罕见抗-Le^a与抗-Le^b抗体和自身抗体的鉴定与输血效果评估

Identification and transfusion effect evaluation for one rare case of anti-Le^a and anti-Le^b antibodies combined with autoantibodies

目的研究Lewis血型系统抗原、抗体血型血清学鉴定的方法，对含有抗-Le^a抗-Le^b抗体和自身抗体患者的输血效果进行评估。方法采用全自动血型／配血系统按照血型血清学检测方法对患者进行Lewis血型鉴定，由血型室筛选与患者相合的血液给予患者输注，同时严密观察患者输血情况，评估其输注效果。结果患者ABO血型为A型，Rh血型系统表型为CCDEe，Lewis血型系统表型为Le（a＋b-）；血清中不仅含有抗-Le^a和抗-Le^b抗体，同时存在自身抗体。经治疗，对患者输注经血型室筛选且配血相合的红细胞、同型血浆和机采血小板，逐步达到预期输血效果，患者血红蛋白水平相对稳定。结论通过对患者进行抗体筛检及Lewis血型抗体鉴定，筛选出与患者配血相合的血液成分进行输注观察；抗-Le^a抗-Le^b抗体和自身抗体阳性患者输注血液成分后临床效果极差，经过治疗后可使输血效果逐步好转，血红蛋白稳定在一定水平上。

Objective To study the serological identification method of the Lewis blood system antigens and antibodies and to evaluate the transfusion effectiveness of patients with anti-Le^a and anti-Le^b antibodies combined with autoantibodies. Methods According to serological theories, we identified the Lewis blood type of the patient using automatic blood/blood compatibility test system. Then we selected the compatible blood and observed the condition of the patient during and after the infusion to evaluate the effectiveness of transfusion. Results The patient was type A blood of the ABO system. The phenotype of Rh system was CCDEe and the phenotype of Lewis system was Le（ a ＋ b-）. There were not only anti-Le^a and anti-Le^b antibodies but also antoantibodies in the patient＇s serum. Infusion of the compatible blood turned out successful. Conclusions Through the antibody screening and antibody identification of the Lewis blood group, screening and infusion of the compatible blood components for patients are observed. The effectiveness of transfusion therapy in refractory anemia patient is poor. However, after appropri- ate treatments it would be improved.