ABO血型定型困难患者配血不合的输血处置对策

Blood transfusion disposal countermeasures of identification difficulty of ABO blood grouping in patients of crossmatching incompatibility

目的:通过调查分析36例患者ABO血型定型困难的影响因素,找寻解决临床疑难交叉配血不合的最佳方法,确保临床输血安全。方法:通过正反定型试验、红细胞吸收放散试验,分别检测患者红细胞上有无A、B、H抗原,运用唾液ABH血型物质的测定方法检测患者唾液中有无ABH血型物质。运用抗体筛选试验,查找患者ABO血型定型困难的原因。结果:36例ABO血型定型困难患者血清中存在IgM自身冷凝集素22例、不规则同种免疫性抗体及IgM冷凝集素1例、不规则抗体3例、IgM加IgG自身免疫性抗体3例、低温抗B抗体1例、弱抗-A和(或)弱抗-B抗体6例。结论:ABO血型定型的影响因素很多,患者血清中存在IgM自身冷凝集素、ABO血型系统以外的不规则同种免疫性抗体、(IgM加IgG)自身免疫性抗体以及患者自身年龄、病因易造成抗原或抗体减弱等因素均可导致ABO血型定型困难,影响临床输血治疗。

Objective： To investigate and analyze influence factor of identification difficulty of ABO blood grouping in 36 patients, to find the effective solutions of clinical crossmatching incompatibility and ensure the safety of clinical transfusion. Method ： Patients＇s the red blood cell were respectively detected presence or absence the A, B and H antigen by ABO Forward and Reverse test methods and RBC absorption and elution test methods. A, B and H blood group substances were detected in saliva of patients by the ABH blood group substances test method. To find the reasons of identification difficulty of ABO blood grouping by the Antibody screening test method. Resuit：There were 36 patients with identification difficulty of ABO blood grouping that serum exist the IgM cold agglutinin 22 cases. The irregular of alloimmune antibodies and IgM cold agglutinin 1 cases, the irregular of alloim- mune antibodies 3 cases, （IgM＋ IgG） autoantibodies 3 cases, low temperature anti-B antibodies 1 cases, Weak anti- A and/or weak anti-B antibody in 6 cases. Conclusion： In the patient＇s serum of the IgM cold agglutinin, the irregular of alloimmune antibodies, （IgM＋IgG） autoantibodies and lots of factors such as patient＇s age and disease caused RBC antigen or antibody weakened could lead to identification difficulty of ABO blood grouping and affect the clinical transfusion therapy.