异基因造血干细胞移植血型血清学转换规律与临床输血研究

Study on serological blood group conversion rule and clinical blood transfusion in allogeneic hemato- poietic stem cell transplantation

目的探讨异基因造血干细胞移植（allo—HSCT）血型血清学和血型物质转换规律，为临床特殊血型鉴定和输血提供理论基础。方法HSCT后动态观察受者白细胞和红细胞生命周期，红细胞嵌合状态与完全转型后血型抗体生成与残留以及血型物质的转换规律，用盐水介质试管法和微柱凝胶法正、反定型，免疫抑制法检测血型物质。结果21例受者造血干细胞植活平均时间为18．6d。8例主侧血型不合红细胞生长为56．6d，9例次侧血型不合为25．9d，4例主、次侧血型均不合为67d（P〈0．01），红细胞嵌合比值由l：9逐渐转为供者血型。受者抗A（B）经预处理后仍有残留，当红细胞完全转型后残留抗体消失，主侧不合转为供者血型；而次侧不合5例O供A受者只能产生抗B，不能产生抗A，3例O供B受者也只能产生抗A，而不能产生抗B，l例A供AB受者抗B缺乏；4例主、次侧不合：2例A供B受者不能产生抗B，2例B供A受者也不能产生抗A。21例受者血型物质均保持自身原有血型型别不变。结论allo—HSCT者红细胞ABO血型均逐渐转为供者，但血清学血型转换后与正常人比较差异有统计学意义（P〈0．（）1），血型物质均保持受者自身原有的血型型别不变（P〉0．01）。

Objective To explore the conversion rule of serological blood group and blood group sub- stance after successful allogeneie hematopoietic stem cell transplantation, and to provide theory for clinical special blood type identification and blood transfusion. Methods The growth cycle of recipient WBC and RBC, RBC chimera, blood group antibody production and remaining in full transition were observed. Conver- sion rule of blood group substance, contradiction between cells typing and sera typing were detected by saline medium tube method and microcolumn gel method after stem cells transplantation. Results The average time of engraftment in 21 recipients was about 18.6 days, RBC growth cycle in 8 major blood type incompatibility was 56.6days, 25.9 days in 9 minor blood type incompatibility, 67 days in 4 bidirectional blood type incom- patibility （ P 〈 0.01 ）. The ratio of RBC chimeric growth was 1 ： 9, gradually conversed to donor＇ s blood group. Residue of recipient anti-A（B） was left after conditioning regimen, disappeared after full transforma- tion, and recipient anti-A（B） was conversed to donor＇s blood type in major blood type incompatibility. 5 A blood type recipient donated by O blood type blood generated anti-B instead of anti-A, 3 B blood type recipi- ent generated only anti-A instead of B in minor blood type incompatibility, and 1 AB blood type recipient do- nated by A did not generate anti-B. Among 4 bidirectional blood type incompatibility, 2 B blood type recipient donated by A blood type blood did not generate anti-B, 2 A recipient by B could not produce anti-A. Recipi- ent blood group substance helped original ABO blood type substance remain unchanged. Conclusion Among patient with allogeneic hematopoietic stem cell transplantation, recipient＇ s ABO and RBC blood type can be conversed to donor＇ s, but there is significant difference between patients of serological blood group and of normal people（ P 〈0.01 ）. Recipient blood group substance helps original ABO blood type substance remain unchanged （P 〉0.01 ）.