3种血型鉴定方法监测ABO血型不合造血干细胞移植患者血型嵌合体

Three methods for monitoring blood phenotype chimera caused by hematopoietic stem cell transplantation recipients with incompatible ABO group

目的探讨盐水介质试管法(试管法)、ABO正反定型/RhD定型卡(血型卡)和低离子/抗人球蛋白微柱凝胶卡(LISS/Coombs卡)在ABO血型不合造血干细胞移植(HSCT)患者血型鉴定中的应用价值,指导临床安全输血。方法以血型卡、试管法和LISS/Coombs卡对24例ABO不合造血干细胞移植患者血型抗原、抗体进行监测,评价3种方法监测血型的优缺点。结果血型卡与试管法均能检出非受者型红细胞,但前者能观察供、受者红细胞嵌合比例的变化,且不受主、次侧移植模式的限制。直接抗人球蛋白试验(DAT)阳性将影响LISS/Coombs卡正定型结果的判读,但其监测抗供者IgG抗体通常较试管法监测IgM抗体延后消失。首次检出供者红细胞的时间主侧平均为36 d、次侧平均为20 d,血型完全转变为供者型的时间主侧为11～22周,次侧为10～13周。结论血型卡能满足ABO不合HSCT患者血型抗原嵌合体的监测,但易漏检抗供者IgG抗体。为保障输血安全,建议在主侧不合移植者反定IgM抗体消失后增加IgG抗体的监测。

Objective To evaluate the application of 3 monitoring methods in blood phenotyping for hematopoietic stem cell transplantation（HSCT） recipients with incompatible ABO and conduct the security of transfusion.Methods The antigens of blood group and corresponding antibodies of 24 HSCT recipients with incompatible ABO group were monitored by tube test with saline medium,ABO micro-column gel test and LISS/Coombs card test.Results Both ABO micro-column gel test and tube test were capable to find the red blood cells derived from donors in the first detection,however the ABO micro-column gel test could monitor the chimera from whether major or minor incompatibility.The interpretation of LISS card was difficult to analyze in the patients with positive direct anti-globulin test（DAT）,however LISS card showed available to monitor IgG anti-A and（or） anti-B,which usually disappeared later than IgM antibody during the tube test.Donor-derived red cell was first detected in the 36 day and the 20 day in major and minor group respectively.The required time of complete conversion of donor blood group was from 11 to 22 weeks in major group and 10 to 13 weeks in minor group.Conclusion ABO micro-column gel test should be very useful in blood phenotyping for ABO-incompatible HSCT recipients.It is advised that the monitoring of IgG antibody should be detected following disappearance of IgM antibody for major incompatible HSCT.