic Transfusion Reaction Caused by Rare Multiple Antibodies of Rh and Kidd Blood Group

目的研究罕见Rh，Kidd血型系统复合抗体引起的速发性溶血性输血反应血清学特征，调查其在输血医学中的临床意义。方法对1例已进行5次9U红细胞输注后发生溶血性输血反应患者的血样，分别在盐水介质、间接抗球蛋白介质中分析其抗体的特异性；并用血清学与PCR—SSP基因分型法鉴定其Rh与Kidd血型；运用微柱凝胶法（MOT）与抗球蛋白试管法（IAT）进行患者与捐血者相容性试验。结果患者为RhE抗原阴性，Kidd血型为罕见Jk（a—b-）型，患者体内含有IgM抗E与IgG抗Jkh抗体，患者血清与28个E抗原阴性的捐血者微柱凝胶法交叉配血相合，抗球蛋白试验法只有4个捐血者相舍。结论罕见Rh，Kidd血型系统复合抗体在临床引起速发性溶血性输血反应。MGT法漏检Jkb抗体，对临床有重大意义。

Objective To study the serologic characteristics of rare multiple antibodies in Rh and Kidd blood group systems and to investigate its clinical significance in blood transfusion. Methods The sample from a patient who occurred hemolytic transfusion reaction after transfused 9 units red cells blood, was detected the specificity of irregular antibodies in saline medium and low ionic indirect antiglobulin（IAT） medium. Her Rh and Kidd blood groups were determined by serology or PCR-SSP genotype tests. The patient＇s serum was cross matched with donors＇red cells by microcolumn gel test（MGT） and antiglobulin tube test. Results The patient＇s E antigen was negative and Kidd type was rare Jk（a-b-）. The result of tests from the patient＇s serum to mentioned above panels of red blood cells in multiple reaction showed that the patient contained IgM anti-E and IgG anti-Jkb multiple alloantibodies. The reactions of the patient＇s serum to red cells from 28 donors of E negative antigen were all negative by MGT test but only 4 donors were negative by IAT test. Conclusion The acute hemolytic transfusion reaction was caused by rare multiple antibodies of Rh and Kidd blood group. The significance that Jkb alloantibody is unsuccessfully detected in clinical screening is worth attention.