单采血小板输注RhD抗原引起的同种免疫作用及其临床应用

Alloimmunization induced by RhD antigens during apheresis platelet concentrates transfusion and its clinical application

目的研究单采血小板(APC)输注中由RhD抗原引起的同种免疫频率及其临床应用效果。方法在没有预防性应用Rh免疫球蛋白的情况下,给予RhD阴性的血小板减少症出血患者RhD阳性血小板,测定输注前及输注后1h的外周血血小板计数(BPC),计算校正血小板增加值(CCI)来评估临床疗效;在接下来的随访中,以低离子强度间接抗球蛋白试验检测每份标本的抗-D水平,计算同种免疫频率。结果输注后27例患者出血症状均得到明显缓解,输注后1h的CCI为(12.7±1.2)×109/L;输注RhD不合血小板引起的同种免疫频率为3.7%。结论输注RhD不合APC临床疗效明显,引起同种免疫反应几率很低,在紧急情况下可给予RhD阴性患者RhD阳性的APC。

【Objective】To explore the alloimmunization induced by RhD antigens during the course of apheresis platelet concentrates（APC） transfusion and its clinical application.【Methods】RhD-thrombocytopenia patients who had emergent bleeding symptoms were transfused with RhD＋ apheresis platelet concentrates.Blood platelet count（BPC） was measured 1 hour before and after the transfusions,then CCI was calculated to evaluate the clinical value.In the follow-up period anti-D of each case was detected by IAT in LIM solution.Thus,the alloimmunization frequency may be computed.【Results】Bleeding symptoms of 27 patients were well controlled after platelet transfusion.The CCI at1 h after transfusion was（12.7±1.2）×109/L.The alloimmunization frequency induced by the transfusions with the RhD-incompatible APC was 3.7 %.【Conclusion】The effectiveness of the RhD-incompatible APC transfusion is outstanding,and the alloimmunization frequency is very low.Hence,in case of emergency,it is suitable for RhD-thrombocytopenia patients to be transfused with RhD＋ APC.